By JEFF GOLDSMITH

As John Glaser argued a recent piece in Harvard Business Review, many health care executives seem have been blinded by the shiny object that is digital health. Forgive us for a powerful feeling of déjà vu. Since the last major digital innovation in health, the electronic health record, fell far short of expectations and probably generated a negative return on investment for many care systems, it is worth thinking about to avoid the same fate with this new wave of digital tools.

As COVID raised concerns about the safety of in-person visits to clinics and physicians’ offices, digital health visits soared during the spring. Traditional health care organizations large and small–hospitals, health plans, physician groups–have since struggled to integrate digital technology effectively into their care offerings and management structure. 

In other industries, digital technology acts as a  force-multiplier for the core business–it helps firms make much more efficient use of their workforce, customers’ time and physical capital. Amazon used its cloud-based IT infrastructure and sprawling  digital “catalog” to compress time to customer fulfillment, eliminating the need for customers to visit stores to get what they needed. And by leveraging other firms’ inventories, it reduced the need to purchase, warehouse and physically handle more than half of what they sell. 

Similarly, digital health applications should not be thought of as a “new product”. Indeed, the capability for digital visits and monitoring and digitally enabled remote work has existed (some say, languished)  for almost two decades. Digital health tools should be thought of as force multipliers for the trusted relationships at the heart of healthcare. Clinicians can be in two places at once-  transforming how patients and clinicians interact by removing both time and physical location as constraints. At the same time, telework enables healthcare enterprises to make more efficient use of scarce clinical and administrative person-power,  shrinking their physical capital footprint. 

Achieving savings in clinician time and reduction in overhead were the twin drivers of Kaiser Foundation Health Plans’ successful digital health strategy. Kaiser’s two-decade long investment in virtual care has resulted in more than half of Kaiser subscriber interactions with their caregivers (preCOVID)  being electronic. The savings in reduced clinic time and overhead dropped through directly to Kaiser’s bottom line by minimizing the consumption of resources inside Kaiser’s fixed capitation pool. But you do not need to be fully, or even partially, capitated to reap digital health’s benefits.

By KIM BELLARD

2020 is almost over; thank goodness.  It has been one of the strangest, and longest, years most of us have ever endured.  We’ve all probably known someone who contracted COVID-19; many of us have had lost loved ones from it.  Most of us have had to make drastic changes to our lives – masks, social distancing, limits on family visits, eating out, concerts, or trips among them.  No, 2020 can’t get over fast enough.

I was struck, though, by a quote I recently read.  Loren Padelford, a vice-president at Shopify, told The Wall Street Journal: “Covid has acted like a time machine: it brought 2030 to 2020.” 

Gosh, I hope not.

Mr. Padelford went on to explain: “All those trends, where organizations thought they had more time, got rapidly accelerated.” These trends include the shift from physical to online, further decline of cash, and work from home/remote learning.  Individuals/families without broadband are being left behind; companies not investing in IT and logistics may not be here in 2030.  Healthcare has not been exempt from these trends.

The pandemic has illustrated both the great strengths and the great weaknesses of the U.S. healthcare system.  Among the strengths are the courage and professionalism of our health care workers, the innovation that has delivered several vaccines within a matter of months, and the ability to adapt to an existing but underutilized mode of care in telemedicine. 

Among the weaknesses, of course, are the lack of planning and coordination that has doomed testing, contact testing, and supply of personal protective equipment; the patchwork quilt of insurance coverage that has left even more without coverage (e.g., due to loss of job based coverage and/or lack of Medicaid expansion); the refusal of many to act in their own best health interests, such as not wearing masks or taking vaccines. 

Legislators/regulators may be taking bold actions like throwing money at healthcare organizations, vowing that the COVID testing and vaccines are “free,” and loosening restrictions on telemedicine, but the underlying disfunction in our healthcare system has never been more visible.  We don’t test enough or fast enough.  We have sick people on gurneys in gift shops, we have dead people in refrigerator trucks, and we still have people crushed by their healthcare bills.

Please, don’t let this be a picture of 2030.