How technology is shifting medical care out of a hospital setting

 

Hospitals, as we know them, are changing. Advances in technology have made inroads into healthcare delivery to varying degrees around the world.

We are familiar with the external pressures driving change to new locations of care delivery: the ageing population, staff shortages, declining government funding, stagnant private medical insurance reimbursement rates and increasing incidence of chronic diseases.  This is pushing private providers to examine how and where they deliver patient care and how they guide patients to the most appropriate and cost-effective settings.

UK’s slow shift from hospital settings

In the UK, the traditional focus has been on having all inpatient and outpatient services set in and around the immediate hospital setting. This is beginning to change but will need to accelerate to create a future coordinated care network designed to treat patients in the most appropriate setting, at the right time to improve access, quality and efficiency. Private sector providers in the UK are well positioned to lead this change and, in fact, will need to do this to prosper in the future UK health environments.

Inpatient care is shifting from the largest to the smallest care focus, while virtual care (and ultimately wellness) will become a predominant means by which the UK will move towards population health as part of an overall national strategy to alleviate pressure on the NHS. For private hospitals, the focus should be to increase patient and consultant loyalty, to deliver personalised and convenient care and to better integrate into an efficient patient care continuum that spans their service or category lines and those in the NHS.

Less inpatient beds in the long term

The long-term trend in many markets will be a reduction in the need for inpatient beds. In the UK private sector, excepting central London, the focus has traditionally been to deliver less complex episodic care treatments or contracted services to free capacity within the NHS. While we expect this focus to continue as the NHS faces continual challenges, we also see the need to better coordinate inpatient care across multiple hospital sites to improve the consistency, efficiency and quality of healthcare delivery.

In the US, we see hospital systems increasingly focusing on the rationalisation of care delivery across their multiple hospital sites to reduce duplication, promote specialisation and to obtain minimum volume thresholds to ensure patient safety and care quality.

There is widespread hope that moving patient care out of a hospital improves overall population health and quality of patient care, while reducing costs. For example, beginning in 2006 the Gesundes Kinzigtal care model in Germany conducted an analysis of current and future utilization, in addition to enhancing primary care management and initiating public health wellness programmes. In 2014, they realised €5.5m in savings for the insured population compared to risk adjusted normal costs of care in Germany.

The same is true in the US with the rise accountable care organisations and value-based reimbursement initiatives driven primarily by the US Federal Government and private insurance companies.

At the forefront of a ‘no-bed’ hospital system is St Louis-based Mercy Virtual Care Centre. Doctors and nurses see their patients on computer monitors that also display patient data and list problems that a computer programme thinks clinicians should monitor, going back to 2006. They also monitor low risk patients 24/7 in their own homes and rely on digital technology to keep tabs on patients remotely, in addition to running programmes to keep patients from going to the hospital.

Shifts to the community & virtual outpatient encounters

With an increased focus on population health management and care coordination, the entire spectrum of outpatient care is expanding.

If we think of a patient as a consumer, we begin to think about developing more hospitality-like elements in health settings, where the experience is providing new consumer-oriented access points and greater choice-based options and on-demand amenities.

For example, to adapt to the continued pressure from changing reimbursement models and the expanding role of technology, the Ochsner Health System, Louisiana’s (USA) largest non-profit academic health system with 30 hospitals, recently announced that 80% of its capital expenditure in 2018 will go to outpatient clinics and there are no near plans to build new hospitals.

Similarly, we have seen new private sector hospital projects cancelled in the UK.

In 2016 Kaiser Permanente, based in California, had more than 100 million annual outpatient encounters with physicians, 52% of which were virtual. This number continues to grow.

Earlier in 2018, HKS Architects partnered with the Centre for Advanced Design Research and Evaluation to produce ‘Clinic 20XX: Designing for an Ever-Changing Present’, which looked at the key drivers of change in healthcare, and tries to develop a framework for a change-ready clinic. Shannon Kraus, principal and board of directors at HKS Architects says: ‘We are trying to figure out if the hospital of the future is really a hospital as we know it. That is a bit of a heresy because as architects, we believe that our healthcare designers and medical planners do play a very important role in community health. But our role now is more than just designing buildings. We see the role as helping owners and operators understand where they can influence the community, where they can change things in the community that have a ripple effect and impact the entire healthcare delivery.’

Rise of virtual clinics & remote monitoring

Both patient preferences and hospital economics are creating a wave of developments in virtual care models. Technology and the focus on convenience and wellness are accelerating demands for change and bring new types of competition and entrants into the market. Take for example, the recent announcement by Amazon.com, Berkshire Hathaway, and JP Morgan Chase & Co to form a new company to provide less expensive healthcare for their employees.

In Canada, Maple is the ‘Uber of Health Care.’ It is a 24/7 virtual GP consult service launched by a group of A&E doctors to assist patients with non-urgent needs who might go to A&E because they could not get a GP appointment. This group sought to build a platform which provided easy access to expert information, virtual consults and prescription delivery, thereby privatising what the government didn’t cover.

In the UK, babylon offers free access to a real time artificial intelligence [AI] nurse via its application and will soon launch an AI GP doctor which can provide faster and more sophisticated medical diagnosis. Globally, it has over a million users and its user base take-up is expected to have high growth in rural areas as well as urban areas such as London where it was launched. In reality its service has no boundaries and provides people a choice to interact easily via a range of technology platforms.

In Australia, GP2U, is a dedicated online medical practice which is a complete ‘virtual clinic’ operating from 7am to 7pm every day. Like Maple and babylon, GP visits are paid out of pocket and prescriptions can be mailed to the patient or filled by a participating pharmacy. In addition, patients, if deemed appropriate, can receive referrals to specialists. Alternatively, they can sit with a GP and use the application to consult a specialist.

Mobile health, as the practice of public health supported by mobile and wireless devices, also plays an important role. This can take many forms, including patient portals which allow patients to interact with their care team anytime and provide secure access to their medical information or call centres as a vehicle for follow-up care.

Remote monitoring of patients, made possible through wearable technology and the Cloud, gives care teams real time updates on their patients and can be stored electronically. This data, in turn, can be aggregated to determine preventative options for population groups and incorporated into AI developments.

Applications already in use are wearable technology to track health and fitness and smartphone apps to record and share biometrics including heart rate and blood pressure.

Conclusion

With the continued changing paradigm for acute and preventative care, treatment providers need to thoughtfully develop and coordinate their inpatient, outpatient and virtual care delivery system for the benefit of the patient and overall quality of care.

Read further IMTJ analysis of the development of telemedicine and tele-surgery, and its potential impact on medical tourism flow.

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