Dennis Truong and Jody Crane have reinvented the traditional house call. ¶ The Kaiser Permanente doctors are responsible for the creation and implementation of a new program called HouseCalls, in which patients can schedule 20-minute appointments with physicians via video. The foray into mobile health saves the patients a visit to urgent care centers and saves those centers money, the doctors said. It’s just one new initiative underway at the national health provider aimed at improving care while lowering costs.
■ Crane: About eight months ago, an internal medicine doctor said they were kind of toying around with trying to connect with patients at home. They learned that it was doable, but that it required a lot of effort and time on behalf of the physician to get the patient, who might not be as tech savvy, to get the audio working, the video working and get the patient ready for the encounter.
We thought we can do this big time in our call centers. We have ER physicians working in the call center, but they were mainly supporting nurses.
Dennis and I showed up one day and we said for today we’re going to do the following: We’re going to offer patients the ability to see us real time on video. We probably saw four or five patients the first day. All the patients were thrilled we were able to handle their complaints.
■ Truong: We’re basically covered in D.C., Virginia and Maryland, so we receive patients in any of those three states. Patients receive HouseCalls as an option. If they don’t have any major complaints that would require an emergency visit, these patients can be seen by us. If they get on the call and they’re still not comfortable, we always have the option to book them with their primary care doctor or book them into one of our urgent care centers.
■ Crane: We do know the volume is increasing over time. About a month ago, we were not marketing it at all and getting 10 calls a day. Now we’re getting 15 to 20 calls a day with some advertising to our members. Our goal is 30 calls a day.
■ Truong: As far as what you lose, of course you don’t have a tactile interaction. That’s why we select certain types of patients that would be appropriate for HouseCalls. In the very rare circumstance that they do make it to HouseCalls and I want to listen to their lungs or want something further done, then I refer them to their care center.
Crane: Every once in a while you’d love to listen to a lung or look in a person’s throat. One thing we’ve found is we can make up for that in a lot of different ways. You can have them feel their pulse and say, ‘Tell me how many beats you have when I say stop.’ You can have them get up and walk around the room and understand whether they’re in a great deal of pain or short of breath when they sit back down. What we’ve found is there is a different approach to evaluating a patient over video.
■ Crane: From a cost perspective, if I can treat a patient without having them go to the emergency room, that’s a huge benefit for us. That patient still stays in our system and they’re cared for by our doctors, but we don’t need the nurse or all the other things you would typically need to care for that patient.
Our ultimate goal is to 100 percent satisfy every patient we come into contact with. They love the convenience of not having to leave their house in the middle of the night or with a painful condition that might make it difficult to leave their home.
We will ultimately reduce our insurance premiums and we’ll be able to attract more patients because we’re providing this quality service at a price that can’t be beat.
■ Crane: I think Dennis and I are philosophically techno-geeks. I’m the guy that gets every gadget the minute it comes out. I had one of the first mp3 players before anyone knew what mp3s were. My wife and I always joke I was born a century too soon. When I came to the organization a year ago and my boss was doling out everything I was going to do, I said, “Can you add telemedicine onto that because I really think it’s the wave of the future.”
Truong: A lot of it is based off our own experiences and passions, our passions for technology and improvement and efficiency. I cannot stand inefficiency. That makes you try to envision, what is one way we can try to do things better?
■ Crane: There’s no doubt in my mind this is a societal thing. The new society is I want what’s convenient for me at a price I’m willing to pay in a way that fits into my lifestyle. The days of taking the day off work to go in to see your doctor are coming to an end. Instead, I’m going to take my lunch break and I’m going to do a video review with my doctor.
In five years, all of this technology will be driven to the home. And in 10 years, it will be ubiquitous where doctors will be able to access glucose readings and oxygen readings ... and actually get alerts when a patient needs to be seen or even call an ambulance. These are the nascent steps toward that goal.
■ Crane: We have about 1,200 physicians in the region and 30 specific physicians are designated as innovation consultants. Their objective is to figure out whether ideas are capable of working and to even pilot these new ideas.
Let’s say you’re providing patient care and something pops into your mind that is cool that you think we should try. There is a light bulb on your computer system, you click it and enter the innovation. We assign those ideas to project managers throughout the region. They’re responsible for vetting those ideas. They’ll rank them in terms of value to patients and value to the organization. If it ranks high enough, we’ll implement it in whatever part of the organization is assigned to that kind of work.
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The Big Idea
Feeling ill and want to consult a doctor? Kaiser Permanente has developed a program called HouseCalls for its members to connect with a physician using a computer or smartphone. And there’s no co-pay.