Viewpoint: In-person healthcare should be a last resort

By harnessing technological advances in telemedicine and digital health, clinicians can create a more efficient healthcare delivery system in which in-person physician visits are viewed as a last priority, according to an op-ed published Thursday in The New England Journal of Medicine.

While face-to-face interactions will always play an important role in healthcare, a healthcare system that de-emphasizes in-person visits and focuses on high-quality nonvisit care could address patients' needs in a much simpler, quicker and more efficient manner, according to authors Thomas Lee, MD, CMO of Press Ganey, and Sean Duffy, CEO of the digital health company Omada Health.

"Viewing in-person physician visits as a last resort sounds radical, but it just represents a deepened commitment to patient-centered care," the authors wrote. "[W]e believe such a model will result in a level of trust that furthers collaborative, honest, supportive care."

The authors noted some health systems are already moving toward this model by enacting telemedicine and digital health programs. Renton, Wash.-based Providence St. Joseph Health uses an Express Care system, which allows patients to engage in virtual visits with clinicians using their phone, tablet or computer. At San Diego-based Kaiser Permanente, 52 percent of the care consortium's more than 100 million annual patient encounters are "virtual visits."

The authors also acknowledged payment models represent a major barrier to de-emphasizing in-person visits and said healthcare providers must be dominant players in their market to fully adopt this model. "[E]very provider's business success depends on market share," they wrote. "The best way to win market share is to design and deliver better care, then modify the payment system to support it."

An "in-person visit as a last resort" model would not only improve healthcare services and solidify the patient-provider relationship, but also give health systems a competitive advantage, since the required technology investments would create more operational efficiencies and patient loyalty, according to the authors.

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