The Patient in the Era of Consumerism
by Barry Solomon, Co-founder TeleMedCo
If we go back to the time when television came over the air, all seven channels of it, and the fast-food banner was carried by White Castle, and healthcare was home delivered, doctors with MD plates would drive up to your home and conduct their examination right there.
As the business models changed, the patient had to become mobile and go to see the doctor at an office. And as this model refined, the office became a full-on practice with multiple examination rooms and a much more impersonal experience. You would arrive on time for your appointment but often have to wait an hour or more because the practice would regularly overbook to ensure sufficient cash flow. You would wait alongside people who had various conditions and ailments, hoping that you wouldn’t catch anything from them. Then you were ushered into a small examination room, usually one of five or more, and the doctor would be running from one to the next. You would have limited focused time with your provider because he or she was busy maximizing the business model.
Then this situation became magnified by the Covid-19 pandemic. The patient/consumer began to evaluate the “healthcare experience” much in the same way as any other shopping experience. Convenience and safety became important variables to be considered. A couple of clicks on Amazon, and you could have just about anything you want delivered to your home. Patients began to look for something similar in healthcare.
So, with the 21st Century technological revolution, along came telemedicine. In its most rudimentary form, it was a simple phone call, a conversation between patient and doctor that could result in the doctor sending a script to the patient’s pharmacy. After the turn of the century and with the technological revolution, it turned into a video consult over a computer or smartphone. The patient and the doctor could see one another, and in ten or twelve minutes of highly focused time, the doctor could render a diagnosis, issue a script, or, if necessary, set up a clinical visit with the patient’s primary care doctor, at an urgent care center, or a hospital ER.
This became more satisfying to the patient in that they experienced it entirely from their home or office. For the duration of the consult, they had the undivided attention of their doctor. There was no wasted time traveling back and forth and waiting in the doctor’s office. And a script could simply be emailed to the patient’s pharmacy or to a mail order pharmacy for delivery the next day.
Slowly but surely, telemedicine became implemented into the continuum of healthcare. Then came the pandemic and the entire process shifted into high gear. The use of telemedicine increased by a factor of sixty times. And as medical devices became available to not only record and track patients’ vitals remotely but to cellularly communicate them to servers manned by teams of nurses, the practice of remote patient monitoring, chronic care management, and transitional care management grew. Chronic care assessment and management became 75% of the 4.3 trillion dollars a year spent on US healthcare.
Medicare was the first to truly embrace this approach as a way of being proactively involved in keeping people healthy instead of just being reactively involved in caring for them when they fell ill. It is a very cost-effective wellness approach. For example, hundreds of dollars can be spent monitoring someone who suffers from hypertension by using a simple blood pressure cuff. The data goes to a nursing team, and if there is an episode, it can be addressed immediately. Doctors can log on at any time to see the progress of their patients. The care team might recommend a new script, a change in diet or exercise, or any other number of other items in a long-term wellness plan for the patient.
This is not only good wellness practice; it is a good business practice too. Better to spend a few hundred dollars on health monitoring and maintenance than to have a catastrophic event like a stroke devastate the patient and require hundreds of thousands of dollars for treatment and rehabilitation to be paid for by the carrier.
As the science advances, more and more devices will become available to monitor and treat human conditions. And with the use of sophisticated AI computers, these processes can move into complete real-time. Medicare paved the way by recognizing the value of this technology. It is only a matter of time before the commercial carriers jump on board. And they will come because it not only improves wellness, it makes excellent financial sense in their business models.
In a country like Nepal, where ensuring affordable and accessible community health care is a significant challenge; telemedicine can be a game-changer. As countries worldwide are embracing this model of health care, Nepal is behind but catching up.
Afghanistan, a country located in central Asia with a population of over 38 million and a life expectancy of 61-64 years in men and women respectively, has been facing decades of war, social problems, and intense poverty for more than a century. Since the 1970s, social conflict and civil war have led a large number of the population to suffer from mental health problems, mostly in youths between the ages of 18-25.
As the adoption of telemedicine continues to grow dramatically, even as the healthcare and health insurance industries prepare for months of COVID-19 treatment and vaccination programs, the crossroads of the Internet of Medical Things (IoMT for patient monitoring and chronic care management) and the use of Artificial Intelligence (AI) are becoming more promising than ever.