Telehealth is evolving from its current transitory state to a permanent fixture in the treatment matrix — and it’s being powered by deeper integration with patient data that supercharges video visits.
Of the many paths to innovation, the one of least resistance in this case would be a telehealth platform built on a major electronic medical records (EMR) database, making patient journeys seamless, physician time judiciously used and keeping payments flowing in more manageable ways.
Speaking with PYMNTS, Dr. Lyle Berkowitz, CEO of KeyCare, said that the video visit is the easy part of the telehealth puzzle. What’s difficult is the patient data integration, which is why KeyCare built its solution using the Epic EMR platform.
Having partnered with Twilio in 2020 to build its own video solution, Epic is proving ideal for KeyCare’s vision of “virtualists” expert in online patient interaction, with a whole-person view of the patient facilitated through Epic’s massive data reserves.
Curiously for the CEO of a telehealth solution, Berkowitz doesn’t see the future of telehealth as simply offloading office visits to video.
“My belief is that the idea of telehealth, virtual care, etc. is not, ‘How do we replace a 15-minute office visit with a 15-minute video visit and pay the same?’ That’s not a winning game,” he said.
Rather, he sees telehealth evolving as a kind of digital triage where the sickest patients receive the appropriate level of attention — a combination of telehealth and in-office, for example — while those requiring lesser interventions can be dealt with asynchronously.
Noting that “the classic pyramid of population health will say that the top 5% represent 50% of the cost,” he said this group needs the extended modes of care, while the bottom half of the pyramid “should be able to do their care online. Self-service, asynchronous, as easy as possible.”
“We’re looking at virtual care as a way to build up a team that is able to provide much more efficient, much more cost-effective care, at much greater scale,” he continued.
Getting there will require some doing, which is where KeyCare intends to invest its $24 million in Series A funding announced in August.
Enough Doctors, Not Enough Time
By “widening the digital front door” with a combination of virtual care, automation, asynchronous care, phone and chat, health systems can begin to better manage patient and staff scheduling while also making the payment process smoother.
This lets practices and health systems see more patients — either virtually, in-office or both — and “they can get care done online in a hyper efficient way for reasonable cost,” he said. “If we pair these things together, we actually can help physicians increase their panel sizes and increase the economics of their health system.”
It’s an efficiency play at scale in which “everyone’s working at the height of their license. In the end, that’s how we see solving health system economics is by pairing up office-based doctors with a virtual team that’s able to extend the amount of care that they can provide,” he said.
Not only does this model of telehealth keep the modality relevant post-pandemic, but it also addresses some core financial imbalances in how care is priced and compensated.
Discussing the system of physicians billing based on relative value units (RVUs) of time spent per patient, Berkowitz said, “The only way that our health system evolves and saves itself is if we start thinking about not RVU-based payments and how many patients can we see in the office, but how many patients can we take care of? And when you start incentivizing correctly, virtual care will expand greatly.”
He noted that Kaiser and similar systems are embracing this model, addressing what is more of a physician time drain than an actual shortage of doctors. In the dominant fee-for-service model, physician time is limited. But if the value-based model has taught us anything, it’s that there isn’t a physician shortage — there’s a shortage of physicians using their time efficiently.
“We should do what every other industry does from legal to consultants to banking, etc,” he said. “You form a team around the smartest individual and the most experienced individual and let them oversee that team to let them manage as many people as possible.”
Dawn of the Telehealth Marketplace
As to which costs are most prone to an evolution in how care is delivered and charged for, he said patients often understand minor medical issues from major, and want treatments and costs aligned accordingly. Powered by Epic EMR data, KeyCare is helping lead this charge.
“The cost of [an] emergency room visit can be very high, urgent care, even going to a primary care office can be high,” Berkowitz said. “If you do an asynchronous visit these days, it’s usually lower than a copay. If you are in a high-deductible plan, it’s a difference between perhaps a $25 eVisit and a $100 visit in the office, on top of taking off time from your day.”
Positioning KeyCare as a burgeoning healthcare marketplace where practices and health systems can essentially plug in and have Epic data backing patient interactions, Berkowitz believes it’s a healthcare aggregator approach that can bring smart consolidation to the space.
“We’re looking to set up virtual care groups on our fully functional Epic-based EHR,” he said. “Then, not only do you get a full-stack EHR, but you get ability to service all these other health systems that have Epic. We would love that idea of being a bit of a marketplace consolidator.”