The health system is committed to a high-value, population health-focused, telehealth approach. "In our effort to work well with the consumer, we don’t dumb down the medicine," says Marc Harrison, MD.
For telemedicine to fundamentally shift the delivery of healthcare, and not just be another promising technology that came and went, it will need to change two patterns:
- The healthcare-consuming public must choose telemedicine options because they are more convenient and still feel safe.
- Providers must choose telemedicine because it is the most appropriate level of quality care for that patient at that time.
Few health systems in the country are testing the system dynamics of telemedicine at a scale like 22-hospital Intermountain Healthcare, based in Salt Lake City, Utah.
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The spokes of Intermountain’s TeleHealth strategy reach into solutions in the hospital, clinic, and home.
An emergency department specialist at one of Intermountain’s rural hospitals may connect with a neurologist at the academic medical center within minutes of a potential stroke patient coming through the door.
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An infectious disease specialist in Salt Lake City can track patterns of infectious disease across the system and spot potential trends before they worsen. Or a busy mom can dial up a provider for a $49 ConnectCare telemedicine visit, rather than take off work for a child's sore throat.
HealthLeaders recently caught up with Intermountain CEO Marc Harrison, MD, who took over the helm of the organization in October 2016, to hear his thoughts on telemedicine’s potential. The transcript below has been lightly edited.
HealthLeaders: Telehealth or telemedicine as a technology is not particularly new, and a lot of hospitals and health systems are deploying some form of program. What is different about Intermountain’s current approach?
Harrison: You usually set up these programs so there is a path of least resistance between the areas that are being served and the hosting organization, in hopes of getting lots of hospital transfers and increasing revenue, etc.
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What I love about the way we have done this service is it is actually the opposite. We try really hard to keep patients in the least restrictive environment that is appropriate for them.
We try to make sure that patients don’t have to move their physical location as long as they have the right advice and oversight.
That population health-, high-value approach has really transformed telemedicine at Intermountain. Once our providers understood that, the number of ideas from our providers on how to use that exploded.
HealthLeaders: Can you share an example?
Harrison: Consider a high-risk mom who comes into one of our frontier hospitals to deliver a high-risk baby. Historically we would perhaps get that helicopter spooled up and get that baby out of there.
But now we may get our neonatologist from one of our big centers online with them, and possibly prepare the team for a resuscitation because maybe they haven’t done one in a month. Let’s make sure this person gets the same care they would in a major academic medical center.
What we find is that a lot of these kids can stay home, with great results, decreased inconvenience for the family, and reduced cost to everyone. It’s a fundamentally different approach, and that has led to accelerated growth.
HealthLeaders: Apart from telemedicine technology that is built on the physician peer-to-peer consultation model, increasingly we are seeing the move into technologies that touch the patient. Describe the adoption you are seeing from the public.
Harrison: I will share some anecdotal info. What I hear from patients is that once they get over the barrier for that first visit, their response is, “Why don’t I do this for all of my visits?”
No waiting rooms, service-on-demand, comfort of my own home. It’s inexpensive, and a lot of people have high-deductible plans these days. Once you get people over that hurdle of trying it once, then they don’t want to go back.
HealthLeaders: What about outcomes? This industry has a huge graveyard of once-promising technologies that were supposed to reduce cost and improve care. How is telemedicine different?
Harrison: Let me answer that in a couple of different ways.
First of all, I don’t see anyone going back from this. The question is how is it going to be provided, and what kind of refinements—convenience or cost or patient experience—will the patient demand? It is here. No one is saying that their bank website froze up last night so they are going back in line to see the teller every week to deposit their paycheck.
The key to getting these really good outcomes is that, in our effort to work well with the consumer, we don’t dumb down the medicine.
I’ll give you an example: One of our caregiver’s totally legitimate big concerns is that if somebody comes in the physician’s office for an earache, the doctor will not give them antibiotics unless they really need them.
The concern is whether we are going to tell everyone who has a sore throat or ear pain via ConnectCare to go to the nearest pharmacy and get antibiotics.
We have worked very hard to make sure that is not the case. These are the tricks—to make sure that convenience is terrific, but great safety and quality will become table stakes in the industry so everyone will get good care via distance.
And we will then be differentiated on some of the finer points. I’m not sure that is really the case yet.
HealthLeaders: What about the cost side? The technology is not free, though a lot of it is using ubiquitous consumer technology, like phones and tablets. How do you get the ROI out of the technology investment?
Harrison: This is the beauty of being a payer/provider. Roughly a third of our volume is at-risk volume, so it allows us to make very patient-centered decisions about how we do things. If we want to be purely fee-for- service environment, putting in things like this may be like cutting your own throat.
But we see the industry heading toward population health value. And in that context, serving the patient where, when, and how they want, and at the right cost, is good for everyone.
Although some of this volume would be great for (inpatient) revenue, we know that is not the way it should work. We are pretty realistic. Building this into our operating model is very important.
HealthLeaders: How about telemedicine as a data tool, such as infectious disease specialists using telemedicine to monitor and spot trends a lot sooner?
Harrison: I think that is a huge advantage. The other advantage is that some of these specialists are hard to recruit and hard to keep busy in the right way. For them to be able to serve appropriately over a large swatch of territory kind of works for everyone.
A) They get a lot of concentrated volume so they really know what is going on, and B) you don’t have redundant staffing costs of having an infectious disease specialist at every hospital.
Everyone benefits. The hospital benefits. The doctor benefits. Most importantly, the patient benefits.
HealthLeaders: Have you addressed the reality that tele-practice can be a fundamentally different way of practicing medicine than in-person contact with the patient? Have you stopped to think how it is creating a new discipline?
Harrison: It is. One of the things we try to do because the clinicians really want this, is we tend to rotate them through conventional face-to-face practice and tele-practice, so they are not solely dedicated to one or the other.
So for that neonatal resuscitation via tele-practice, it’s a real-life neonatologist who has cared for babies up close. One of the things that is interesting is when you are in a bunker looking at screens at a distance, your peripheral vision is sometimes a little better than when you are right up close to a very sick patient where the stress is high and it’s possible to lose your peripheral vision a little bit.
Having an extra set of eyes who are maybe a hair more remote is very helpful.
HealthLeaders: What’s next on the horizon? What ties this together from a collection of pilots into a connected system?
Harrison: A couple of things. I think we are only beginning to see what staffing models might look like. You might say to yourself, we know that critical care nurse practitioners are really capable of doing 80% of what an intensivist can do.
With really great tele-critical care support, can they do even more? What does that do to the cost basis of care? How do we extend our tele-infectious disease service with use of other mid-level providers?
How do we actually use predictive analytics to be able to let that tele-intensivist know that, based on algorithms derived from people’s labs and their vital signs, somebody is heading down a hole in a couple of hours when they look okay right now?
That next layer of predictive technology, even better monitoring, better teamwork, and even more people practicing at the top of their license… that’s where it starts to come together.
HealthLeaders: There is a lot of stress on reimbursement in general. Does that shift your view of telemedicine’s potential?
Harrison: In an era of regulatory uncertainty, we’re sticking to our guns and say we will keep value high. High quality and low costs is what we can focus on and execute regardless of the reimbursement system. I feel pretty confident telehealth plays a big role in this, particularly when we see people acting as consumers. It’s not a silver bullet, but I think it’s a component.
To learn more, please join our livestream June 20 from 11:00 a.m. to 2 p.m. ET. In HealthLeaders Media Live at Intermountain Healthcare: Connected, Comprehensive TeleHealth we'll go beyond the technology to understand the workflows and how telemedicine can deliver high-level clinical expertise into new areas with speed and efficiency.
Jim Molpus is the director of the HealthLeaders Exchange.