Healthcare Model Advantages

Telehealth only leads to over-utilization of care. It does not actually replace in-person visits, it only costs us more money. 🤨 Sound right? That concern has shaped the policy conversation for years. It began due to a widely cited study demonstrating DTC telehealth increased total utilization. It became a benchmark for both caution and debate, especially in Medicare policy debates (can read here: https://lnkd.in/erZ4qYXV) Btw, that study was from 2017. Yet we still had that story ingrained and was hard to shake despite some research showing different results. Well in a new study, we have new evidence to may get rid of this belief once and for all. This study analyzed 100% of Medicare Fee-For-Service (FFS) claims from 2019 to 2024 to assess how telehealth has affected outpatient visit volume. It focused on evaluation and management (E&M) visits across three specialties with different levels of telehealth use: 🔹 Low: Orthopedic surgery 🔹 🔹 Medium: Primary care 🔹 🔹 🔹 High: Behavioral health Here’s what stood out: 1️⃣ Telehealth stabilized: After its initial spike, telehealth found its place. In 2024, it made up 38.4% of behavioral health visits, 6.3% in primary care, and just 1.2% in orthopedics. 2️⃣ More telehealth didn’t mean more visits. Total E&M visits were actually lower in specialties that used telehealth more: 📉 Behavioral health: 4.1% relative decline 📉 Primary care: 7.2% relative decline (Compared to orthopedics as a baseline) 3️⃣ Telehealth was substitutive, *not* additive: This is a key difference. Virtual care mostly replaced in-person visits rather than creating new demand. It met patients where they were without overwhelming the system. 4️⃣ Overall utilization stayed steady: Despite new care models, visit rates held consistent. Telehealth expanded flexibility, but capacity constraints and clinical workflows still shaped how care was delivered. These findings challenge long-held assumptions (I can't believe that it has been 8 years). We now have strong, early data suggesting that broad telehealth adoption doesn’t drive overutilization in Medicare. That’s a meaningful shift. It is time to move beyond outdated fears and into more thoughtful, evidence-based policy. As someone who’s worked in both emergency medicine and telehealth, I’ve seen how virtual care can meet real needs without excess. I hope we continue building systems that reflect that. Not just in theory, but in how we support access, quality, and sustainability in practice. 🧠 Curious to hear your thoughts especially if you're working in policy, digital health, or any corner of the system where these questions come up daily. 🔗 Read the full study here: https://lnkd.in/eyam4jHF Note: this is a preprint so might be more to add post peer review #digitalhealth #telemedicine #telehealth

Would you rather... 1. Pay $25,000 upfront for a medical procedure, or 2. Take a chance and pay either $20,000 or $50,000 three months later Yes, you might pay less later, but you also might pay a lot more. And with option 2, you have no control over which number it is. This is our healthcare system. And most people only get option 2. That's how most health insurance 'networks' work... get the service and they'll tell you the cost later. But lots of smart employers are adding option 1 to their health plans. It's called Direct Contracting. The price is negotiated and known upfront. No more Russian Roulette with employer or employee finances. Most employers waive their plan members' out-of-pockets for choosing the 'direct' purchase option. Everyone wins... * employees get access to needed care, * employers save money on services, and * doctors get paid quickly and without insurance hassles. Why isn't every health plan sponsor using this easy to implement strategy?

🚨 Centers for Medicare & Medicaid Services just announced 15 states chosen for the Transforming Maternal Health (TMaH) Model that focuses on improving maternal health care for people enrolled in Medicaid and Children's Health Insurance Program (CHIP). ✨ California is one of them! The model will enable participating state Medicaid agencies (SMAs) to develop a value-based alternative payment model for maternity care services through a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy. Model includes: 💠 Goals to reduce disparities in access and treatment by improving outcomes and experiences for mothers and their newborns and reducing program expenditures. 💠 States include: Alabama, Arkansas, California, District of Columbia, Illinois, Kansas, Louisiana, Maine, Minnesota, Mississippi, New Jersey, Oklahoma, South Carolina, West Virginia, Wisconsin 💠 3-year Pre-implementation Period: when states receive targeted technical assistance to advance each model element and a 7-year Implementation Period to execute the model. 💠 3 key pillars: 1. Access, Infrastructure, and Workforce: Increase access to birth centers and midwives, access to perinatal community health workers and doulas, and data collection, exchange, and linkage through improvements in electronic health records and health information exchanges 2. Quality Improvement and Safety: Implement “patient safety bundles,” or specific protocols that promote the reduction of avoidable procedures, leading to improved outcomes, promote achieving “Birthing-Friendly” designation, and introduce an option to promote shared decision-making between mothers and providers 3. Whole Person Care Delivery: Institute evidence-based medical and social risk assessment to drive risk-appropriate care, deliver care consistent with individual preferences, routinely screen and follow-up for perinatal depression, anxiety, tobacco and substance use during prenatal and postpartum periods , incorporate, home monitoring and telehealth technology for birthing people who have medical conditions like gestational diabetes and hypertension that complicate pregnancies, routinely screen and follow-up for HRSNs and establish reliable referral pathways to and from community-based organizations to address HRSNs, develop and implement Health Equity Plans for the local population as well as cultural competency technical assistance for providers #maternalhealth #valuebasedcare #equity #wholeperson https://lnkd.in/gy6wM96Z

𝐓𝐞𝐥𝐞𝐡𝐞𝐚𝐥𝐭𝐡 + 𝐇𝐨𝐦𝐞 𝐂𝐚𝐫𝐞 + 𝐑𝐞𝐦𝐨𝐭𝐞 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐌𝐨𝐧𝐢𝐭𝐨𝐫𝐢𝐧𝐠 (𝐑𝐏𝐌) + 𝐃𝐢𝐠𝐢𝐭𝐚𝐥 𝐓𝐡𝐞𝐫𝐚𝐩𝐞𝐮𝐭𝐢𝐜𝐬 (𝐃𝐓𝐱) 𝐂𝐨𝐧𝐯𝐞𝐫𝐠𝐞𝐧𝐜𝐞 𝐢𝐧 𝐂𝐚𝐫𝐝𝐢𝐨𝐯𝐚𝐬𝐜𝐮𝐥𝐚𝐫 𝐇𝐞𝐚𝐥𝐭𝐡 represents a forward-thinking, patient-centric approach that tackles the multifaceted nature of chronic heart conditions. 1. Personalized and Continuous Care DTx and RPM Integration: DTx provide personalized, evidence-based interventions tailored to each patient’s unique needs. Simultaneously, RPM devices offer continuous monitoring of vital cardiovascular metrics such as ECG, blood pressure, and heart rate. The integration of these technologies ensures that care plans are dynamically adjusted in real-time based on continuous patient data, providing a truly individualized treatment approach. Telehealth and Home Care Synergy: Telehealth facilitates remote consultations and follow-ups, making it easier for patients to receive consistent medical guidance without leaving their homes. Home care services complement this by offering in-person support, including medication management, physical therapy, and regular health assessments. 2. Enhanced Patient Engagement and Adherence Patient Empowerment: The use of intuitive RPM devices and accessible telehealth platforms empowers patients to actively participate in their care. With real-time feedback and educational resources readily available, patients are more likely to adhere to their treatment plans and make informed lifestyle choices. 3. Early Detection and Timely Intervention Proactive Management: The combination of real-time data from RPM devices and AI-driven insights from DTx platforms enables healthcare providers to detect early signs of deterioration in a patient’s condition. This allows for timely interventions that can prevent escalation, reduce the risk of severe cardiovascular events, and potentially avoid hospitalizations. Virtual Acute Care: Telehealth platforms offer rapid escalation of care when necessary, connecting patients with specialists or emergency services in response to alarming data detected by RPM. This ensures that urgent medical needs are addressed promptly, reducing the risk of complications. 4. Cost-Effectiveness and Accessibility: Reducing Healthcare Costs: By reducing the need for frequent in-person visits and minimizing hospitalizations, this integrated care model helps lower overall healthcare costs. Shifting care from costly hospital settings to more efficient home environments not only reduces expenses but also optimizes the use of healthcare resources. Expanding Access: This model is especially advantageous for patients in remote or underserved areas, providing them with access to specialized cardiovascular care that might otherwise be unavailable. Telemedicine and RPM bridge geographical gaps, ensuring that high-quality care is accessible to all. #DigitalTherapeutics #RemotePatientMonitoring #Telehealth #Cardiovascular

Driving FHIR Adoption with HL7’s Foundry: Reducing Barriers & Accelerating Interoperability The Health Level Seven International FHIR Foundry is transforming how health organizations implement interoperability by providing a collaborative space to test, validate, and refine FHIR-based solutions before full deployment. At #HIMSS25, leaders emphasized how Foundry is reducing the learning curve for adopters, ensuring seamless integration into real-world healthcare environments. 💬 “Anything you put in the way of an adopter … it’s all just obstacles. The idea of Foundry is to help implementers get started,” said Preston Lee, PhD, MBA, FAMIA, CTO of Logica Health. Since its launch, the platform has grown to support 86+ published products, driving real-world testing and innovation. As CMS and #TEFCA push for FHIR APIs, the need for scalable, standardized interoperability has never been greater. By automating processes like prior authorization and seamless data exchange, these initiatives are set to save $15 billion over the next decade. 🔗 Interoperability isn’t just a regulatory requirement—it’s the key to a frictionless, patient-centered health system. How is your organization preparing for FHIR at scale? Let’s talk! https://lnkd.in/eWMPX-3Y #FHIR #Interoperability #HealthcareInnovation #HL7 #HIMSS25

For a routine healthcare visit at a hospital there are usually 2 options: 1) An in-person appointment that requires paying for parking, travel time, walking through a maze of hallways, sitting in a waiting room, filling out forms at check-in, and then finding out the appointment is delayed by 20 minutes because the clinic is running behind. 2) A virtual visit that requires no travel time, selecting a time at your convenience from multiple slots, and a simple check-in online with an appointment that is going to start and end on time. According to Deloitte research about 24% of survey respondents say they are willing to switch doctors to ensure access to virtual health options and about 65% of respondents said they view virtual care as more convenient than in-person care. Patient demand for sophisticated virtual experiences in healthcare is growing. If the banking, retail, and entertainment domains offer convenient personalized digital options then shouldn't healthcare? As more physicians work hybrid schedules we have an opportunity to meet our patient's desire for flexibility. Deloitte report: https://lnkd.in/dy8XXyYp #telehealth #digitalhealth #healthcareIT #virtualcare #healthcaretransformation

A recent study conducted at Memorial Sloan Kettering Cancer Center demonstrates the impact of remote care management on patient safety and satisfaction. With telehealth, patients experience enhanced accessibility to care, leading to improved outcomes and higher satisfaction rates. This approach not only provides convenience but also ensures consistent monitoring, significantly reducing hospital readmissions and emergency visits. The integration of remote care technologies has proven to be a game-changer, fostering a more proactive and preventive healthcare environment. These findings underscore the importance of leveraging digital health tools to optimize patient care and outcomes. Key Insights: Enhanced Accessibility 📱 - Telehealth improves access to care, ensuring timely medical attention. Improved Patient Safety 🛡️ - Continuous monitoring reduces emergency visits and hospital readmissions. Higher Satisfaction Rates 😊 - Patients report greater satisfaction with the convenience and quality of remote care. Proactive Healthcare 🚀 - Remote management allows for preventive measures, addressing health issues before they escalate. Operational Efficiency 🔄 - Streamlines healthcare processes, making care delivery more efficient and effective. https://lnkd.in/e36qX3gF

**MORE THAN JUST A SHOT: HOLISTIC MANAGEMENT OF OBESITY** GLP-1 / GIP agonists medications are powerful tools in obesity management, offering substantial weight reduction (8-21% in trials). Weight reduction results in decreased neuroinflammation, which likely translates into improved outcomes of psychiatric co-morbidities. Yet, as I have observed in my patients, real-world outcomes of using these weekly injectables reveal challenges: from gastrointestinal side effects and nutritional deficiencies to muscle and bone loss, adherence issues, and high treatment costs. Crucially, these medications are most effective when paired with comprehensive, evidence-based nutritional and lifestyle interventions! Current practice guidelines emphasize integrating: - Personalized initiation discussions and goal setting. - Baseline screening for dietary patterns, emotional eating, medical conditions, and disordered eating. - Comprehensive physical assessments including muscle strength and body composition. -Social determinants of health evaluations. Lifestyle assessments covering activity levels, mental stress, sleep, and social connections. - Ongoing nutritional and medical management is essential to handle side effects, altered dietary preferences, and prevent nutrient deficiencies, along with preserving muscle and bone mass through resistance training and protein-rich diets. - Supportive strategies, such as group-based visits, nutritional counseling, telehealth, and Food is Medicine initiatives, significantly enhance outcomes and equity. Holistic care isn't merely additive, it's foundational. Leveraging comprehensive approaches empowers clinicians to enhance both patient health and treatment effectiveness. Reference: Check out this hot off the press journal article for more in depth information: https://lnkd.in/eMv83B4x #ObesityTreatment #WholePatientCare #GLP1Agonists #Nutrition #LifestyleMedicine #PatientCenteredCare #psychiatry #psychotherapy

The urgent care network's CEO was direct: "𝘞𝘦 𝘯𝘦𝘦𝘥 𝘵𝘰 𝘳𝘦𝘥𝘶𝘤𝘦 𝘤𝘰𝘴𝘵𝘴 𝘣𝘺 15% 𝘵𝘰 𝘴𝘶𝘳𝘷𝘪𝘷𝘦 𝘵𝘩𝘦 𝘮𝘢𝘳𝘬𝘦𝘵 𝘤𝘰𝘯𝘴𝘰𝘭𝘪𝘥𝘢𝘵𝘪𝘰𝘯, 𝘣𝘶𝘵 𝘸𝘦 𝘤𝘢𝘯'𝘵 𝘤𝘰𝘮𝘱𝘳𝘰𝘮𝘪𝘴𝘦 𝘱𝘢𝘵𝘪𝘦𝘯𝘵 𝘤𝘢𝘳𝘦." We recognized an opportunity to fundamentally rethink the organization's operating model through a technology-enabled transformation. 𝗧𝗵𝗲 𝗖𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲: 𝗠𝘂𝗹𝘁𝗶-𝗗𝗶𝗺𝗲𝗻𝘀𝗶𝗼𝗻𝗮𝗹 𝗣𝗿𝗲𝘀𝘀𝘂𝗿𝗲  - Reimbursement compression from payers  - Increasing competition from retail healthcare providers  - Rising patient expectations for digital experiences The traditional approach would have been incremental: trim staff, reduce supply costs, chase marginal efficiencies to achieve an 𝟴-𝟭𝟬% 𝗰𝗼𝘀𝘁 𝗿𝗲𝗱𝘂𝗰𝘁𝗶𝗼𝗻 while degrading patient experience. 𝗧𝗵𝗲 𝗕𝗿𝗲𝗮𝗸𝘁𝗵𝗿𝗼𝘂𝗴𝗵: 𝗗𝗮𝘁𝗮-𝗗𝗿𝗶𝘃𝗲𝗻 𝗖𝗮𝗿𝗲 𝗥𝗲𝗱𝗲𝘀𝗶𝗴𝗻 We built a digital transformation strategy around three core capabilities: 𝟭. 𝗣𝗿𝗲𝗱𝗶𝗰𝘁𝗶𝘃𝗲 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝗙𝗹𝗼𝘄 𝗢𝗽𝘁𝗶𝗺𝗶𝘇𝗮𝘁𝗶𝗼𝗻 We analyzed three years of visit data and created an AI-driven staffing model that predicted patient volume with 94% accuracy at hourly intervals. This allowed precise staffing aligned to actual demand rather than static scheduling. Impact: 18% reduction in labor costs while reducing average wait times by 12 minutes. 𝟮. 𝗩𝗶𝗿𝘁𝘂𝗮𝗹-𝗙𝗶𝗿𝘀𝘁 𝗖𝗮𝗿𝗲 𝗣𝗮𝘁𝗵𝘄𝗮𝘆𝘀 Rather than viewing telemedicine as a separate offering, we redesigned the entire care delivery model around a virtual-first architecture. Patients began with an AI-triaged digital intake, followed by a virtual provider assessment, and only then proceeded to in-person care if clinically necessary. Impact: 41% of cases were resolved without in-person visits, reducing facility costs while increasing patient satisfaction scores by 9 points. 𝟯. 𝗨𝗻𝗶𝗳𝗶𝗲𝗱 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗜𝗻𝘁𝗲𝗹𝗹𝗶𝗴𝗲𝗻𝗰𝗲 𝗣𝗹𝗮𝘁𝗳𝗼𝗿𝗺 We consolidated fragmented clinical and operational data into a unified platform, giving providers real-time decision support integrated into their workflow rather than requiring separate analysis. Impact: 17% reduction in unnecessary tests and procedures, 28% decrease in prescription costs through more precise medication management. 𝗧𝗵𝗲 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: 𝗕𝗲𝘆𝗼𝗻𝗱 𝗖𝗼𝘀𝘁 𝗥𝗲𝗱𝘂𝗰𝘁𝗶𝗼𝗻 The combined impact exceeded all expectations:  - 23% reduction in total care delivery costs  - Patient satisfaction improvement from 72nd to 89th percentile  - Clinical quality metrics improvement across 7 of 8 key measures  - Provider satisfaction scores increased by 14 points Rather than merely surviving market pressures, they established a new care delivery model that attracted acquisition interest at a multiple 2.4x higher than the industry average. 𝘋𝘪𝘴𝘤𝘭𝘢𝘪𝘮𝘦𝘳: 𝘝𝘪𝘦𝘸𝘴 𝘦𝘹𝘱𝘳𝘦𝘴𝘴𝘦𝘥 𝘢𝘳𝘦 𝘮𝘺 𝘰𝘸𝘯 𝘢𝘯𝘥 𝘥𝘰𝘯'𝘵 𝘳𝘦𝘱𝘳𝘦𝘴𝘦𝘯𝘵 𝘵𝘩𝘰𝘴𝘦 𝘰𝘧 𝘮𝘺 𝘤𝘶𝘳𝘳𝘦𝘯𝘵 𝘰𝘳 𝘱𝘢𝘴𝘵 𝘦𝘮𝘱𝘭𝘰𝘺𝘦𝘳𝘴.

New research in #JAMA confirms what many in value-based care have long believed—at-risk Medicare Advantage (MA) arrangements (upside and downside) lead to higher quality and efficiency compared to fee-for-service (FFS) MA within the same physician group. Key findings from the study (2016-2019 data on over 5 million person-years): ✅ Lower inpatient admissions & readmissions ✅ Fewer ED visits, including avoidable ones ✅ Improved disease management & medication adherence ✅ Reduced high-risk drug use Physician groups in 2-sided risk models are delivering better outcomes while managing costs more effectively. This study had a wide variety of physician practices including agilon health, Cedars-Sinai, Sharp Community Medical Group, UCLA Health, VillageMD. As Medicare payment structures evolve, this is critical evidence supporting 2-sided risk-sharing arrangements as a driver of improved patient care. Are you seeing similar trends in your practice? #MedicareAdvantage #ValueBasedCare #HealthcareInnovation