Telehealth, community clinics to serve the patient surge

By Anthony Brino
08:09 AM

With an aging society and millions of people gaining insurance for the first time, the country needs more doctors and clinical practitioners. By some estimates, there could be a shortage of 136,000 physicians across primary care and the specialities by 2025.

In many places, getting an appointment with a primary care doc or a specialist can already take anywhere from a few days to more than a month, and the influx of close to 20 million people covered in exchange plans and Medicaid is adding to the demand.

But some believe that the shortage can be mitigated with telehealth — digital visits letting physicians consult more patients and letting patients stay home rather than truck into an office or hospital.

In Philadelphia, Thomas Jefferson University Hospitals is investing $20 million in telehealth and walk-in clinics to make that vision a reality. Led by CEO Stephen Klasko, MD, a TED-talking, science fiction writing ob-gyn, Thomas Jefferson is trying to reinvent academic medicine and evolve a new strain of healthcare, as it merges with Abington Health to become the largest provider system in greater Philadelphia.

As Klasko sees it, American healthcare needs to “change its DNA,” from reforming medical education to embracing consumer technology — telehealth chief among them.

And the future is now. Pennsylvania is set to expand Medicaid and cover some 600,000 uninsured individuals.

“How are those patients going to be seen?” wonders Klasko, who once ran one of Pennsylvania's most successful obstetrics and gynecology practices. “There’s just not enough primary care doctors and ob-gyns to handle the demand. If all we’re doing in the same old thing, we’re going to basically say to those patients, I’ll see you in two months. They’re going to end up in the ERs.”

Telehealth and walk-in clinics could make the experience and financing easier for all involved — the patients, clinicians and payers. Specialists, for instance, can go consider all the patients, “find who doesn’t really have to come in and would actually be more conveniently treated in a freestanding clinic or by telehealth, so that I can see patients who urgently need to be seen.”

Klasko continued, arguing that telehealth could be particularly valuable in maternity and early pediatrics: “The standard obstetrics approach is a visit six weeks after birth. The visit is literally me saying 'hi' to the patient, seeing the baby, saying that’s the most beautiful baby I’ve ever seen, talking to the patient about contraception, making sure that she doesn’t have depression or any major problem and I might put my hand on her abdomen just because she’s there and she paid $35 for parking. The ability to at least offer the patient the option, at her convenience, having the same visit by telehealth is a great option. That also allows us to keep slots open, and let docs see more patients.”

Klasko is so optimistic about the potential of telehealth that Jefferson is investing in the telehealth company American Well, which is providing the platform for the hospital system’s virtual rounds and urgent consultations.

“From our perspective, we’re going from the Blockbuster model to the Netflix model,” said Klasko, also describing the approach as a “hub and hub” model that extends the expertise of Jefferson clinicians to patients closer to home, at community hospitals and or in their homes. “We believe that 65 percent or so of patients who end up in a hospital’s emergency rooms don’t need to be there, and because it could not just be five hours of a patient’s life but $1,500 of their deductible.”