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At The Helm: Creating A System Where Health Outcomes Are Paramount

At The Helm: Creating A System Where Health Outcomes Are Paramount

Healthcare in the United States is no longer focused primarily on care provided at the point-of-service. It now requires a broader perspective such as a focus on health promotion, population health, and individualized approaches. The main goal is to achieve the Triple Aim: Patient Satisfaction, Better Health Outcomes, and Reduced Costs.

The Triple Aim is of course an oversimplified objective – a goal. To get there one must come to the realization that our healthcare system has to be first radically transformed. In her new book, An American Sickness: How Healthcare Became Big Business and How You Can Take it Back, Elizabeth Rosenthal, MD., examines the current state of our health care system and concludes that it is in a state of disrepair.

Due to third party involvement and the takeover of finances (insurance/health plans), we have failed miserably in controlling the cost of administered healthcare services across the country. We spent $10,000 per person in America in 2016, which is almost twice the average cost in most developed countries. Today, we are at a staggering $3 trillion according to data from the federal government and the Robert Wood Johnson Foundation.

Although they are at the core of the system and the reason for the existence of the medical universe, doctors and patients are not being served well. Often times, they are left out of the decision making process and have to beg their way to either provide a service or receive the clinical services they want. Because of concepts like “out of network”, patients pay more and/or cannot access the doctors of their choosing. Meanwhile, doctors have to deal with a myriad of obstacles unrelated to the doctor/patient relationship.

Furthermore, doctors spend an inordinate amount of time filling questionnaires or as scribes typing endlessly on keyboards. At great expense, they hire personnel that sit all day calling insurers or health plans and asking for pre-authorizations for diagnostic procedures, labs, or prescription medications.

One must recognize that the American healthcare system is one of the best ones in the world. We have prestigious training institutions, some of the best doctors and hospitals in the world, as well as some of the most advanced and ingenious technology. However, due to administrative costs and third party meddling, we have miserably failed in controlling the costs on healthcare services across the country.  In 2018 we have approximately 55 million Medicare beneficiaries, and by 2030 we will have close to 80 million. If nothing is done about this, our healthcare system will only get worse.

Dr. Robert Pearl, CEO of Kaiser Permanente’s medial group in California and an authority on our health care system, says that Americans are dying unnecessarily from failure of prevention or complications of chronic illness. “We value intervention over prevention: we value the newest advance over the things that are tried and true. To achieve improved outcomes we would need not only better coordinated care but also the use of technology.” Dr. Pearl is an advocate of virtual visits, telemedicine, and other technologies that improve communication between doctors and their patients.

Dr. Pearl writes in his book, “Mistreated, Why We Think We’re Getting Good Healthcare – And Why We’re Usually Wrong”, that about 50% of medical care costs go to 5% of the people. He explains that these individuals have multiple chronic conditions, have severe disease, and that our healthcare system missed the opportunity 20 or 30 years before to actually prevent them from developing those kind of diseases.

Going from an industry in the business of providing care to one that’s geared entirely toward maximizing profits is particularly troublesome for our senior Medicare/Medicaid beneficiaries. Not only do they have to deal with an excessively expensive and complicated system but also one that is splintered and scattered. It is no secret: our healthcare system is fragmented, suffering from what George Halvorson, CEO of the Institute for InterGroup Understanding, calls “clinical linkage deficiencies, evidenced by conflicting incentives and lack of coordination, cost lives and fuel the unsustainable spiral of US healthcare expenditures.”

Recognizing the problem of our healthcare industry, the government has introduced in the last few years a series of laws/programs to better serve doctors and patient care.  In keeping with the triple aim, the government is transitioning from volume based to value base care. They instituted such things as MACRA, MIPS, bundle payments, and more. As we all know many doctors are not happy with these ideas. Recognizing this, the government recently passed the (C.H.R.O.N.I.C) Care Act, paving a way for greater access to technology and care while reducing costs. This bipartisan act signals an important shift in the government’s recognition of the value of telehealth services, like Chronic Care Management or Remote Patient Monitoring. As the Act offers easier access and flexibility to choose these services, providers offering Medicare services can now take full advantage of the new law’s ability to allow for timelier, convenient, and continuous care. By offering continuous RPM and CCM, a provider is better able to monitor a person’s health and trends or changes in the management of his or her condition. In addition, these Telehealth services offer more timely care to help patients with more urgent issues as Dr. Pearl suggests.

As the number of patients with chronic conditions continues to rise, it’s crucial that clinicians be proactive in providing more effective and appropriate care for each individual, in order to improve outcomes and ultimately reduce costs.

As a result, Digital Telehealth Solutions was created in an effort to keep patients healthy and out of the hospitals. We believe that keeping Doctors informed by connecting their patients to our platform, we can help them in achieving better outcomes.

When it comes to judging the currents of the healthcare industry, there is an old journalism expression that serves to be a pretty reliable guide: once is a fluke, twice is coincidence, and three times is a trend. Based on the truism, we at DTS feel confident in writing that technology is here to stay for providers and patients.

By utilizing this technology, and integrating this kind of value in healthcare, Digital Telehealth Solutions can help optimize practice revenues while also providing Chronic Care Management to patients and increasing care coordination.

Chronic Care Management is our specialty and our Health Care Coordinators are trained to do all the necessary work to get a practice started with no initial investment. Digital Telehealth Solutions provides the work involved in motivating patients to persist with the necessary therapies, interventions, and then helping them to achieve an ongoing, reasonable quality of life. The ongoing care is provided month to month and the time is documented within our platform. The process starts with identifying the patients that have two or more chronic conditions that will last at least a year, then inviting the patients to participate. Our Healthcare Coordinators then build a care plan for each patient that includes and assessment of the patients’ medical, functional, and psychosocial needs, consistent with the patients’ choices and values.  This documentation spans from a minimum of 20 minutes to 60 minutes of care coordination in which it is then provided to those Physicians enrolled with our company at the end of the month. Chronic Care Management helps patients systematically monitor their progress and coordinate with experts to identify and solve any problems they may encounter in their plan of care treatment.  As an effort to help Doctors take better care of their patients a series of different CPT codes and G-codes are used by CMS for reimbursement purposes. This Chronic Care Model can be applied to a variety of different chronic conditions, health care settings, target populations and specific DRG’s.

Integration of resources and coordination of care play crucial roles in reaching goals for enhancing community health and reducing the overall cost of care. It is to the interest of health care providers to avail themselves of newer reimbursement models stemming from the Medicare Shared Savings Program, Quality Payment Program, Bundle Payments, and Valued-Base Care.

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