Modern Healthcare: Letter to the Editor

BY NEIL A. SOLOMON, MD

As the Chief Medical Officer of a mobile medical group serving high-risk patients, I fully agree with Dr. Marc Harrison’s recent lessons learned on the transition to value (Healthcare leaders still learning how to offer value-based care, January 11, 2020) – and would add two more.

First, we can’t deliver value if patients can’t access care. For vulnerable patients who are both socially disadvantaged and medically complex, a care model based around brick-and-mortar delivery sites leaves too many patients without a successful and reliable source of care. Many of the patients who most need care cannot or do not reliably attend medical visits—due to physical, behavioral, and social barriers. The costs associated with their detachment from the traditional delivery system are high both in terms of disease burden and dollars. Mobile providers who can reach patients “where they are” and build trust-based longitudinal relationships are needed if we are to improve outcomes and value in this part of the population.

At the same time, in order to elevate outcomes for the full high-risk, high-cost population a mobile care model must be scalable. Traditional house call practices have difficulty reaching enough patients because much of the doctor’s day is wasted in the car and few clinicians are interested in practicing in such a model. The next generation of house call practices must address these challenges using technology and other enablers. Our practice uses a telemedicine platform to link our PCPs into home-based visits.

Interestingly, our telemedicine-enabled program is achieving similar results to those cited by Dr. Harrison--a 50-60% reduction in hospital costs and a 38% reduction in ED costs--in a very high-risk population. Our findings are consistent between Medicare and Medicaid, and urban and rural populations.

As health care leaders create value-based care models it will be important to adapt to the needs of the highest risk patients and to design strategies to scale. The next several years will likely reveal many different strategies across innovative delivery systems.