What strategies will help to deliver telemedicine “at scale”?

Posted on by • Posted in Clinical Work Flow, Scale, Telemedicine, Telemedicine Strategy, Virtual Care Strategy, Virtual Healthcare, Virtual Visit • Leave a comment

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Costs and benefits of telemedicine in the ICU | athenahealth

Every health system and physician group is now focused on strategies to make telemedicine more scalable across their networks. When we spoke recently with a chief medical information officer (CMIO) leading his system’s telemedicine strategy, he shared, “If there is one thing I wish executives would understand about telemedicine, it’s that it will never make doctors more efficient.”

His data show the average video visit takes just as long as an in-person encounter. True, there is no physical exam, but the virtual conversations can be lengthy. And adding in time lost to helping patients troubleshoot technology, some of his colleagues report that virtual visits may actually take a little longer.

He went on to explain that other kinds of virtual encounters, specifically asynchronous communication with a provider, sometimes supported by automated symptom triage engines like Zipnosis, are far more time-efficient ways to communicate with patients. Certain clinical situations may better lend themselves to these types of “e-visits”. Take dermatology, where sending a high-resolution picture of a rash to the clinician is more valuable than trying to view the problem live on a Zoom call.

Of course, video visits can be far more convenient for patients—and there is huge value in in providing access to patients wherever they are. But delivering telemedicine “at scale” to meet rising consumer expectations will require finding the right balance of asynchronous communication, telemedicine, and in-person visits to best fit specific clinical circumstances.

And we’ll need to rethink clinical workflow—centralizing some telemedicine delivery at the system level across individual practices.

Preparing for generations of Medicare growth

Posted on by • Posted in Aging Population, Demand, Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Market Trends, Medicare, Medicare Advantage • Leave a comment

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The healthcare industry is now at the peak of the long-awaited transition of the Baby Boom generation into Medicare. The “greying” of the Boomers will continue to bring a rapid influx of new Medicare beneficiaries, but this is just the beginning of a protracted period of growth for the program, with the number of Medicare-eligible Americans increasing by more than 50 percent over the next three decades.

Using data from the US Census Bureau, the graphic above shows how the generational makeup of the Medicare population will change across time. The next decade will bring the fastest growth, as the latter half of the Baby Boom generation turns 65. Over that time, the Medicare-eligible population will increase by almost a third. Gen X will begin to age into Medicare in 2029. (Go ahead, take a minute. It hurts.) While fewer in number, Gen X beneficiaries, combined with the longer lifespan of Baby Boomers, will bring no respite from Medicare growth, with enrollment still increasing 11 percent between 2030 and 2040. 

As the country looks at a prolonged period of Medicare cost growth, we’ll be counting on a ballooning workforce of Millennials and Gen Z youngsters—each part of generations even larger than the Baby Boom—to continue to fund the Medicare trust across the next 25 years, when the first Millennials will receive their Medicare cards. (See how it feels?)

Intermountain, SCL Health to create $11B system 

Posted on by • Posted in Health System, Horizontal Consolidation, Horizontal Integration, Hospital, Hospital Industry, Market Consolidation, Market Power, Market Share, Market Trends, Mergers & Acquisitions, Population Health, Vertical Integration • Leave a comment

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Trends In Hospital and Health System Marketing in a Rapidly Consolidating Industry - Hirsch Healthcare Consulting

Salt Lake City-based Intermountain Healthcare announced plans to merge with Broomfield, CO-based SCL Health to form a 33-hospital, $11B dollar system working in six states. The combined system will keep the Intermountain name, be based in Salt Lake City, and be led by Intermountain CEO Dr. Marc Harrison.

Harrison said that the merger will accelerate the evolution toward population health and value, and “swiftly advance that cause across a broader geography”—a similar value proposition to the system’s previously proposed combination with South Dakota-based Sanford Health, which fell apart last December after Sanford’s CEO stepped down following his controversial comments about mask-wearing.

Intermountain has long been regarded as a national leader in clinical quality, and its integrated payer-provider approach is often cited as a model for US healthcare. The merger with SCL Health will enable expansion of its SelectHealth insurance plan and integrated care model into Colorado, Montana and Kansas, including the fast-growing Denver metropolitan area, making the combined system a formidable player across the Mountain West.

But as we’ve written before, achieving that vision will require a level of integration not often realized in similar mergers, and the burden of proof is on health systems to demonstrate that the merger will create meaningful value for patients and consumers.

We’ll be watching closely to better understand their plans for lowering costs and improving access and quality for patients across the region.

The Biden administration’s booster strategy gets clumsily underway

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Communication, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Health Policy, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine RNA, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

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After a confusing week of mixed messaging and conflicting opinions from the public health officials advising the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), late Thursday night CDC Director Dr. Rochelle Walensky announced her decision to recommend COVID booster vaccines for adults over 65, residents of long-term care facilities, and those younger than 65 with underlying medical conditions.

Controversially, Dr. Walensky contradicted the CDC’s own Advisory Committee on Immunization Practices (ACIP) by also recommending that people who are at greater risk of COVID exposure due to occupation or institutional setting—including healthcare workers and teachers—receive a booster shot. Earlier Thursday, ACIP members voted down a recommendation to provide boosters to healthcare workers, despite the FDA’s endorsement of that approach earlier in the week.
 
By Friday morning, President Biden announced he would soon get a booster shot himself, urging those eligible to do so, and re-emphasizing the administration’s primary focus on delivering first doses to those still unvaccinated. There will be more to come on boosters: the FDA and CDC guidance only applies to those who received the Pfizer-BioNTech vaccine at least six months ago; boosters for the Moderna and Johnson & Johnson vaccines are still under review.

This week’s saga caps a month of back-and-forth between public health officials, the White House, and the medical community, following Biden’s August promise—considered by many to be premature—that boosters would be broadly available starting September 20th. The inclusion of healthcare workers in the booster campaign is welcome news; we were flummoxed by ACIPs decision to bypass that critical segment, given mounting hospital staffing shortages amid the surging Delta variant.

More broadly, we’re increasingly distressed by the relatively uncoordinated and poorly-managed communication approach of the Biden administration on vaccines—particularly following a campaign in which competence was touted as a key advantage over the previous administration.