New care delivery methods should be assessed in greater context, not just access

By | August 29, 2017

As we move to delivering value to those we serve, consumerism has taken a front seat concerning how we think about how we deliver care. However, we should be cautious when doing so to avoid creating a situation where we drive up costs.

Retail clinics have been touted as a way to decrease unnecessary emergency department visits, as well as providing more timely access to primary care for services that are amenable to a different care setting. Unfortunately, as I have discussed before, the data has shown that the use of retail clinics have increased the cost of care, as the increased access has caused the consumer to use the services when they would not have sought care otherwise. So instead of lowering costs by using a less expensive, more convenient substitution for other services, we are seeing just the opposite. The proliferation of retail clinics has also strained the workforce for nurse practitioners and physician assistants.

Telehealth has also been touted as a way for consumers to get the care they need in a way that is much easier for them, and much cheaper and less resource-intensive than the present physician office model. Providing services to those unable to travel or in rural areas are great use cases that do make sense. Both the Kaiser Health Foundation and the Veterans Affairs Office have shown that when telehealth is part of the overall services provided, they deliver on their promises.

Unfortunately, we are now seeing that when telehealth is used as just a consumer convenience, costs go up instead. CalPERS Blue Cross Blue Shield in 2012 began to cover telehealth visits. About a third of their members used the services over an 18-month period, but when RAND Corporation reviewed the results, they found that less than 12 percent of those who used the services did so instead of seeking a different level of care. In fact, for those that used telehealth, the average cost was $45 higher per patient. Basically, they used the telehealth services and their normal provider office-based services instead of substituting one for the other.

But this doesn’t mean we should stop supporting retail clinics or telehealth. They have great promise to provide services to those that otherwise cannot get them, and lower overall costs of care. However, the point is that we need to be very focused on the problems we are solving when we use new technology or service models. If the goal is just to increase access, then we will continue to see the creation of healthcare consumers with possibly increased costs and more strain put on present resources. If we are trying to increase access while decreasing costs, we will need to be very vigilant in how we implement such solutions. We need to focus on what areas we are trying to impact, and work with those we serve to understand the value of their use. For example, when you call an office make an appointment or log in for a virtual visit, we must make sure we help you understand the optimal way to use all the services offered.

We are just in the early phases of many consumer-focused innovations and we must work through these concerns. If we do not, we will lose the true value of the innovation by not pivoting and improving on how we use them.