Could the Future of Health Care Include Fewer In-Person Physician Visits?

Added on Jan 29, 2018

The recent frenzy of blockbuster mergers and acquisitions in the health care industry promises to further disrupt an already-disrupted health care industry.

Mergers like CVS-Aetna and other payer-providers “getting into low-end primary care” will result in new models of care that compete with traditional models, Press Ganey Chief Medical Officer Dr. Thomas Lee explained in a recent interview about the challenges health care providers and consumers will face in 2018. “We can safely assume that this new kind of ‘animal’ is going to try to compete for consumers’ dollars by bringing them what they want, and doing it more cheaply and conveniently. That will be good for consumers, but it will threaten providers who aren’t flexible enough to adjust and respond.”

As for those providers who are willing and agile enough to respond, one avenue they may consider is the increased adoption and systemization of nonvisit health care, Dr. Lee and Sean Duffy, of San Francisco-based Omada Health, write in a recent NEJM Perspective article. Nonvisit health care—also known as telehealth/telemedicine or virtual health care—is used by physicians and other care providers to evaluate and communicate with patients without physically seeing them in the office. In short, nonvisit care enables providers to “meet” patients where they are.

“Face-to-face interactions will certainly always have a central role in health care, and many patients prefer to see their physician in person. But a system focused on high-quality nonvisit care would work better for many others—and quite possibly for physicians as well,” the pair write in the article, titled “In-Person Health Care as Option B.”

By prioritizing the care attributes that consumers are seeking—specifically, convenience and cost—nonvisit care is poised to become a competitive differentiator. In fact, it already is for some organizations, the authors write, noting that at California-based Kaiser Permanente, “virtual visits” make up 52% of the organization’s more than 100 million annual primary care encounters.

Virtual visits are empowering—they let the patient pick where and how they are seen, and they significantly reduce wait times, the authors explain. And they are just the tipping point for how technology could improve the patient experience for those with chronic health needs, acute conditions that do not require laboratory tests, and more.

More importantly, systemizing nonvisit care may optimize what is already happening in health care by deepening the partnership between patients and clinicians, and easing some of the physicians’ burden as well. “Virtually all physicians already use nonvisit interactions to some extent,” the authors write, “but their improvised approaches could be vastly improved if health systems were designed with such care as the explicit goal.” By eliminating practices such as patients sending in photos of rashes that are then forwarded to their physician’s dermatologist friends, a system focused on “high-quality nonvisit care” would elevate the safety and quality of care that is already delivered outside a physician’s office, they contend.

There are drawbacks to deemphasizing in-person visits, not the least of which is the still-dominant fee-for-service payment model that rewards providers according to the quantity rather than the quality of care they provide, the authors acknowledge. Fortunately, “payment models are already evolving to support nonvisit care” by making greater use of bundled payment programs and accountable care organizations that incentivize delivery models to meet patients’ needs while reducing costs, they write. Furthermore, there may be the added value of a competitive advantage, operational efficiencies and increased patient loyalty for those clinicians and systems that embrace nonvisit care.

In an ideal future, care management could resemble “an information-technology ticket system,” the authors hypothesize. “A patient could open an app, file a ‘need,’ answer a few tailored questions, and receive immediate guidance. The case would be ‘closed’ only when the patient’s need was resolved.” Not only would this improve the traditional model of care, but it would also represent “a deepened commitment to patient-centered care” in an era in which high-performing providers and organizations are increasingly driven by that mission, they write.

Whatever the future of health care holds, consumers will be at the center of it.