Telehealth

TELEHEALTH The Return of the House Call

How technology is shifting how we access our doctor, lowering medical cost and replacing sick care with health care.

WORDS BY | FAWN ABERSON

The onslaught of Covid-19 has impacted economies around the world, threatened everyone all at once, and is literally forcing “the masses” to consider not only their own health, but the health of others around the globe. With the hyper focus on how we are all feeling physically, adapting economically, interacting socially and professionally, the use of technology has been evolving us rapidly towards a “new normal”. Even more significant is that a greater part of this evolution will likely remain in play long after this pandemic has loosened its grip on our lives. Zoom, Teams and Google Chat virtual video meetings have been adapted and used by everyone from the White House to the Jenkins’ house, from the boardroom to the classroom, and yes, affected even patient/doctor visits. Virtual communication, although not new, has never been used so broadly by so many socioeconomic groups all at once.

As 2020 ushered in the Covid-19 pandemic and subsequent rules of engagement, it also ushered into the spotlight a tele-health company called One Medical. Touted as the nation’s largest independent membership based, primary care provider, it is working to forge an innovative path leading patients to access primary care by conducting virtual visits with their physicians through online video and chat platforms. Although office visits are still available, the technology component of this care is paid for as part of the patient’s memberships. The cost is around $199 annually and it includes a phone app and access to services 24/7.

“We focus on how can we help people and engage and empower them in being more proactive about their health.”

One Medical was originally formed out of a single practice established in 2007 by Dr. Tommy Lee, who was looking to make primary care more economically feasible. Most practices in primary care struggle to make profitable margins despite the fact that the amount of money spent per person on health care is higher in the United States than in other countries. By 2017, One Medical had grown to 72 locations throughout the US and in 2018, the Carlyle Group, a private equity management firm, invested $350 million in the company. One Medical went public in January of 2020, filed under the initial public offering trading name, 1Life Healthcare Inc. Thanks to an expansion partnership with Providence St. Joseph Health, it grew into 8 more locations including Portland and Seattle and now has - Dr. Natasha Bhuyan, Regional Director of West Coast Markets for One Medical. similar partnerships with large hospitals in other markets. This trend is helping hospitals build their provider network, reverse the current system of economic rewards, and shift focus from sick care to one focused on preventative healthcare. One Medical office spaces are generally small but “designer” in décor to make their members/ patients feel less anxious about emergency rooms and unintentionally seeing a doctor. However, a lot of what they are banking on is connecting with their patients through virtual video visits or chats as a way to cut costs for patients and employers by improving the primary care experience.

Doctors at One Medical are paid a salary rather than on a fee-for-service basis, allowing more time with patients and removing incentives to refer patients to specialists. “Testing is a national concern. At One of a lack of adequate or available testing.”

“I joined the medical practice because I was looking to impact people’s lives and be intimately involved. Primary care seemed such a great avenue to do that. I joined One Medical becauseit’s a more innovative way of practicing medicine. We are a membership-based primary care practice and our goal is to transform health care for all by integrating this 24/7 virtual care with the in-person in-office care model. In addition, we also we have lab services in our offices.” Shared Dr. Natasha Bhuyan, family physician and the Regional Director of West Coast Markets for One Medical.

“We focus on how can we help people more proactive about their health, and making health-care more accessible and convenient.” She continued. “We have same day/ next day appointments, we have an app you can use to do a video chat with a physician, access your health records or, get prescription renewals. Through virtual care, we can help manage chronic disease such as diabetes and obesity, we can treat common issues like urinary tract infections and rashes and even look at muscular skeletal issues. One of the biggest things we are seeing patients for right now is mental health, which is a really important part of what we do in medicine.”

In early April of this year, One Medical also began to activate mobile testing sites to help diagnose the coronavirus in communities all over the country. These sites are intended to keep people who fear they may have the virus from overwhelming hospital further spreading the virus in spaces that are already struggling to get the personal protective equipment (ppe) they need to service critically ill patients.

Medical we thought it was important to be able to offer wide spread testing because it is an important component of the public health response to Covid-19 and in understanding the prevalence of disease,” stated Dr. Bhuyan. “We set up mobile testing because you actually end up using far less ppe than in the hospital, and you are able to swab and test a higher volume of patients. We are able to offer hundreds of tests to people in a place like Portland per week because people need it. The long and short of it is, the loss of life and our economy being shut down as long as it has, is because and engage and empower them in being

She concluded.

Due to Covid-19, One Medical is also offering free memberships for front-line responders and essential workers for 30 days. Folks from these groups simply need to call the hotline at 1-888-0nemed1, or email essentialworkers@onemedical.com. For anyone else with Covid-19 concerns, or who

would like to try out the virtual care features, they can also activate a free 30 days membership by going to www.Onemedical. com to download the app and then type in the code GETCare30. Dr. Bhuyan explains the process at One Medical as follows;

“For those with Covid-19 concerns, once they have registered as members, they will connect with a clinician who will set them up at a mobile test site, most often the same day. When you arrive at a site, the entire test itself is less than 5 minutes. We use a nasal swab to get some respiratory secretions as a sample and send it to a commercial lab. The turnaround time to get results is about 2-3 days. At the mobile test sites, what we are testing for is the actual virus and active infection; it’s known as PCR or RNA testing which looks for genetic components of the virus. Why this testing is more complicated than the other test is related to the swab itself and the availability of ppe for the health care providers. If you don’t have enough of either, you aren’t able to provide testing.”

In their office setting, One Medical staff is also offering the coronavirus antibody test which is a blood test that checks for prior infections a couple of weeks or months ago, keeping patients with respiratory concerns in separate spaces from non-respiratory concerns. They currently work with most health care insurance and Medicare, however Medicaid is still unavailable.

“ We d o n ’ t w a n t t e s t i n g t o b e c o s t prohibitive, so if you don’t have insurance we won’t charge you for the testing.” She shared. “That said, in some cases the outside lab we send the test to may send you a bill separately as part of their fee, and that is generally around $51. 00.”

One Medical is also working with the local Health Departments in each state on reporting cases and critical data, but as always, mindful of the sensitivity of client patient confidentiality.

“Data sharing is a huge topic in medicine. How do we honor and respect patient privacy, but at the same time, how can we act without knowing all the information? Internally, our teams are thinking about this all the time.”

As testing sites across the country wrestle with these questions, what is emerging from the data that has been gathered, is that the prevalence of chronic diseases paved the path of destruction wreaked by Covid-19. This disproportionately impacted communities of color who are more likely to die if infected then their white counterparts. “We really need to understand, what are systemic issues that persist in our healthcare system that disproportionately impact different communities? The reality is, part of that is related to our infrastructure and part of that is related to our implicit bias that we know people in health care have. This is such a big issue. What I distill it down to is, I know that my mission at One Medical as a clinician, and as a person of color, is making sure that we do reach and give quality primary care to all people, and that it is inclusive. That means we do talk to our patients about race and ethnic identity when we are treating them because part of this is also their family history, right? Another thing we touch upon is education. I am not talking about educating our patients; I am talking about educating us as providers. We need to understand what health disparities mean, and how implicit bias impacts how we deliver care. Starting with a diverse health care workforce is important and that is something we are always looking to expand, as is making sure we have clinicians of color and of diverse backgrounds able to serve those communities.” Stated Dr. Bhuyan.

For a Black person interested in pursuing a medical degree, the latter of Dr. Bhuyan’s statements implies yet another different, yet same, kind of struggle. Throughout history, it has always been a challenge for Black and other communities of color to enter the upper echelons of the medical field, starting with even being accepted into medical schools in the first place. According to the Association of American Medical Colleges, active physicians by race/ethnicity are 56.2% White, 17.1% Asian, 5.8% Hispanic, and 5.0% Black. 13.7% of active physicians are of unknown race and/or ethnicity. Yet, as evidenced by the example of OneMedical and Dr. Bhuyan, where there is a will, there is always a way

“For me, yes it is important to focus on Covid- 19 but also, let’s not forget what good primary care looks like. Good primary care needs to continue during and coming out of this pandemic. This pandemic is really pushing us to this new frontier of medicine, to see what we can offer virtually via telehealth options and safe access in order to make sure people get the care that they need.”

So as we move through 2020 with health at the forefront of our minds, it’s hard not to consider all of the underlying conditions that have perpetuated the Covid-19 pandemic, viruses of the past and even the bad health habits of humans in general. All can be traced to similar factors that have perpetuated chronic illnesses over the course of our lifetime. Human consumption of badly cared for or modified food, breathing of polluted air or living in toxic environmental conditions, lackadaisical or poor access to resources needed for good hygiene habits, and generally inadequate attention to our own immune systems and general wellbeing, are all common but controllable factors we could improve upon with either personal or collective attention. If we choose not to focus on improving these things, the bottom line will be that the economic and personal habits of us humans will continue to make the entire world sick. It bodes the question: if we want to continue to move about this Earth with some sense of freedom and ability to make enough money, how might we do so with more respect, care for ourselves and others, and then make that an ongoing practice? Like so many things these days, the answer may lie in better technology.

Perhaps as we begin accessing primary care more frequently through technology, moderating our wellness will serve as an integrated part of fortifying our immune systems and improving our personal behaviors. Maybe then we can spend less time treating our sicknesses and more time supporting our health.

“For me, yes it is important to focus on Covid-19 but also, let’s not forget what good primary care looks like.”