Concierge Telemedicine: Case studies in challenging delivery model
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1) The document discusses the potential for a subscription or concierge medicine model for wound care, obesity, and infectious disease treatment using telemedicine. 2) Two case studies are presented of patients who enrolled in a cash-only telemedicine program for obesity treatment and were successful in losing weight. 3) The author argues that a concierge model could remove barriers to better wound care outcomes by eliminating insurance constraints and focusing on prevention rather than sick care. 4) Future opportunities discussed include developing a concierge wound care model using telemedicine and apps to coordinate chronic disease management.
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Concierge Telemedicine: Case studies in challenging delivery model
- 1. Concierge Telemedicine: Case studies in Challenging delivery model Ravi K. Kamepalli, MD,FIDSA,CWSP. Regional infectious diseases and infusion center, Inc. Clinical Assistant Professor The University of Toledo college of Medicine Lima, Ohio. nobadbugs@gmail.com www.nobadbugs.com www.epiphanee.com @woundphysician #removingbarrierstohealing
- 2. Disclosure Part owner www.epiphanee.com & one of Founding Investors in Fruitstreet.com I don’t claim to be a concierge medicine physician, but we run a cash only obesity medicine practice using Telemedicine… call it subscription medicine Passion for all things Infection,Woundcare,obesity and technology related to #removingbarrierstohealing
- 3. Objectives Discuss if Subscription / concierge medicine is possible option for wound care, Obesity and Infectious diseases Different version of cash only / on demand method in Advanced wound care delivery and obesity medicine Out of the box thinking in Obesity and Wound care delivery and use of Telemedicine as Instrument of change.
- 4. Definition Concierge medicine is delivery of healthcare services to patients without the constraints of insurance companies. It's a direct relationship between the patient and doctor where the patient is billed monthly or annually for unlimited care services. Concierge medicine or “membership medicine” is a term used to describe a medical practice model in which patients pay an annual fee or retainer in exchange for enhanced medical services. This fee may or may not be in addition to other charges. In concierge medicine practices, doctors limit their patient panel size to ensure increased time and availability for each patient. The first concierge medicine practices were established in 1996 and located in Seattle & Bellevue, WA and Oregon.
- 5. Reasons for Concierge Medicine Dwindling reimbursements Mounting administrative tasks Increased patient loads Declining insurance reimbursements Increasing overhead costs Feeling rushed or making a mistake Remaining independent Burnout / Stress Long hours, overworked Time consuming EMRs Large patient panel sizes with not enough time for each patient Changing government regulations Decreasing family time / a better work-life balance.
- 6. My experience with subscription/ concierge service Platelet Rich Plasma -74 cases Obesity Medicine Telemedicine –ID /woundcare
- 7. Is concierge service even possible in wound care? No Payment base Mostly vulnerable patients get wounds Insurance model doesn't help… Disconnected model of care delivery. Innovative solutions can be provided No uncertainty / No surprise cost Patient and provider make the choices that would assure better outcomes No 3rd party payment constraints Prevention – real value Wellcare rather then sickcare JUST DO THE RIGHT THING NO YES
- 8. WOUND CARE SUBSCRIPTION MODEL FOR PRP USE
- 9. Obesity -Case Study 1 63 year old gentleman suffering with obesity had right knee replacement done in Nov 2011 to Nov 2013 had total of 5 right knee surgeries. He enrolled in weight loss program on Feb 2017 with 392.8 pounds & BMI 54.8 and on 9/14/18 his weight is 297.1 & BMI 41.5 with weight loss initially of 107 pounds by Feb 2018 but has gained muscle and now is at 95.7 pound weight loss.
- 10. Case Study 1: Patient Perspective
- 12. Case Study 2 Retired Pharmacist who is 69 years old who presented Hospital on 06/05/18 with fever 102 and MSSA bacteremia treated for endocarditis 6 weeks from 6/6/18 - to 7/18/18 H/o CABG in 2004 and with AVR in Mar 2014 and in 2016 had Endocarditis. April 2017 in Cleveland Clinic had AVR plus root and a 3-vessel CABG Weight of 264 on 06/26/18 with BMI 40.1 and on 7/13/18 he enrolled in weight loss program with his successful weight loss of 28 pounds on 9/27/18 with weight of 236.2 and BMI 35.9.
- 15. APP BASED WOUNDCARE WITH TELEMEDICINE INTEGRATION
- 16. Game-changing ways telemedicine will transform healthcare Establishing a roadmap to interoperability and care continuity Driving a shift from out-of-market to local providers Reducing the costs of high-quality specialty care, while improving access and outcomes
- 17. Future What we do now is Pay for service Is there a Concierge wound care model that can be developed- if so what and how ? National vs International If time and travel are saved would individual patient /consumer pay ? How can we use technology to achieve it - Telemedicine + Blockchain
- 18. Concierge Telemedicine – Care anywhere and any time The IDEAL Model – Personalized, Preventive ,Participatory, Predictive, Payment optimized Medical Model that is Purpose driven. Work with Providers and payers to align interests with Patients Taking Capitated risk Providers own financial risk of caring for the patient Increased focus on preventive medicine Avoid costly healthcare events Care Coordination capability for managing chronic conditions Delivering care Protocols Identifying Problems and delivering care alerts Proactive care interventions High touch Health coaching between appointments
- 19. Whole person Approach There is scope for On Demand targeted subscription services Practical approach to Market demands – Nutritional products etc. Combine technology with solution delivery in Remove barriers to healing. App based Tele-Woundcare and Wellness Readmission prevention Correct approach to Product use – industry solution TEAM Approach with INNOVATION + MASSIVE ACTION = SUCCESS
- 20. Final Message U.S. health expenditures are $3.2 trillion, almost $10K per person, and account for 17.8% of GDP. 75% of this is preventable chronic disease and mostly diet related. LET’S JUST DO THE RIGHT THING – MONEY WILL FIND US.
Editor's Notes
- Establishing a roadmap to interoperability and care continuity Interoperability of electronic health records (EHR) has long been a topic of discussion in healthcare, and is necessary to better enable workflow efficiency and improve patient care continuity. However, solutions for interoperability have thus far eluded healthcare systems in large part due to the complexity of integrating technology systems to allow for seamless data transfer to healthcare providers. Today, advancements in telehealth networks allow physicians to connect from a center of excellence to community hospitals and outpatient care locations using secure, cloud-based networks across distances near and far. In almost every case these connections occur outside of the silos of EHR and other individual clinical systems at care facilities, creating an interoperable environment. The right telehealth network can enable face to face interaction while also capturing and distributing data to all relevant care teams, providing the backbone for an integrated patient history served across the continuum of care – in any facility and from any provider involved in the delivery of care. Driving a shift from out-of-market to local providers Telehealth is like a disruptive power grid which can instantly redistribute physician time and expertise across the landscape to any location where that service is needed. Today, physician adoption is slow causing many provider organizations to contract outside groups to staff telemedicine services. Just as we saw when digital imaging enabled a new virtual teleradiology service in the late 1990’s, early staffing was performed largely by physicians from outside the U.S. However, once local radiologist realized that they were being outsourced, virtual service contracts shifted back in large part to local providers. A skilled local provider will always win because of their established relationships and convenience to the patient. Reducing the costs of high-quality specialty care, while improving access and outcomes It’s no secret that cost is the most problematic issue facing healthcare on a global scale today. In the U.S., we have a rapidly aging population, rising prevalence of non-communicable diseases and a general decline in health behaviors. This is combined with rising physician shortages and the need for more specialized care than ever before. With greater demand and less access, costs are rising. However, telemedicine can fundamentally bend the cost curve by alleviating workload and stress on shared health professional staff, increasing access to high-quality care to rural and community-based facilities and shortening hospital stays and reducing readmissions through in-home monitoring. As more healthcare systems invest in telemedicine, healthcare costs for patients and providers alike will be reduced and quality of care should improve. As telehealth technology advances, healthcare will be transformed. Hospitals, enabled by telemedicine, will increasingly serve as command centers for care. At every access point across the patient care continuum, this new care delivery method incorporating big data, machine learning and artificial intelligence will improve access, standardize care and reduce costs for patients and providers, alike. Through continued advancements, the telemedicine industry will grow exponentially, revolutionizing healthcare as we know it today.