How will healthcare change in the future? Dr. Stephen Klasko shares his insights on healthcare reform in this informative talk cleverly staged in the year 2020.
Try to imagine how the practice of medicine will be like in 2020 or 2030.
This not an easy exercise considering recent healthcare reform efforts and scientific discoveries make even a six-month view into the crystal ball a little cloudy. To help us get an idea of what the future of healthcare will look like, we consulted Roswell Park Cancer Institute.
Here are 3 changes, they said we may see:
A new way to deliver care
The traditional, one-size-fits-all, office visit model of medicine has reigned for decades. Physicians are locked into a system that requires they see patients in their office every 15 minutes, and alternatives like e-mail consultations have been slow to catch on.
Healthcare has been stuck here because of the payment structure, says David Moen, a physician and medical director of care model innovation at Minneapolis-based Fairview Health Services. Moen’s job is to rethink the traditional model and find ways to make the alternatives work. The current financial structure limits this innovation, he says, and fails to take into account patient engagement and drive efficiencies.
But at Fairview, they are initiating care reform, Moen says, which will in turn inform payment reform. Moen says the future of care includes different delivery models (think phone, Internet, and group visits), a greater focus on patients’ behavior, and a far more team-oriented approach.
“This is probably the most opportune time in decades for physicians to provide leadership to the change taking place,” he says.
Moen’s colleague, Eric Christianson, an emergency department physician at Fairview, has been trying his hand at what some believe will become a new tier for healthcare delivery: online visits.
As part of a pilot program with BlueCross BlueShield of Minnesota, Christianson has started seeing some patients via the Internet, using a Web cam and a telephone. Already, after only about 40 visits, Christianson says he can see how this method would make him more efficient, and give him some flexibility in his schedule.
“It seems to me to be a very common sense, logical step,” he says. “The technology is out there. There are still things that need to be worked on, but as it’s being developed and being refined, it’s clear to me that it could be utilized for betterment of patient and physician experience.”
Not only will the online care model extend healthcare access to people in rural or underserved areas, but it can offer the physician a unique way to control her schedule. Imagine spending half of the day in the office seeing patients, then returning to work — perhaps from the comfort of your home — in the evening after your child’s softball game or dinner with the family. Any down time between patients, such as a last-minute cancellation, can be filled with another appointment.
A patient can go online to find out which physicians are available for an online visit, says Roy Schoenberg, CEO of American Well, which provides the online system.
The physician can review records, communicate, and write a prescription — and actually get paid (albeit less than for an office visit).
Minnesota is one of only a few areas using the online care model, but Schoenberg envisions the system evolving to allow for other disciplines to participate and for physicians to consult with each other.
Christianson also sees the mode taking off. “There’s no question that online care is something that is going to grow,” he says. “This is just another layer we can utilize and help with the efficiencies of the whole system.”
Perhaps the ultimate move toward more efficiency would be seeing more than one patient at a time. Imagine if you could corral a half-dozen of your patients with similar conditions into a single visit, allowing you or your staff to give the information and guidance once. For some physicians, this is already a reality, and many see group visits as a new model for the practice of the future.
Although group visits have been around for several years, the concept is gaining in popularity, and more payers are beginning to reimburse for them.
The concept started around patients with a similar condition, such congestive heart failure, who are in a rehab program, says Erica Drazen, managing director for the emerging practices division of CSC Healthcare Group, a planning and performance improvement consulting firm in Waltham, Mass. In a group visit, there may be a facilitated discussion about diet or exercise, after a nurse or physician has evaluated each patient individually.
“Patients listen to what is going on with every patient, as well as talk amongst themselves,” Drazen says, which provides them with greater insights into their condition and builds support among the group.
“As you hear questions and answers, you learn a lot about yourself,” she says. “Patients love the visit experience.”
Surprisingly, privacy concerns don’t seem to be a barrier to such visits, Drazen says, and of course any exam is done in a separate room.
This can allow the physician to be more efficient, and it also gives her some insight into the condition she might not otherwise get in one-on-one visits.
Group visits tend to be limited to organized systems of care, such as an HMO or large clinic that allows for reimbursement, Drazen says, but “where they are introduced, they spread pretty quickly.”
Rather than being uncomfortable for patients with chronic illnesses, group visits can be empowering, says David Ehrenberger, a family-practice physician at Bloomfield Family Practice, which has conducted group visits and is participating in a patient-centered medical home pilot project.
“That group dynamic is extremely powerful,” he says.