Making Tradeoffs Between Access, Quality, Equity, and Cost

TOPICS:

Posted By: Healthcare NOW Radio Host July 24, 2024

Joshua Liu, MD

Co-founder & CEO at SeamlessMD
LinkedIn: Joshua Liu
X: @joshuapliu
Co-host: The Digital Patient Podcast
Musings and Insights

𝐇𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐢𝐬 𝐜𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐞𝐝 𝐛𝐞𝐜𝐚𝐮𝐬𝐞 𝐲𝐨𝐮 𝐜𝐨𝐧𝐬𝐭𝐚𝐧𝐭𝐥𝐲 𝐡𝐚𝐯𝐞 𝐭𝐨 𝐦𝐚𝐤𝐞 𝐭𝐫𝐚𝐝𝐞𝐨𝐟𝐟𝐬 𝐛𝐞𝐭𝐰𝐞𝐞𝐧 𝐚𝐜𝐜𝐞𝐬𝐬, 𝐪𝐮𝐚𝐥𝐢𝐭𝐲, 𝐞𝐪𝐮𝐢𝐭𝐲 𝐚𝐧𝐝 𝐜𝐨𝐬𝐭 – 𝐰𝐢𝐭𝐡 𝐧𝐨 𝐨𝐛𝐯𝐢𝐨𝐮𝐬𝐥𝐲 𝐜𝐨𝐫𝐫𝐞𝐜𝐭 𝐬𝐨𝐥𝐮𝐭𝐢𝐨𝐧 𝐭𝐨 𝐦𝐚𝐧𝐲 𝐜𝐨𝐦𝐩𝐥𝐞𝐱 𝐬𝐜𝐞𝐧𝐚𝐫𝐢𝐨𝐬:

→ Virtual care increases access to care and may improve clinician well-being… but could decrease access and clinician supply for those without broadband Internet.

→ Digital Health can improve average health outcomes as those with technology access and motivation will engage… but this technically increases health disparities as those who don’t engage have outcomes that remain the same.

→ More time spent with each patient means less patients that can be seen overall… how do we know the right balance between access to care and quality of care?

→ Shifting from only physician-led visits to some nursing/allied health-led visits to potentially even AI agent visits some day… is any form of care better than no care?

So how should we think about this?

My thoughts:

→ 𝐇𝐚𝐯𝐞 𝐜𝐥𝐚𝐫𝐢𝐭𝐲 𝐨𝐧 𝐨𝐩𝐞𝐫𝐚𝐭𝐢𝐨𝐧𝐚𝐥 𝐩𝐫𝐢𝐧𝐜𝐢𝐩𝐥𝐞𝐬 𝐚𝐧𝐝 𝐭𝐫𝐚𝐝𝐞 𝐨𝐟𝐟𝐬 𝐚 𝐡𝐞𝐚𝐥𝐭𝐡 𝐬𝐲𝐬𝐭𝐞𝐦 𝐢𝐬 𝐰𝐢𝐥𝐥𝐢𝐧𝐠 𝐭𝐨 𝐦𝐚𝐤𝐞:

E.g. if the current standard of care leads to an outcome of X, and providing digital health tech leads to an outcome of X + 20% for only those who use it… can we live with some patients having the baseline outcome of X and some getting the outcome of X + 20%?

In other words: are we willing to trade off perfect health equity in exchange for a higher average outcome? If yes, under what circumstances?

The reality is we can’t have perfection in every aspect of healthcare delivery. e.g. higher quality of care will always cost more.

But if we can be clear about the tradeoffs we are willing to make, then we can be more aligned on system-level decisions and move more quickly.

→ 𝐁𝐞 𝐚 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐡𝐞𝐚𝐥𝐭𝐡 𝐬𝐲𝐬𝐭𝐞𝐦:

We need to deeply understand how different reimbursement models and care delivery models change provider and patient behaviour.

In particular, we must learn under what circumstances certain approaches thrive or fail and why.

→ 𝐀𝐩𝐩𝐥𝐲 𝐧𝐮𝐚𝐧𝐜𝐞 𝐭𝐨 𝐡𝐨𝐰 𝐰𝐞 𝐚𝐩𝐩𝐫𝐨𝐚𝐜𝐡 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐟𝐮𝐧𝐝𝐢𝐧𝐠 𝐚𝐧𝐝 𝐝𝐞𝐥𝐢𝐯𝐞𝐫𝐲:

E.g. private vs public healthcare is the wrong debate because it leads to people looking at all of healthcare through a single perspective.

Instead we should be asking: what is the right funding/delivery model for different aspects of healthcare, with private/public approaches leveraged simply as tools to be used?

Instead of making blanket statements of “private health care doesn’t work”.

We should be asking: “under what circumstances does private health care work better than public healthcare? Does any of that apply to our current situation?”

*****

How do you believe we should think about making these tradeoffs?

The Digital Patient

The Digital Patient takes an “edu-taining” approach to all things digital patient care. On this show hosts Dr. Joshua Liu, and Alan Sardana talk with healthcare, technology, and innovation leaders about the latest advancements in digital health, trends in digital transformation, and strategies for optimizing the patient experience.