Written by Breanna Hardy
Health care has become increasingly digitized ever since the beginning of the pandemic. Growing in popularity, telehealth services also have the capacity to alleviate staffing needs.
Kaiser Permanente’s Dr. Amit Saini, assistant physician-in-charge of access, service and health promotion, said that Kaiser Permanente Northern California saw a 3,000% increase in utilization of telehealth services since the pandemic hit.
“Within a span of days, we were able to convert our office-based appointment systems into almost 100% telemedicine,” said Saini.
March 15, 2020 was a turning point for many clinics that had to navigate life during shelter in place. While telemedicine was an option, it wasn’t widely used and adopted the way it is today.
Kaiser adopted phone and video appointments with accommodations for patients who are hard of hearing. The health system also launched secure messaging for doctor-patient emailing.
“Very, very quickly we were able to provide all the care virtually,” Saini said.
And while usage has fallen a little since the height of the pandemic, telehealth appears to be here to stay.
“Video visit volume and the telephone appointment volume has gone down, but it has not gone to pre-pandemic levels. It has stayed significantly higher than the pre-pandemic levels,” Saini said.
It’s not just limited to pediatric or general care, Saini said. Telemedicine also includes specialty care, like dermatology, general surgery or orthopedics. But some exams and interventions don’t allow for telemedicine.
Saini believes that many people now prefer telemedicine because they’ve seen results. People have experienced that telemedicine appointments have been quick and convenient without interrupting the flow of their day.
“If our patients don’t want it, we cannot force the care to them. But it feels like they also are liking some aspect of the telemedicine and they’re doing it,” Saini said.
There is room for telehealth to grow beyond health systems in the Valley after the pandemic, too.
Babylon Health, a U.K.-based artificial intelligence telehealth provider, is looking to break into the U.S. market.
Babylon Health bought FirstChoice Medical Group in Fresno and Madera, which was first announced in October 2020.
Dr. Marcus Zachary, a physican with Babylon, told the story of Babylon’s CEO Ali Parsa, who wanted to reimagine health care. The company vision is to keep people healthy and not only care for people when they’re desperately ill.
The company invested in automation and artificial intelligence technology, but also weighs when patients need in-person care.
The United States journey with Babylon started in January 2020, and Zachary has been involved with the company for about a year and a half.
Zachary said though Babylon is a global company, there are many feet on the street in Fresno, and those who provide oversight reside in Fresno and Northern California.
“We’ve got a really long term plan, and intend to become a real part of the fabric of the Fresno community,” he said.
The goal of the telehealth platform is to provide value-based care, which bills the doctor based on the quality of health care the patient received. Managed health care (HMO) tracks the costs, and not the care.
“So the criticism was, whether consciously or unconsciously, there was an incentive to just provide less care,” he said. “And so we didn’t see the benefits in terms of quality and access and definitely for patient satisfaction.”
The Affordable Care Act in 2011 encouraged providers to go into value-based care contracts.
Value-based care incentivizes visits to the doctor, with emergency visits, hospitalizations and specialist visits going down.
“When it’s necessary, of course there is FirstChoice Medical Group where they can go and they can be in the clinic,” Zachary said.
The FirstChoice Medical Group is still “captain of the ship,” Zachary said, but Babylon’s role in the system will help with the impact of hospitals and urgent care centers.
“This is a real problem, particularly for the FQHCs in managing their Medi-Cal populations,” he said.
Federally Qualified Health Centers are community-based health care providers that receive government funding to provide care in underserved areas.
This telehealth format is poised to serve more Medi-Cal patients and in turn open more appointment slots for patients with complex needs who need to be seen by a doctor in person.
There’s a scarcity of primary care in the Central Valley, and seeing patients through a telehealth appointment will allow for clinics and urgent care centers to run more efficiently.
While telehealth services are making moves in the digital sphere, prescriptions are too.
Prescription digital therapeutics is a form of digital health care. Doctors can prescribe patients further care through apps like Spark, created by Limbix Health, Inc.
Prescription digital therapeutics are designed to be prescribed by licensed clinicians. This particular app is geared toward adolescents, 13 to 21 years old, who struggle with mental health illnesses.
“Our apps are designed to be self-driven. So it’s not a telemedicine or telehealth approach where you have a doctor on the other end of the app,” said Ben Lewis, CEO of Limbix.
Lewis said that some waitlists for psychologists are up to six months long for teens struggling with depression. But depression is at an all-time high — about 20% of teens struggle with it.
Though pediatricians are screening for it in routine check-ups and diagnosing it at a higher rate than in years past, treatments have not kept pace. And some patients do not follow up on the referral after a physician recommends seeing a psychologist.
Spark is an app designed to be a successful treatment for mental illness, and Limbix is planning its clinical trial for this summer in partnership with Duke Clinical Research Institute.
“It’s intended to be prescribed, which means that we’re going through the FDA to prove that our app is both safe and effective,” Lewis said.
The process to prove an app is safe and effective is relatively new, but it has been done before. EndeavorRx is an FDA-approved video game treatment for people struggling with ADHD.
Moving forward, prescription digital therapeutics will change the market — specifically in adolescents — and open up effective treatment options that are scalable, accessible and covered by insurance.
“There will never be a six-month waitlist to use the app,” Lewis said.
While digitized health is not meant to replace in-person care, it can keep clinic waitlists down and streamline access to care and help alleviate staffing shortages.
“And it doesn’t mean that people won’t need psychologists. Of course they will still need psychologists. Of course we’ll still need to have access to in-person care or telemedicine…but they’re able to get help immediately rather than wait for that help,” Lewis said.