Recently, I spoke with an innovative young engineer who called my company to explain the synergy between his new product and the concierge model of healthcare. He was promoting a device designed to improve the transmission of data collected from the patient himself while out of the office, similar to a Holter monitor. Instead of collecting the information and coming into the office for an appointment with the physician to review the data, the data would be transmitted electronically. The thought was that by transmitting over the Internet instead of by appointment, providers could more quickly evaluate the data and make more timely adjustments to treatments. I asked if he felt this would reduce the number of office visits and improve care.
He hadn't conducted studies on the improved health of patients who used this approach, but his hunch was that the technology was beneficial because it allowed a lower-level provider to review the data in real time. It eliminated a needless doctor/patient interaction. On the surface, the approach sounded good. It could possibly be beneficial to the patient, and it would reduce costs.
The problem is, embedded in this approach, is the move further away from any real patient/physician interaction, which is contrary to the concierge care model. Concierge care offers patients a dedicated, more personal relationship with their chosen physician — not appointments and analysis with lower-level providers.
The changes in healthcare today are all about balancing the factors of quality and cost. At the onset of managed care, the focus was to control costs by managing referrals to more expensive specialty-care providers and diagnostics. Now, the changes are built around moving care down to less expensive modalities; whether it is taking patients out of a hospital setting and putting them in ambulatory care or having PAs and NPs care for patients, rather than physicians that are more expensive.
But what about the issue of quality? While these changes may make sense in terms of managing initial costs, the devil lies in the details. Primary-care physicians may spend a large portion of their day delivering routine care, but it is the detection and treatment of more complicated issues often hidden by seemingly routine symptoms that makes their role so critical.
The truth is, patients have better outcomes and are more compliant when they have more time with their personal physician. Concierge care is built around developing that one-to-one relationship with a physician who really knows her patients, and can serve as a role model, lifestyle coach, and health advocate, taking the time to deliver not just acute care but preventive care. This type of care is paid for by the patients themselves, who choose to be part of this health program, and who by doing so, reject the vast and not so subtle movement toward the lowering of healthcare.
So, if truly improving patient health and outcomes is the goal of the engineer's new device, the most important factor he should consider is more time for a patient who has a health condition that requires monitoring to spend with his personal physician — the healthcare expert who truly knows him and can detect significant changes — not less. Certainly not care delivered electronically, monitored by a data analyst.
The device he was promoting has promise though. In the short term, insurers might embrace this approach as it would enable them to pay lower cost, lower-level providers, rather than more expensive physicians. And, in time, if the device demonstrates that it improves health outcomes, both concierge and traditional patients could benefit from its use.
However, I don't think it ever could — or should — replace that all-important human interaction and connection that takes place between physicians and patients. What about you doctors? Do you like the idea of this kind of technology?