The following is a guest article by Dr. Tom Hale, Chief Medical Officer, VirtuSense Technologies.
There is little controversy that the cost of healthcare remains on an unsustainable trajectory. Presently there are two alternatives to this fee for service (FFS) driven economic Armageddon—significant price regulation or a shift in payment economics to value based care (VBC) driven by outcomes and quality metrics.
From my experience at Mercy Virtual, the world’s first virtual care center, there are two attributes that drive the success in value-based economics: increased access to care and decreased variation in care delivery. If strategies are built around these fundamentals it will create higher profitability, lower the cost of care, and improve outcomes.
One of the most intriguing innovations that can enhance this value strategy is the ability to collect increased data from patients 24/7/365 and then utilize artificial intelligence (AI) and machine learning (ML) to convert that data into useful and actionable knowledge for providers, caregivers, and patients. Instead of limiting meaningful clinical information to the interaction with the formalized healthcare systems (encounters that comprise less than 10% of the available data for even the sickest of patients), use of available biosensors, patient engagement platforms, and AI-supported predictive analytics can create a unique model of care delivery that provides earlier interventions, thus lowering costs.
If providers were paid to prevent events from occurring (value payment economics) instead of being paid to react to the same event which has already occurred (Fee for Service economics) the dynamics of clinical care delivery change from huge investments into hospital utilization conglomerates to investments into patient-centric innovations that utilize data available 24/7/365. This creates access on demand and asynchronous and individualized care delivery so that patients stay out of hospitals and are able to live in place.
Fall prevention is a perfect example. Today it is a $52 billion cost to Medicare, and yet, despite attempts at creating solutions through penalties and regulations, the problem continues to escalate along with the danger and increased injury to patients. There are innovative solutions utilizing AI and internal Lidar sensor technology that can evaluate fall risk in ambulatory patients and predict bed and chair exists in hospitalized patients 30-60 seconds before the exit occurs. The savings would be in the multiple billions of dollars—an incentive that would be huge in a value payment economic model.
There’s also technology that utilizes Remote Patient Monitoring (RPM) through wearable sensors and AI that collects patient vitals collection in the hospital, and it can be worn home and monitored remotely until the patient is satisfactorily back to good health. The result is earlier discharge, decreased hospital-adverse events, decreased readmissions, and a much better patient outcome. The decreased cost is a positive for value economics, but in a FFS structure designed to keep patients in the hospital, it’s the opposite.
Healthcare is poised for disruptive innovation through technologies like AI and ML. It is time for innovative economics such as Value Based Care to become the standard. The result will be liberating.
About Dr. Tom Hale
As the Chief Medical Officer at VirtuSense Technologies Dr. Tom Hale is building value-based services for ACOs, MAs, and other at-risk models. He previously pioneered the development of telemedicine and virtual care at Mercy Health. Under his leadership, Mercy telehealth services launched the world’s first virtual care center, Mercy Virtual. Prior to that, Tom led a 350 member multi-specialty organization as the President of Mercy Medical Group.
