The Technologies that Deliver Value to Value-Based Care

Dr. Michael Rivers, Director of Ophthalmology, Modernizing Medicine

The way we pay for healthcare in the U.S. is changing and it’s long overdue. Our country spends a higher percentage of our GDP on healthcare (nearly 20%) than any other developed nation, but we trail nearly all of them in average life expectancy. Fortunately, the U.S. healthcare system is taking on a seismic shift in reimbursement with the adoption of value-based care with the hope of reining in costs and improving care. By tying provider reimbursement to positive health outcomes, our healthcare system can spend money more efficiently and encourage better patient results.  

Replacing the old “fee-for-service” model, which billed patients regardless of their outcome, is a positive step for patients, payers and providers alike because it will ultimately drive down the cost of care. But, realizing value-based care in the truest sense demands much more than changing reimbursement models. It will require providers to examine every aspect of care delivery and improve upon any inefficiencies to maximize value—and outcomes—for the patient. 

The rapid adoption of telehealth during the pandemic, for instance, revealed instances where remote access to care is just as effective— or even more effective—than an in-person visit, and can reduce costs. By identifying technologies such as telehealth that drive efficiency, health tech can play a significant role in supporting value-based care and controlling costs. Nearly every consumer-facing industry—transportation, e-commerce, food services—has streamlined processes and become more efficient through tech adoption over the previous 10 to 20 years and similar adoptions in healthcare can contribute to a better patient experience.

These are the technologies that will factor into improving value for patients:

Telehealth 

Nothing in health tech has received the same attention as telehealth since it emerged as a critical tool for continuing patient care in an era of social distancing. Telehealth is not a one-size-fits-all solution for replacing in-person care, but it is improving specific areas of medicine. 

Pediatric care, for example, is a perfect fit for expanding the use of telehealth. Parents often have questions about their child’s health or need a fast resolution to an emergent medical situation and telehealth creates an unprecedented level of access to their care providers. Telehealth can also replace routine appointments, such as post-operative visits or initial consultations for an elective procedure. Creating access to the physician for a quick consultation or saving the patient the expense of a parking garage both provide value to patients. The access to care factor is also critical for patients who live in rural areas or “healthcare deserts.” Providing them an accessible form of preventative care through telehealth can mitigate the risk of long-term illness and potentially save patients from avoidable testing, surgeries or other expensive services. 

Telehealth has even incorporated some features that very closely replicate the experience of an in-office visit. For instance, multi-user telehealth calls allow for a nurse or physician’s assistant to “room the patient” and go over preliminary information before the physician joins the teleconference. I expect the technology will continue to evolve to a point where in-person visits and telehealth visits have very few discernible differences.  

Artificial Intelligence

Emerging technologies that leverage AI have attracted the attention of insurance companies for their potential to dramatically lower the cost of care. As an example, a physician-performed screening for diabetic retinopathy can cost $300, but AI-powered technology exists that can conduct the same screening via a photograph of the eye for less than $30. 

Widespread screening tools with AI capability remain more common in concept than in practice, but companies like Google are looking for imaginative ways to utilize smartphone cameras for other types of screening, such as for skin cancer. Earlier detection and prevention would save the patient and insurers from the extremely high costs of cancer care. 

AI can also increase efficiency within individual patient visits. Every care provider is constantly amassing de-identified clinical data that could lend itself to faster and more effective clinical decisions if we can get it into the hands of the physician. That data could build the most comprehensive library of clinical information imaginable and completely reshape how clinicians diagnose disease, prescribe drugs or make referrals to specialists.  

The Patient Benefits of New Technology 

The bottom-line cost savings will ultimately measure technology’s impact on healthcare, but we can also find value in improved patient satisfaction. Consumer brands such as Amazon have built loyalty through positive customer experiences and the convenience of its platform. By making healthcare more convenient for the patient, we can drive higher rates of drug adherence and appointment compliance that will contribute to more positive clinical results.

Patient engagement technology that provides real-time patient feedback on clinic experiences and health outcomes will also add tremendous value to making providers more efficient. Aggregating that data and analyzing patient experiences will offer a clearer view of weak points in the patient experience and help to identify ways to provide better care for the next patient.

New technologies that promise to influence healthcare are emerging more rapidly than ever before, but not all of them will contribute to value-based care and lower the cost of care. By identifying the true drivers of value, such as telehealth, AI and patient engagement tools, we can build a more efficient and cost-effective healthcare system.

Dr. Michael Rivers is a board-certified ophthalmologist and retina surgeon, who is also Director of Ophthalmology at the health tech company Modernizing Medicine