Can Any Solution to Telehealth Significantly Reduce The Healthcare Spending In The US?
<p>The quantitative answer to this question has evaded medical professionals for dozens of years. There are many reasons, but two principal ones are the use of high-cost labour in some solutions, and secondly, a piecemeal approach which may not support a long-lasting business model.</p><p>A holistic view surfaces some basic truths which ‘we hold self-evident’. The volume transactions are in outpatient visits which can be more easily handled by telehealth. It is the largest healthcare cost segment, and the second highest increasing segment. Main contributors are doctor and ER visits.</p><p>So, if one could come up with a more comprehensive telehealth solution, hypothetically, to handle 30%-50% of such cases, the volume would result from addressing low-acuity cases and monitoring chronic illness. That means that a desired telehealth solution should be able to handle more patients and likely shift to on-demand. To get the costs down, the solution should also be able to utilize fewer doctors and better utilize nurse practitioners who can prescribe medicines for many conditions. As telehealth requires telecommunications links, the heart of the system must have flexibility, adequate performance, and low cost to facilitate natural interaction of the participants and meet the requirements of medical practice. Lastly, in order to minimize the medical staff costs, it suggests that 1) medical staff be used more efficiently, 2) there be the latest in predictive analysis, and 3) there be better ties to integrated healthcare systems. Clearly, the market trends over the past 20 years have substantiated the use and growth of urgent care centers and manned mini clinics as consumers seek more convenience and/or lower costs.</p><p>So, we would be looking for a solution for folks who are aggravated and not feeling well. They do not want to waste time and money to arrange appointments, wait, drive, and get prescriptions --- they are seeking convenience. They probably need a good health certificate or have a seasonal or chronic illness and might need a prescription. What are the statistics regarding the top diagnoses of low-acuity cases? According to a 2014 CDC study, approximately 1.25 billion ambulatory care visits in the United States; an estimated 417 million, or 33% of these visits could be treated through telehealth. These would include conditions such as sinus problems, bronchitis, upper respiratory infection, nasal congestion, pink eye, allergies, flu, cough, and ear infection. Plus, there is an increasing growth of chronic illnesses such as diabetes, hypertension, hyperlipidaemia, congestive heart failure, stroke, and chronic obstructive pulmonary diseases. For a comprehensive telehealth solution with technology available today, we believe a reasonable target would be around 340 million visits per year --- if there were adequate healthcare access points of the right kind.</p><p>To reduce the costs of healthcare access points, VideoKall has invented the first known, Unmanned Micro Clinic (UMC) cabin. These unmanned, monitored and automatically sanitized cabins are self-service and would be available 24x7 for on-demand access, with a remote nurse practitioner performing virtual medical examinations, as the UMCs are equipped with 2-way satellite video connections, thereby avoiding the use of the hacker-prone internet. Together with a more efficient host hospital medical call center, patients will use the UMC because it will be more convenient and cost roughly half that of a retail mini-clinic visit for outpatient services. In addition, as the UMCs can use satellite, they can also be installed in mobile units for disaster relief and in very low population density areas, but also in areas where broadband fibre is unavailable.</p><p>To provide convenient access near work, home, school, travel or shopping, and rural areas, the Unmanned Micro Clinics need to be deployed in supermarkets, corporate buildings, universities, large senior living facilities, high schools, truck stops, and rural community centers. That number totals approximately 6 million locations providing a potential captured market of less than 1%. If this 1% translated into 32,000 locations, with 10 visits per day [close to CVS reported traffic for mini-clinics for up to 365 days per year, there would be a total of 117 million visits per year. Further, if the service cost of using the UMC for the patient and insurance company, together, approximately $60 per visit, compared to $90 for a mini-clinic or $155 for an urgent care center, the difference of $60 on average, would amount to a savings of over $7 billion. Likely, the 32,000 units would take around 10 years to build out, but over those 10 years, the US healthcare costs could be reduced by around $35 billion.</p><p>The impact on satellite usage is equally impressive. The bandwidth required to handle 117 million, 10-minute virtual medical examination calls per year is 37 satellite transponders of 36 MHz each, based on 10% of all calls occurring on a simultaneous basis.</p><p>In addition, an analysis published in the Journal of the American Medical Association, concluded that, in the US, the healthcare sector was responsible for 8 percent of the country’s total emissions. This reinforces a market study conclusion, by Fairleigh Dickenson University, that over 80% of the consumers live closer to their supermarket or drug store, than their primary care physician. By patients only having to travel to their nearest UMC, total emissions could be reduced by at least 4%. In 2016, about 143 billion gallons (or about 3.41 billion barrels) of finished motor gasoline were consumed in the United States; a representative 4% would save almost 6 billion barrels per day. The UMC is indeed a low carbon footprint primary healthcare facility that could easily fit into an area the size of a parking space. </p><p>So, what are the challenges of deploying 32,000 UMCs whose total installed price is less than the annual salary of a nurse practitioner for a normal shift? The primary challenges are the capital costs of deployment. With the current competitive climate for hospitals and clinics, and with some hospital revenue categories being capped, the strategy is to “capture” and treat as many patients as possible at the lowest cost in higher traffic areas and refer the more serious patients to the more expensive physician offices, clinics, and hospital ERs. A low-cost business model would allow deployment of UMCs to moderate and high traffic locations but would be challenging for the more rural areas but perhaps at lower traffic levels than mini-clinics --- similar to what drugstores and supermarkets have been experiencing with mini-clinic deployment. The solution for rural areas with inadequate traffic, where the need is greater, the travel distances are longer in miles and time, the chronic illnesses are greater, and the average income is lower, are UMCs and broadband connectivity, subsidized through existing federal programs, rural co-ops, and corporate social responsibility programs. One might seek a forum where large corporations with CSR policies and commitments can work with rural communities and VideoKall to sponsor rural self-service micro clinics, linked by satellite to major hospitals where the medical services are sourced. The proposed business model would allow large corporations to be seen to be ‘giving back’ to rural communities such as those affected by natural and manmade disasters. This minimal cost CSR Rural Healthcare program has many benefits because it leverages new self-service healthcare technology in telehealth with a very strong benefit multiplier.</p><p>It is amazing that the potential of comprehensive telehealth has not been adequately highlighted to date. Not only would it greatly benefit the healthcare industry, but also patients would be paying less in outpatient visit costs, co-pays and premiums. Also, on a daily basis, they would enjoy less personal stress and waiting, consistent quality from centralized medical call center with a supervising physician, savings in time and expense travelling to/from a medical facility, a better quality of life, and increased longevity.</p><p> </p>