Using connected care tools to further value-based care goals

Prevention is better than cure -- this age-old adage continues to guide the healthcare industry as it moves from volume-driven to value-based care models. In value-based care models, healthcare providers are paid based on the quality of care they provide, measured by clinical outcomes, patient and provider experience and the cost of care.

According to Ainsley MacLean, M.D., chief medical information officer and chief AI officer of the Mid-Atlantic Permanente Medical Group, the focus on prevention is a central aspect of the health system's value-based care strategy due, in part, to its origins, which lie in providing preventive care to workers in the 1930s.

"For instance, if one of the workers were to step on a rusty nail and have something like tetanus, you could obviously treat tetanus, but if you could do something preventative where these workers receive, say, appropriate tetanus shots or something to that effect, everyone really wins in the end," she said during a fireside chat at the Connected Health 2024 virtual summit.

Today, the 40-hospital health system that spans eight states and the District of Columbia retains its laser focus on prevention in its value-based care efforts. But it has also widened its approach to include team-based care, characterized by multidisciplinary collaboration, and data-driven strategies underpinned by technology to enhance chronic disease management and population health management.

The technology piece is becoming harder to navigate as health IT evolves at breakneck speed. At the virtual summit, MacLean laid out Kaiser Permanente's approach to digital transformation through the lens of value-based care.

Connected care tools supporting value-based care

Kaiser Permanente is using various connected healthcare tools to enhance clinical outcomes, improve the patient and provider experience, and expand healthcare access.

Telehealth is one of these tools. Kaiser Permanente has been using telehealth for decades; however, as with other healthcare organizations, the health system saw its telehealth volumes skyrocket during the pandemic. MacLean noted that telehealth accounted for 20% of medical visits before the pandemic, rising to 50% during the pandemic's peak.

"One of the things that I always like to emphasize is that telehealth, a lot of times we think of it just as that video experience, but it's really so much more than that," she said. "It's about how can we, as a system, get you the care you need as quickly as possible, but the right kind of care?"

For instance, Kaiser Permanente offers e-visits for urgent care needs, allowing people to seek care and receive treatment while attending to their other responsibilities. Not only that, but the health system also offers acute care in the home where patients are most comfortable.

However, research shows that Americans' preference for in-person care persists. Data published earlier this month reveals that only about a third of adults 18 and older selected telehealth visits over in-person appointments in 2023. To ensure a seamless patient journey, Kaiser Permanente is creating hybrid models of care.

One of the ways we frame it is as this is just another tool within your tool chest when you're seeing a patient for you to use. I do think that in this day and age, with the plethora of technology, the plethora of companies out there, the technology really needs to sell itself.

MacLean explained that Kaiser patients can choose between video visits and in-person appointments when they want to book an appointment. If the patient elects to do a virtual visit, and during the visit, the healthcare provider feels the patient requires hands-on care, they can bring them into the clinic or refer them for other ancillary services.

Another vital tool in Kaiser's connected healthcare toolbox is remote patient monitoring. RPM has boosted chronic disease management, enabling Kaiser clinicians to more effectively treat various chronic diseases, including diabetes, hypertension and congestive heart failure.

"Congestive heart failure is one of those things, and as a radiologist, I know what it looks like on X-ray, and it can really get worse quickly, but if you can catch it early, you can bend the curve," MacLean said. "So, if we can get these patients early, get a phone call out from our doctors, reach out to them, get them maybe one of their medications increased … and then keep them out of the hospital -- it's so much better for them not to lose all that additional time."

In the realm of diabetes care, Kaiser offers patients a smart foot mat that monitors and screens for diabetic ulcers. The monitoring data collected through the mats enable radiologists to catch diabetic ulcers before they worsen to the point the patient needs an amputation, MacLean said.

The health system also combines its connected care tools to further streamline certain areas, like the pregnancy journey. According to MacLean, pregnant women have the option to conduct some of their perinatal care visits via telehealth, and they use RPM devices to send various readings to their providers from their homes.

"That's been, I think, really life-changing for a lot of women," she said. "And I think, kind of, empowering women to take control."

Integrating AI to enhance the provider experience

Like most other healthcare organizations, Kaiser Permanente is evaluating the use of AI. One use case that appears promising is AI-driven ambient listening devices.

The health system launched the technology -- which records patient-provider conversations and documents them as notes in the EHR -- in phases, allowing physicians to provide feedback at every phase, MacLean explained. Kaiser has rolled the technology out to more than 24,000 physicians across its system. However, that does not mean every physician is using it.

"One of the ways we frame it is as this is just another tool within your tool chest when you're seeing a patient for you to use. I do think that in this day and age, with the plethora of technology, the plethora of companies out there, the technology really needs to sell itself," MacLean said.

The physicians using the technology have embraced it. According to MacLean, physicians have shared how the technology has given them more time to complete other administrative tasks, see more patients or simply have more time in their personal lives.

"One of our doctors who used it literally on the first day told me this great story that he normally, after a really busy shift within the emergency department, goes home, eats a big dinner, and then kind of passes out, goes to sleep in his bed," she said. "And he noticed that his first day using this ambient listening device that he found himself in his car driving to the gym, and he was like, 'I have literally not driven to the gym after work since I was like 16.'"

Though these AI tools are not cheap, MacLean noted that the trade-off makes the investment worth it. Because the technology eases the administrative burden straining physicians, it can help support physicians and keep them in the workforce longer without getting burned out. MacLean pointed out that losing experienced physicians to burnout is ultimately far more costly for health systems.

Mitigating risk and breaking down barriers

Though connected care technologies are an integral part of the move toward value-based care, MacLean stated that the various challenges associated with implementing these technologies must be addressed to ensure they have their intended impact.

For one, healthcare providers must ensure patients can access the connected healthcare tools they offer.

"Some of the ways we do that is encouraging really active engagement in this digital front door, in our patient portal, really tracking what percentage of our patients are enrolled within that and what can we do to help educate them or even get family members who can participate in that care because it's critically important," MacLean said.

The health system also takes a data-driven approach to ensuring health equity, conducting research to identify the populations that might not have access to the devices needed for connected health services or have the digital health literacy to use them.

"Technology is the ultimate equalizer once you get there and once you have access to that technology," MacLean emphasized.

Further, Kaiser Permanente is careful about technology selection. Its rigorous internal technology investment and governance structure are focused on evaluating clinical evidence and assessing the return on investment for these advanced technologies, MacLean said.

This internal structure is especially critical as research continues to uncover risks related to AI bias. Kaiser Permanente also has an AI governance framework to ensure the implementation of responsible AI that is developed using unbiased data.

"It comes down to who's training the models, who's developing the models, who's checking the models," MacLean noted. "And so, sort of validating that every step of the way."

Another strategy that Kaiser Permanente employs to ensure successful technology selection and implementation is keeping physicians at the center of these decisions.

"As physicians, we're the subject matter experts," MacLean said. "If I'm taking a flight somewhere, I want to know that that pilot is equally empowered to make decisions… And for me, as the passenger, that gives me incredible peace of mind. So likewise, as the patient, I would want to know that my cancer doctor, my heart doctor, my neurosurgeon, brain surgeon … they feel that they can practice in an environment in which they can make decisions around what equipment they use, [and] what data and what outcomes they feel are most important."

Achieving value-based care is challenging, and maintaining it is even more so. However, by creating clinical care and technology utilization strategies focused on provider well-being, patient experience, objective data, research and health equity, Kaiser Permanente aims to avoid the common pitfalls of today's technology-focused healthcare landscape while advancing its value-based care goals.

"For us, we're looking at it with this lens of what's really adding value, not what's the flavor of the week," MacLean said.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.