The California-based health network, Kaiser Permanente had a total of 110 million visits last year, 59 million of which occurred through virtual visits. This marks the first time a large healthcare system has reported more virtual than in-person encounters.1
Digitalization amidst cost and quality concerns
It is well known that healthcare spending in the U.S. outpaces that of other high-income, OECD countries.2 Despite the heavy investment, however, our healthcare outcomes, including life expectancy and chronic disease prevalence trail behind our developed counterparts.
This pressure to reduce costs and improve outcomes coupled with our aging population and the explosion of direct-to-consumer services has left traditional healthcare organizations scrambling to keep pace with an increasingly digitalized society and industry. One strategy that has emerged to cope with the pressures to deliver higher value is telemedicine, defined as the use of electronic information and telecommunications technologies to support and promote long distance clinical health care.
Companies like ZocDoc and Teledoc offer more convenient, lower cost alternatives to traditional visits, which can subject patients to long wait times. While the data on the effect of telemedicine on overall healthcare spending and quality are not clear, patients nonetheless expect the healthcare industry to embrace 21st century technology.3,4
Embracing Telemedicine at Kaiser Permanente
Kaiser Permanente has adopted a 4-pronged approached to incorporating telehealth into the front lines of healthcare delivery. Since investing $10 million in Vidyo, a visual communications company that integrates video into electronic health records, Kaiser Permanente has aggressively expanded its telemedicine options.5
- Teledermatology: A medical assistant trained to obtain high-resolution photos with a digital camera in a primary care physicians’ office can send the picture to a team of rotating dermatologists from across the region. The medical group has found that 70% of skin rashes can be diagnosed and treated from the digital picture alone. These e-consults increase the capacity of specialists to incorporate same-day appointments for patients who require in-person consultation.
- On-site specialty consultations: When a PCP believes a patient would benefit from a specialty consultation, he/she can obtain one via video. More than 40 medical and surgical specialties offer this service. This program reduces delays in diagnosis and treatment and helps to coordinate care among the specialist, patient, and primary care physician.
- Virtual urgent care visits – Patients are connected to emergency physicians by private, secure video. Through virtual visits, 80% of issues can be resolved by phone and 60% of the remaining visits can be resolved by video. An internal survey found that 90% of patients were very or extremely satisfied with the care and advice they received.
- Follow-up and specialist visits – All specialties offer the option of a video visit for follow-up, routine, and urgent medical problems, specialty consultation, surgical follow-up. An internal, password-protect application within a VPN firewall allows physicians to use software application to connect.6
What’s next for Kaiser?
Kaiser Permanente’s adoption of telemedicine is just one component of a broader online platform that is a part of the $400 million investment the organization has made into new and emerging technologies. The online platform is a step toward realizing the organization’s “care anywhere” philosophy.
Kaiser should study the effects of these programs on cost, quality, and patient satisfaction across disease states and populations. By implementing telemedicine on such a broad scale across many different provider types, disease states, geographies, and populations, Kaiser has the ability to contribute substantially to our understanding of the effects of telemedicine.
Kaiser should also transform their telemedicine technologies into proactive rather than reactive tools. Currently, patients engage with online tools only when they are sick. As more payment models move toward accountable care organizations that compensate organizations based on their ability to keep a population of patients healthy, organizations like Kaiser will have to deploy tools to focus on preventative health measures.7
Finally, the suite of online options for patients only work if clinicians choose to engage. Already burdened by long work days and excess paperwork, Kaiser should engage front line clinicians to ensure online tools are not viewed as time consuming or burdensome.8 Physicians in a fee-for-service payment model should be reimbursed adequately and some clinicians may require more support and training on how to engage with online tools.
Beyond the short and long-term adoption of telemedicine, questions still remain:
- How will privacy and data security be addressed in healthcare as providers move toward online visits?
- How will traditional healthcare organizations make decisions about which digital health technologies to invest in and incorporate when the data about their effect on cost and quality is lacking or unclear?
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- Eric WIcklund. Kaiser CEO: Telehealth Outpaced In-Person Visits Last Year. mHealthIntelligence. 2016. https://mhealthintelligence.com/news/kaiser-ceo-telehealth-outpaced-in-person-visits-last-year. Accessed November 13, 2017.
- U.S. Health Care from a Global Perspective. Commonw Fund. 2014;35(1):307-325. http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective. Accessed November 13, 2017.
- Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. In: Shepperd S, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2015:CD002098. doi:10.1002/14651858.CD002098.pub2.
- Mistry H, Garnvwa H, Oppong R. Critical Appraisal of Published Systematic Reviews Assessing the Cost-Effectiveness of Telemedicine Studies. Telemed e-Health. 2014;20(7):609-618. doi:10.1089/tmj.2013.0259.
- Susan Morse. Kaiser fund invests $10 million into Vidyo telehealth platform | Healthcare IT News. 2015. http://www.healthcareitnews.com/news/kaiser-fund-pumps-10-million-telehealth-platform-vidyo. Accessed November 13, 2017.
- Robert Pearl. Engaging Physicians in Telehealth. NEJM Catal. 2010. https://catalyst.nejm.org/engaging-physicians-in-telehealth/. Accessed November 13, 2017.
- Burwell SM. Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care. N Engl J Med. 2015;372(10):897-899. doi:10.1056/NEJMp1500445.
- Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377. doi:10.1001/archinternmed.2012.3199.