“Part of the innovation is to get the patient to the most efficient point in the health system for the interaction they need to have today,” said Tom Andriola, vice president and chief information officer for the University of California System. “We’re not trying to build more hospitals. We’re trying to use the ones we have efficiently.”
A big part of what is driving healthcare to where it is most convenient for patients is new technology that allows telephone or video conference meetings, better scheduling, more streamlined service and even a team of experts on call to assist a practitioner in a rural location with a specific treatment.
But it is not all about technology. It is also about where appointments are being made, whether that is at a local pharmacy, in a clinic on a corporate campus or even in an individual’s home. These moves continue to bring more healthcare services out of the hospital setting, making better use of the beds there for more specialized or acute cases while more routine and preventive care moves to where it is more accessible for patients.
This in turn is shaping how medical buildings are designed and built. In California, where hospitals are working to meet strict seismic guidelines, there are advantages to having those buildings be as efficient as possible and move more services to other medical buildings that need to follow less-rigorous seismic requirements.
All of these topics were discussed at Bisnow’s recent all-day National Healthcare NorCal event at The Fairmont San Francisco. Panels discussed construction, design and consumer demand when it comes to accessing healthcare.
Healthcare providers are starting to re-examine the services that are needed within each community. The default is to think that each community needs a hospital and everything in it, but that is not really the case, said Dr. Denise Brown, Vituity’s chief strategy officer and executive vice president.
“You don’t actually need the hospital there. What you need is access to care that could happen somewhere else,” she said. If a patient needs expert care, it may make more sense to get that patient to somewhere like Stanford where experts are on hand, rather than whoever is responding in an ER situation locally, she said. “It’s not scarcity. It’s resource utilization in a different way.”
Once they get beyond thinking about hospital beds, providers can focus on how to take care of people in various settings, whether assisted living, psychiatric, telemedicine, even paramedic care that doesn’t necessitate taking the patient to the hospital, Brown said.
Such shifts lead to a redistribution of where hospital beds are needed, said Dr. George Tingwald, director of medical planning for Stanford University Medical Center. There may be fewer hospital beds needed in a particular community, but there is a shortage of beds at academic medical centers because of the specialized care received there.
Some of these shifts are leading to partnerships within the healthcare system, but also with outside partners. And some of that is supported by new advances in technology to provide remote treatment to patients.
It used to be that patients would have to come to a central Veterans Affairs campus for treatment, but that is not a pleasant experience if someone isn’t feeling well and has to drive five hours for a one-hour appointment, said Bonnie Graham, director for the San Francisco VA Health Care System.
There is also the challenge of staffing facilities in rural areas. So now the VA does a lot of appointments through phone and video connections and employs a “hub-and-spoke” model where smaller staffs in outlying areas can call on experts when there is a situation that demands a specialist’s input, such as the quick treatment needed for a stroke patient.
The VA is also working with college campuses with a large number of students who are veterans, providing care on campuses that integrates telehealth. Some localized care is going as far as bringing medical care to patient’s homes. The VA does a lot of home care.
To make these approaches work, the system needs “touchdown spots” in different parts of the state where nurses, who are going to homes with a laptop and doing care, can report in and do their paperwork without returning to a hospital or clinic. Graham said the VA is looking for partners to offer those sites.
Reaching patients at home isn’t a new concept, but there is a renewed interest, particularly when it comes to treating chronic conditions. Some of this can be done remotely through phone and email, while other providers are actually sending physicians to patient’s homes. Healthcare startup Heal allows in-home care of those with multiple chronic conditions, keeping them out of the hospital and ER, and helping to save insurer costs, Heal Medical Director Dr. Justin Zaghi said. Patients use an app to schedule appointments and doctors can refer to data from technology in the home for keeping an eye on measurements like blood pressure. This creates a better situation for the patient, who may have difficulty traveling to an outside appointment, but it also has benefits for the physician and insurer, since there are cost savings to not having office space for at-home doctors or not having a receptionist, but instead an app for booking appointments, Zaghi said.
Dr. Jordan Newmark, chair of the department of anesthesiology for Alameda Health System, mentioned a study out of Camden, New Jersey. That data-driven study found there was a huge reduction in costs and better outcomes when attention was paid to how to keep patients who accessed healthcare the most at home and healthier so they spent less time in the hospital.
“Finding ways of bringing resources to patients at home is important,” Newmark said. Often, with chronic conditions, the earlier the intervention, the better the outcome.
But that means people need care where they can get it and that is accessible despite the challenges of geography or time. Newmark mentioned he has patients who live 3 miles from the hospital, but can’t come in for an appointment because they can’t take the time away from managing children or get time off work.
“It’s access to care — meeting patients where they are and eliminating barriers to care,” he said.
