Kaiser Permanente's Ramin Davidoff, MD, explores how new ideas in healthcare are actually old concepts brought back to life with new technology.
[Editor's Note: Ramin Davidoff, MD, is executive medical director and chair of the board for the Southern California Permanente Medical Group; chair of the board and chief executive officer for The Southeast Permanente Medical Group; chair of the board and chief executive officer of the Hawaii Permanente Medical Group; and co-chief executive officer of The Permanente Federation.]
Tech pioneers, venture capitalists, and innovators are perpetually pursuing the next big thing in healthcare. The imperative to improve outcomes and revolutionize the patient experience, while lowering costs, drives this endless quest.
There is no doubt that innovation is critical to moving the health system forward. What’s more surprising is seeing so many approaches from the past continue to drive progress. Health systems are reaching back—as far back as the advent of modern medicine—to solve the quality-cost conundrum. As William Faulkner wrote, “The past is never dead. It’s not even past.”
Ramin Davidoff, MD, medical director and chair of the board for the Southern California Permanente Medical Group, chair of the board and CEO for The Southeast Permanente Medical Group, chair of the board and CEO of the Hawaii Permanente Medical Group, and Co-CEO of the Permanente Federation. Photo courtesy Kaiser Permanente.
Let’s look at three approaches to delivering care that are making a comeback.
House calls: The phrase evokes the not-so-recent past. In the 1930s, house calls made up nearly 40% of physician-patient interactions, but by the 1980s the figure dwindled to as low as 1%. Health systems are turning back the clock to deliver a full spectrum of care in patients’ homes, from telemedicine right up to hospital-level acute care. It’s care that was more convenient and safer for the patient while hospitals were stretched to their capacity by patients with COVID-19, and it delivers better outcomes.
House calls connect homebound seniors and others facing mobility challenges with their primary care providers to manage chronic conditions. Physical therapy appointments are also taking place in the home. Due to the pandemic, nearly 100% of talk therapy sessions now occur over video.
The pandemic expanded health systems’ thinking around the types of care that could be delivered in patients’ homes, with the goal of keeping patients safe during spikes in infection rates. COVID-19-era waivers that were recently extended for two more years encouraged systems to expand the house call concept to deliver acute-level hospital care in the homes of patients. It is bringing hospital care to areas that may not have a brick-and-mortar hospital nearby.
The model has serious momentum behind it. More than 100 health systems and 250 hospitals have been approved by the Centers for Medicare & Medicaid Services (CMS) to receive Medicare reimbursement to deliver hospital-level care in the homes of patients, and thousands of patients have benefited already. As technology and innovation increasingly enable patients to receive even advanced care in their homes, health systems likely will focus more on emergency care and surgeries.
Value-based care: The Affordable Care Act, which celebrated its 13th anniversary in March, didn’t invent the concept of value-based care, but it kicked the movement into high gear. The law laid the groundwork for systems to test new approaches for delivering higher quality care in return for incentive payments and bonuses. Meanwhile, the federal government set ambitious goals for moving payment arrangements away from quantity-oriented fee-for-service models to models that prioritized better outcomes delivered at a lower cost.
Over the intervening decade, varying degrees of success were achieved across performance and participation targets, but it’s clear the federal government and health systems are committed to value-based care models.
The foundation of this commitment is the growing body of evidence that value-based care delivers on the promise of improving patient outcomes while lowering the cost of delivering that care. Value-based care may have lost its place as the next big thing in health, but it is still front and center in health systems’ plans for innovating care delivery.
Care coordination: Health systems decided at the turn of the 21st Century that it would be better for the patient if the metaphorical left hand (the patient’s primary care provider) knew what the right hand (a patient’s many specialists and other members of their care team) was doing and vice versa. The emergence of electronic health records paved the way for a more efficient flow of information between these many points of patient contact, and patients are reaping the rewards.
Health systems are building on the early successes of coordinating care to instill this practice throughout a patient’s journey. Health systems are acquiring or merging with community-based services and physician practices, enabling clearer, more effective lines of communication and coordination on behalf of the patient. The movement toward coordination has the added benefit of improving the quality of care while making it more affordable.
Health systems should remember that new doesn’t always translate to best. As the United States continues to search for healthcare’s holy grail of better care at a lower cost, let’s consider that what’s worked in the past can work in the future.
