Why are telehealth companies treating healthcare like the gig economy?

Why are telehealth companies treating healthcare like the gig economy?

Telehealth has taken off.

Spurred by the pandemic, many doctors in the U.S. now offer online appointments, and many patients are familiar with getting live medical advice over the internet. Given the obvious benefits, many experts have concluded that telehealth is here to stay. “It’s taken this crisis to push us to a new frontier,” said Seema Verma, administrator of the Center for Medicare and Medicaid Services. “But there’s absolutely no going back.”

Now the question is, where are we going? Telehealth has played an essential role during the pandemic, and it could do even more good in the years to come. But we are still in the very early days of its development. And if we are to realize telehealth’s full potential, then we must first reckon with the fact that there are serious flaws in the predominant way it is delivered today– flaws that endanger patients themselves.

Legacy telehealth services like Teladoc and others were built for a time when telehealth was a fringe phenomenon, mostly used to support acute needs like a bad cold or a troubling rash. They largely offer, in effect, randomized triage care. Patients go online, wait in a queue and see the first doctor who happens to be available. These companies market this as a virtual house call, but for patients, the experience may feel more like being stuck on a conveyer belt. Too often, they get funneled through they system with little to no choice along the way.

Insurance companies love this model because it is cheap to operate. But patients bear the cost. Doctors, in this arrangement, get paid to work the assembly line. Every minute they spend listening to patients– learning about their lives, building a personal relationship– is a minute they’re not moving them down the line, seeing the next patient and earning their next fee. The system doesn’t reward doctors for providing care; it rewards them for churning through patients.

As we build telehealth’s future, doubling down on this model would be a worrisome mistake since it is antithetical to how our healthcare system should operate. Healthcare has long been premised on the idea that you should have an ongoing relationship with your local care provider– someone with a holistic, longitudinal view of your health, who you trust to help navigate difficult or sensitive medical issues.

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The randomized triage model breaks this bond and replaces it with a series of impersonal interactions that feel more like the ones you have with an Uber driver– polite but transactional, brief and ephemeral. Healthcare, however, should not be treated in the same way as the gig economy.

As a physician, I am troubled by the prospect of what happens when you scale this model up. Every time a patient gets passed from one doctor to the next, there is a chance that critical information is lost. They won’t understand your baseline mood, your family context or living situation– all critical “intangibles” for informed treatment. That lack of longitudinal data leads to worse outcomes. This is why the healthcare system has long been designed to minimize patient handoffs– and why it would be a mistake for us to choose a telehealth infrastructure that increases them.

What, then, does a better approach look like?

We are at the very dawn of telehealth’s integration into our country’s healthcare system, and I won’t claim to know the full answer. But I do know that patients are far better stewards of their own health than a random doctor generator. A more effective approach to telehealth puts the power in the patients’ hands. Because when we give them choices and then listen to them, patients tell us what they prefer.

Data gathered by my company makes it clear that by a substantial margin, people want to make this decision themselves: 9 out of 10 telehealth patients prefer to schedule an appointment with a provider of their choosing rather than seeing a randomly assigned doctor after waiting in a digital queue.

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Not only that: when given this choice, most patients– about 7 out of 10– make an appointment with a nearby doctor when booking a virtual visit. Patients instinctively know that at some point, they’ll want or need to physically be in the same room with their doctor. And they know that choosing a local provider makes it possible to pick up the conversation in-person right where they left it off online. They don’t want to be forced to choose between telehealth and an ongoing relationship with a trusted provider. And they’re right– they shouldn’t have to.

None of the legacy telehealth companies focus on this imperative. Instead, while the pandemic rages on, they are rushing to scale while their randomized triage model is still viable. And the markets may reward them in the near term for being in the right place at the right time. But long-term value will be derived from listening to, responding to and iterating on what patients want.

Experience suggests patients will reward whoever can give them the most control over their healthcare. That’s where I’m placing my bet, too.

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Hospitals can care for Medicare patients at home in pandemic

Hospitals will be allowed to care for Medicare patients in their own homes during the pandemic under a new program announced Wednesday to help hospitals deal with the latest surge.

Some hospitals already offered patients with private insurance the choice of getting care at home instead of in the hospital. The pandemic dramatically boosted use of such programs.

The Centers for Medicare and Medicaid Services said it will let hospitals quickly launch home programs, which will offer around-the-clock electronic monitoring for Medicare and Medicare Advantage patients who are sick enough to be hospitalized, but don’t need intensive care.

COVID-19 patients are eligible. Six health systems already offering “hospital-at-home” care were approved to participate in the Medicare program immediately.

“We’re at a new level of crisis response with COVID-19” and this option will help hospitals increase their capacity to help more patients, CMS Administrator Seema Verma said in a statement.

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Hospitals would need to meet certain standards to participate. Those include providing twice-daily visits by medical workers and equipment such as blood pressure and oxygen-level monitors, and keeping patients connected via an iPad or other device to a command center should they need help. Medicare would pay hospitals the same rate as for in-hospital care.

Earlier in the pandemic, CMS expanded coverage for telemedicine appointments and launched a program paying for care in field hospitals and hotels.

“This will help health systems create capacity to care for patients during the surge,” said Dr. Bruce Leff, a geriatrics professor at Johns Hopkins School of Medicine and a home hospital pioneer. 

He said hospital-at-home programs have proven benefits for patients and can prevent complications they might experience in a hospital. 

Leff helped CMS plan the program, along with experts at major hospitals already running such programs and three companies that contract with hospitals to run programs for them: Medically Home, Contessa Health and Dispatch Health.

Since the pandemic began, all three companies have reported a surge of new, privately insured patients choosing to stay at home, where they can be more comfortable and have family around. 

Medically Home Chief Executive Rami Karjian said he hopes elderly patients who might defer care during the pandemic “will now get the care they need.”

 

What do you think about receiving at-home care instead of checking in for care at a hospital? Are you for or against this program? Would you try it?

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What you need to know about at-home Covid-19 tests

Is Covid testing on your shopping list?

Costco, a popular wholesale store with locations across the US, has announced that it will sell a direct-to-consumer diagnostic test for Covid-19, joining a growing list of retailers providing diagnostic tests.What you need to know about at-home Covid-19 tests

Kent Sepkowitz writes that even though at-home Covid-19 tests will now be available at a number of retailers, it does not necessarily mean testing will get faster or more accessible.

But there are problems with the program, starting with the cost. The test is not cheap, especially for those looking to test themselves and family more than once. At Costco, the kit costs $129 for the most basic version and $139 for the fancy version that includes video instructions. Federal law mandates that private insurers, Medicare, and Medicaid cover Covid-19 tests without any cost to the patient. Whether they will pay fully for a more bells and whistles program such as that provided by Costco likely will vary plan to plan.

That price is actually cheaper than buying the at-home kit directly from AZOVA, the company that administers the program, which charges at least $20 more. AZOVA is also encouraging pharmacies to offer the kits. In a blog entry titled, “Four ways to generate revenue when you offer Covid-19 testing in your pharmacy and on your website,” lists some tips on how pharmacies can maximize profits, including receiving a $22 to $29 administration fee for in-pharmacy tests and $5 for each test ordered online and conducted at home, noting that “you don’t need to do anything but add a link to your website” to get the five bucks a pop.

As for the speed of the results– sorry, you’ll have to wait at least a couple days. The term “home test” evokes the home pregnancy test approach where the wait for the big reveal is measured in minutes. However, for the Covid-19 test, the “home” refers only to where you collect the specimen, not where you run the test. This is performed by a lab reached by (hopefully) overnight mail.

AZOVA promises a result by email one to three days after receipt of the kit in an approved lab. But there is an additional lag in the time of one to three days for the kit to be delivered to you at home if you order it online. In other words, order on Monday and get your test result at the earliest on Wednesday but as late as the weekend. (Costco advertises a slightly quicker turnaround between ordering the kit and receiving it at your home.) So those who would want to use the test for assurance prior to seeing the family or returning to the office need to plan many days in advance.

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Which Brings us to accuracy. The involved companies claim the test is excellent, with the website advertising 98% sensitivity and 99% specificity, meaning almost every case is detected by the test with very few false positives. But we don’t know how accurate a test really is until people have used it in real life conditions, rather than under perfected lab conditions. OraSure experienced this difference when its home test for HIV, once approved, showed a higher false positive rate than clinical trials had shown.

And that was the good old days, before the Trump administration weakened the process for how lab tests can gain emergency use authorization (EUA) through the FDA. In the name of swiftness, the FDA decided to allow qualified labs themselves to determine whether their test worked. No longer is the company’s data subjected to FDA scrutiny prior to issuing EUA. It is possible therefore that some tests that would not have received FDA emergency authorization six months ago are now receiving a greenlight.

Plus, there is the simple fact that a test is performed today may accurately show no infection, but by the time the result is available– days later– the same person may have become infected. The immediacy of the test result, therefore, is crucial for both personal and public health decisions.

So here we are, eight months into the pandemic and still waiting for an accurate, fast, cheap, readily available test– the game-changer first promised in April. The at-home version in its current form may be helpful for worried families but will not be a game-changer from a public health perspective.

But having several companies trying to solve a problem the Trump administration should have resolved long ago, similar to governments in South Korea, China, Germany and other countries, is a faintly hopeful sign.

The collaborating companies seem to understand that basic principle for controlling the Covid-19 pandemic is the same as for every infectious disease: it is necessary to have a rapid and reliable test to identify who is potentially infectious. Otherwise we are simply trying to swat flies in a pitch-dark room, hitting and missing, missing and hitting, with no hope of knowing anything at all about the effectiveness of our efforts. This single profound limitation more than anything else has led us into America’s historic public health catastrophe.

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Let’s Break Down The Safest Ways To Vote In The 2020 Election

Make your safe voting plan, and stick to it.

Let's Break Down The Safest Ways To Vote In The 2020 Election

Election Day is Here

Americans everywhere are off to the ballots to vote in one of the biggest elections of our lives. The stakes of this year’s election couldn’t be higher, and it’s more important than ever for all eligible voters to make their voices heard this year. We find ourselves amid a global pandemic as we wake up to Election Day 2020, offering its own unique challenges to an already contentious race. The health and safety of voters, poll workers, and volunteers are of the upmost importance as we navigate social distancing during the constraints of polling times. Many might be wondering, “is it even safe to vote this year?” The short answer is yes. There are still ways to vote safely in the pandemic. Let’s break down the three primary methods of voting this year and how safe they are during the age of COVID-19.

Voting by Mail

Voting by mail, also called absentee voting, is going to be the safest choice. Mail-in voting is the act of filling out your ballot at home, and then mailing it to your local elections office to be counted. You can also drop the ballot off at a drop-off location, as many Americans had to do, with the deadline quickly approaching and fears rising of ballots not arriving and, therefore, not being counted in time. The process for voting by mail varies by state- some states are automatically sending mail-in ballots to every registered voter this year, while other states will only send one if you specifically requested it. Mail-in ballots are the safest way to vote in the COVID-19 era. There are no lines, no crowds, no human interaction required and, as a bonus, you can do it from the comfort of your couch!

Early Voting

The second safest way to vote in the 2020 Election is to participate in Early Voting. Many states allow its voters to vote early in-person before Election Day. Early Voting comes with so many benefits: it’s often faster and more convenient than voting on Election Day. And, because you’ll beat those November 3rd crowds, it’s a safer bet in the age of COVID-19.

Voting on Election Day at the Polls

Finally, there’s the option to show up to the polls on Election Day to vote. Voting this way will require extra caution given the pandemic, but if mail-in voting and early voting aren’t options for you, there are concrete steps you can take to make your visit to the polls as safe as possible.

Wear a mask and practice social distancing at all times. Carry hand sanitizer. Pay close attention to posted signs and any instructions you’re given from poll workers. They’re there to keep the lines moving and to make sure everyone stays safe. Try to go during times you think the polls will be less crowded- for example, midday might be less busy than right after 5 p.m. when everyone gets out of work.

Ready, set, vote!

Ultimately, whether you vote by mail, vote early in-person, or vote on Election Day at the polls, have your voice be heard, and do so safely. Take every precaution you can to protect yourself and your community in the process. Together, we can make sure that everyone gets to participate in their democracy safely this year. Make your safe voting plan, and stick to it.

How did you vote this year? Did you feel that voting safety precautions were thorough?

 

Now, more than ever, you’ll want to make sure you’re insured. Your health and health coverage is our priority. Follow the link below to compare plan options and call us at 877-413-1556 with any questions. We look forward to hearing from you!

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