Even as digital healthcare models, such as telehealth, get massive new investments due to the coronavirus pandemic, we need to take care that the most vulnerable patients are not left behind.
For the sickest and neediest among us—whose healthcare tends to drive the highest costs—tech-driven healthcare could bring with it some grim unintended consequences. Among them: deepened isolation, uneven access and even higher costs in the end.
Pre-pandemic, there was not much urgency to rush to new tech solutions. Last year, only 11% of U.S. consumers were using telehealth, according to McKinsey & Company. There was no rush to build out infrastructure.
Enter a global pandemic. This year, nearly half of canceled in-person doctor visits have been replaced by the video variety.
It’s a trend that’s expected to stick, with estimates that telehealth may soon account for $250 billion in spending.
Healthcare system leaders, attracted by potential cost savings and competitive concerns, are now hard at work mapping out new digital infrastructure—telehealth, remote health monitoring systems and even video robots that will bring a doctor to a patient’s bedside in an acute care setting.
My concern: Healthcare will become increasingly impersonal, and access will be uneven.
This could almost certainly disenfranchise very sick and vulnerable folks—the elderly, those on dialysis or methadone, late-stage cancer patients, those who are very poor, to name a few.
Cutting off a lifeline
Begin with access. According to the Federal Communications Commission, 6% of Americans don’t have access to fixed broadband internet at threshold speeds. That figure rises to nearly 25% of all rural residents. The problem is even more acute among those who are very sick, whose conditions tend to thrust them into poverty. If you’re severely disabled and incapable of work, telehealth becomes a choice between broadband and eating.
Then there’s the matter of technological ability. To the deaf, blind or those of a certain age where computers remain a mystery, videoconferencing for life-sustaining treatments can be of little use. The same applies to the legions who still require regular in-person visits for chemotherapy, dialysis and methadone.
From where we sit in the healthcare journey, in providing access to care for patients on Medicaid, we see it every day. Roughly 50% of folks in our populations are incapable of scheduling their own appointments for various reasons. Asking them to master teleconferencing or video conferencing through a healthcare portal and its required two-factor authentication security systems is not reasonable.
Even as the healthcare world sees the dollar signs of cost savings and begins mapping out the software systems and other new workflows, we need to think hard about these groups. It’s easy to make the mistake of equating access with care. They are not one and the same.
It isn’t that the very sick and the elderly are simply vulnerable due to illnesses. It’s that illness has left them shut off from the rest of the world. They often live in isolation, with few friends or relatives to come to their aid.
We know that the sickest are the ones that can drive up costs quickly when preventive routines are not in place, and, if these folks don’t get the care they need, the costs will be enormous.
In-person visits can provide tremendous long-term savings. They allow a doctor to treat the most troubled patients holistically, checking for underlying issues like depression, addiction, family strife and abuse. The chance to address contributing psychosocial matters goes a long way in improving outcomes for the central illness at hand.
Take the simple price of social isolation. While the rest of us have begun to discover the strains of restricted life under COVID-19—even for just weeks or a month—many of these patients have been living under lockdown-like conditions for years.
AARP examined the health of isolated people 65 and older. It found them sicker, enduring longer stays and requiring more expensive treatments when admitted to a hospital. They also spend more time in nursing facilities for aftercare. The additional cost to Medicare annually: $6.7 billion.
A study published by the National Academies of Science was even more alarming, noting that patients suffering from isolation run a 50% increased risk of developing dementia, a 29% rise in heart disease and a 59% hike in functional decline.
And these are just the costs for the everyday elder population. Imagine how high they soar when one adds in mental illness, severe disability, drug addiction or a cast of afflictions that already leave them physically worn.
For these people, in-person visits aren’t simply a better way to practice medicine. They’re a lifeline to the outer world, a chance to interact and feel cared for, one that can’t be replicated by video. Though some might dismiss this as a feel-good argument, the improvement in outcomes—and ultimate costs—is quantifiable.
Take dialysis treatment, which can hardly be done by video. The Medical Transportation Access Coalition looked at the cost of missed appointments due to lack of transit, which naturally led to worsening health and more expensive treatment down the road. It found that by merely providing adequate transport so patients can keep their appointments, Medicaid’s return on investment for treating kidney disease and diabetic wounds was $42 million for every 10,000 patients—each month.
A previous study in the Journal of Health Economics and Outcomes Research backs this finding, estimating that greater use of nonemergency transit alone might save as much as $1 billion per year.
It would be wise to keep all this in mind as we rush into telemedicine, robots and other tech. If the ultimate goal is better health at a lower cost, it can’t fully replace the human contact of the doctor-patient relationship. The numbers bear it out.
Dan Greenleaf is the president and CEO of LogistiCare.