Pros and cons of Kaiser’s ambitious mHealth efforts
Last year, Kaiser Permanente conducted 10.5 million patient-doctor visits via e-mail, telephone or video tools. A factor in the popularity of these virtual visits probably rests in the fact that patients do not need to miss time from work or school.
- A secure e-mail service allows users to attach images (such as a digital picture of a rash, for instance) in a message to a Kaiser dermatologist. In 80 percent of those cases, the dermatologist was able to offer a definitive diagnosis and prescribe without an office visit.
- A mobile service targeted at Kaiser patients scheduled for surgery includes self-care information, answers to common questions about the surgery and video coaching from doctors to patients who are experiencing difficulties before or after surgery. In all, the service resulted in one fewer in-person visit per patient than occurred among those who did not take advantage of these systems.
Robert Pearl, MD, executive director of the Kaiser Permanente Medical Group, points in a report to the benefits of integrating mobile technology into all levels of a healthcare delivery system.
In that report, “Kaiser Permanente Northern California: Current Experiences with Internet, Mobile and Video Technologies, (The Kaiser Report),” Pearl doesn’t shy away from the challenges yet to be overcome in Kaiser’s delivery system. And all the claims are backed with stats from independent studies.
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The suite of Internet, mobile and video tools designed by Kaiser is delivered to 3.4 million members, 8,000 doctors and 21 hospitals in northern California. Launched in 2008, it grew from 4.1 million virtual visits to the 10.5 million visits in 2013.
A good deal of its success rests in the fact that Kaiser members, providers and payers exist in a bubble containing Kaiser doctors and nurses, hospitals, skilled nursing facilities, rehab centers and Kaiser pharmacies, with Kaiser as the payer and all the patients are Kaiser members.
A bubble it may be, but it’s a large one. The KP.org website garnered more than 34 million visits in the third quarter of 2013, one-third of which were to the mobile version.
Since 2003 Kaiser has offered 15-minute phone visits to patients in lieu of an office visit. The use of mobile phones has increased the number of patient phone visits from 640,000 during the dark, pre-mobile days to 2.3 million in 2013.
Kaiser also deployed teleconferencing capabilities for pregnant women deemed at-risk for substance abuse. Using an encrypted, Web-based video interface, the Kaiser Early Start program makes a substance abuse counselor available to the women. Following an initial interview, the counselors develop a care plan and schedule follow-up visits. Since the program began, the rate of fatal demise went from 7.1 percent in the control group to 0.5 percent among those women who participated in the teleconferencing program.
Despite these and numerous other successes, Pearl admits that “assessing the overall impact of new technologies on cost is difficult,” as is determining quality of care and patient satisfaction. That’s because Kaiser has introduced other non-mobile quality of care innovations and “cost savings for the new technologies have been slow to materialize.”
For most healthcare providers and payers, there are still a number of important challenges slowing down the adoption of mobile, Internet and video technologies.
They include the costs around implementing a secure and encrypted transmission of patient data along with secure passwords. When first deployed, Kaiser required patients signing up for the various mobile services to come into their Kaiser center to complete an authentication process. In addition, the capital investment and the inability to assess the ROI for those investments as well as for staff training has been a hindrance to any definitive measurement of its financial success.
What’s more, the Kaiser Report notes that it took six years of “concentrated effort” to increase online registration from 20 percent to its current 73 percent level. Also, while virtual visits are initially less expensive than office visits, they still require physician time and, often, a follow-up office visit.
In some ways the increasing number of virtual visits has proven to be a double-edged sword.
Perhaps they are improving patient care, but they are also increasing the time needed for what is commonly called “desktop medicine” – reviewing lab and test results, outreach to patients, responding to patient e-mails and phone calls and renewing prescriptions. As a result, the Kaiser Report flatly states “physicians’ schedules had to be revised to include time to respond.”
The still very current “pay-per-visit” business model for healthcare is yet another barrier to adoption. While not an issue for Kaiser, for other providers insurers reimburse for virtual visits in only 21 states where it is required, according to the Kaiser Report.