Continuous Remote Care and a New Healthcare System
(I.e., What the US Healthcare System will Look Like After Telemedicine’s Next Transformation)
In part I of my take about the future of telemedicine, I talked about what telemedicine will look like when its true promise is realized — virtual, continuous and proactive, with the ability to flip many chronic disease treatment paradigms from management to reversal.
We have practiced this telemedicine model at Virta Health since day 1 and we call it Continuous Remote Care. Our patient outcomes are unmatched in type 2 diabetes care, but even we would be the first to tell you we have only scratched the surface of the potential of this care delivery model.
Collectively, if we truly push for these shifts in the way care is delivered and chronic diseases treated, what lies ahead is not only better patient health, but a radically improved healthcare system that benefits everyone. The way I see it, these changes can deliver at least three drastic improvements to American healthcare:
1: Chronic diseases will no longer be a life sentence
One of the major forces driving healthcare, and specifically the treatment of chronic metabolic diseases like type 2 diabetes, is the entrenched belief that a person’s condition will only worsen and at best, we can only slow down the progression of the inevitable. In fact, this runs counter to existing evidence — many chronic diseases can be systematically reversed, and not just “managed”. We see it with our own data at Virta, but there are myriad other examples from corporations, scientists, and medical professionals, too.
As it becomes more accepted that many chronic diseases are reversible or preventable altogether, our collective expectation of health outcomes will change radically. All too often we hear from patients how deeply frustrated, even angry, they are for being told that they are sentenced to a life of medications, without any option for something different.
It is not inconceivable, then, to imagine a scenario where vendors and/or solutions not meeting these new expectations for outcomes will simply go out of business. Health plans that don’t cover evidence-based reversal and prevention solutions will be considered behind the times (or even worse, unethical) for not doing so.
2: Access and Equity are Improved
Much of the pain in our existing healthcare system is disproportionately felt by low-income individuals and people of color. One of the easiest ways to understand these disparities is by looking at the “subway map” metaphor. For example, in New York City, life expectancy declines 10 years moving from midtown Manhattan to the South Bronx. As Dr. Don Berwick bluntly states, “At a population level, no existing or conceivable medical intervention comes within an order of magnitude of the effect of place on health.”
Poor health outcomes are also directly linked to economic misfortune, and adverse health events are one of the leading causes of personal bankruptcy in the United States. The elevated rates of diabetes among Blacks, Native Americans, and Latinos create a discriminatory cycle that as a nation we simply cannot tolerate any longer.
With Continuous Remote Care and the possibility of disease reversal, we have the promise of changing these statistics for the better. The best care and treatments are now available anywhere as long as there is basic phone and Internet access.
To be sure, there are barriers. Technology access, literacy, and coverage provide real challenges that will require effort from policy makers to ensure disparities in our current healthcare system are eradicated from this future vision.
But what is promising about Continuous Remote Care is that the highest quality healthcare can be accessed with only a standard smartphone, now owned by 4 out of 5 people, a rate that also holds steady across different minority groups in the U.S. This means that irrespective of geography — and even in areas where there is a dearth of medical providers — people can receive individualized chronic disease care matched to their culture, condition, lifestyle, and other factors. Imagine being able to scale the services of branded health systems such as Cleveland Clinic or Mayo Clinic across the entire U.S. Everyone deserves this quality of care regardless of where they live or what they can afford.
Is it really possible? Many health care experts have told me that they didn’t think we’d be successful in treating Native Americans, or our Veteran population. Many of these patients live in food deserts, have technology challenges, are very low-income, or share a combination of these factors. At Virta Health, their health outcomes, though, are comparable to what we see across our larger patient population nationwide. Continuous Remote Care with high degree of individualization makes it possible.
3: We tame the “tapeworm” of the American economy
Our national healthcare bill is now $3.6T, and as Warren Buffet likes to say, it is a tapeworm on our economic system. Endless discussion has been dedicated to the dream of better outcomes at a reduced cost, yet we are no closer to making this dream a reality.
One reason why this is so? We seem satisfied to keep doing the same things that haven’t worked. In chronic disease care, we’ve focused on either treating symptoms (e.g. high blood pressure or high blood glucose) with pharmaceuticals OR treating the expensive end complications (e.g. kidney failure associated with type 2 diabetes). We continue to spend billions on pharma research and development, force economic burden onto consumers, and use band-aid solutions (again, endlessly treating the chronic disease symptoms) instead of root-cause interventions. This pattern enables the persistence of a system largely dedicated to costly sick-care that doesn’t benefit the patient or the tax payers.
The way to fix this is not with changes on the margin, but by going directly at chronic diseases, which represent over $1 Trillion(!) in healthcare spend.
You can argue that we don’t have the collective political or economic will to achieve this vision, but we are long past the point of having any other option but to fix this out of control mess. We have built an industry saddled with the morally repugnant quality of profiting off of people getting and remaining sick. An industry where we spend billions of dollars with very little accountability for results (other than individual company P&L’s).
This can and will change.
The speed at which we have achieved advancements in the era of COVID-19 gives me hope that it will. Not taking the time to rethink what’s possible would be a dangerous mistake with profound implications for the future of public health. We can do so much better for people with chronic conditions. Knowing this, it’s a moral imperative that we do.
