With the 2020 election season heating up, politicians on every side of the aisle are staking out a position on "Medicare for All" – attempting to answer the question "who should pay for the skyrocketing costs of healthcare?" while entirely ignoring the more fundamental question "why does U.S. healthcare cost so much in the first place?" Yet, the stark reality is that the average American now spends more on hospital bills than they pay in taxes. Given that, it is a truism that unless we break the Cartel-like stranglehold that hospitals have on the U.S. healthcare system, there is no payer – including the U.S. government – that will be able to keep up with rising healthcare costs coupled with diminishing marginal returns.
Heroic measures to save a few patients from exotic disease make headlines, but they belie the fact that an overwhelming majority of patients don't belong in the hospital at all. They belong in the caring, capable hands of an unhurried primary care doctor – one that is unburdened by the crushing yoke of bureaucracy and empowered by the tantalizing promise of context and data. This type of easily available, accessible and timely primary care is a promising new reality enabled by relationship-based doctor house calls. As counter-intuitive as it may seem at a time of increasingly acute doctor shortages, the deceptively easy fix to the U.S. healthcare system is found in better primary care, delivered by happy doctors, to the privacy of your own home. Fewer patients per day, more time with each patient, and a tectonic shift to focus on value over volume are the principles driving the increasing popularity and interest in a return to old-fashioned doctor house calls.
Delivering doctor house calls at in-network insurance rates require re-inventing the entire business process of medicine. Leading house call providers have delivered end-to-end automation that reduces the bureaucracy and operating expenses of traditional primary care by over 65 percent. Cutting operating expenses by 65 percent and bureaucratic waste by 90 percent means the same doctor can see 14 patients instead of 40 patients per day – focusing on quality, comprehensive care for each patient. This model has numerous compounding advantages that all work in unison to improve health outcomes while dramatically lowering costs. In fact, every dollar invested in intensive primary care saves $13 in overall healthcare costs..
Atypical for healthcare, it turns out the very innovations that lower OpEx for providers unlock ease of access, convenience, and value for patients as well. Enabling web or app-based booking, for example, means patients don't wait on hold and doctors don't pay a "scheduling person" in their office. Offering patients upfront eligibility verification and price transparency through machine learning eliminates billers and collections agents while delighting patients who actually know how much their healthcare is going to cost up front, for the first time ever. Getting doctors to the patient's door in a timely and convenient manner has the immediate and obvious impact of dramatically reducing unnecessary ER trips by 71 percent or more.
The staggering overuse of the ER as "urgent care" has given rise to everything from telemedicine to retail clinics and an ever-growing number of urgent care facilities. Such services suffer from low uptake rates, increasingly transactional care, and dangerous levels of underdiagnosis and over-prescription of antibiotics and other common medications. Furthermore, these services exacerbate disconnected transactional care that entirely misses the opportunity to use every provider-patient interaction to identify lurking and emerging issues that are treated best when treated early.
The transformative value of house calls is that doctors have nearly 400 percent more time with each patient in the patient's home environment – where the doctor has unique and unprecedented access to the social determinants of health (SDoH) that drive up to 80 percent of health outcomes. Enabling doctors to see actual pill bottles, food, allergens, fall risks, and lifestyle factors firsthand is the catalyst for personal, precise medicine customized to the needs of each patient in the context of their real life. Seeing the SDoH also enables doctors to meet unmet needs that mitigate risks, increase compliance, remedy food insecurities, and much more. In short, a house call doctor can treat the whole patient, not just the hurt finger.
The doctor-patient relationship formed during an unhurried house call is the foundation of coordinated and data-driven care that is increasingly proactive and predictive – so that patients spend more time being well, and less time getting well. Straightforward extensions to the care delivery platform mentioned above provide one-touch, patient-controlled access to prior health records. Ubiquitous mobile technology enables real-time monitoring of key vitals on outpatient chronic disease patients for the first time. Prior health data enables the house call doctor to proactively close care gaps by identifying potentially serious health issues as early as possible. Real-time monitoring empowers doctors to intervene before changing vitals advance to acute episodes. Collectively, data-driven house calls for chronic disease, Medicare and post-acute patients are shown to reduce unnecessary medications 39 percent, reduce wasted tests 55 percent, cut hospital readmissions 28 percent and reduce the length of stay by 26 percent.
Combining SDoH with prior health records, an extensive, unhurried examination and real-time vital signs unlocks the actual potential of telemedicine as a convenient and immediate extension of your personal doctor-patient relationship, rather than a dehumanizing interaction with dispassionate provider lacking the context or data to deliver effective healthcare. Furthermore, machine learning can process the comprehensive data mentioned above to deliver invaluable decision support to providers and predictive care to patients.
Neither cramming more people into germ-filled waiting rooms, admitting more patients into infection-rich hospitals nor dehumanizing healthcare with gimmicky triage has had a meaningful positive impact on U.S. healthcare costs or outcomes. While spending more and more, we’re seeing U.S. life expectancy decline for the first time ever. To paraphrase the late Biggie Smalls… "more patients, more problems." It’s time for something new, and everything old is new again. So too are doctor house calls, which may just have the perfect triumvirate of pleasing doctors, payers, and patients requisite to save the U.S. healthcare system from itself.