Virtual Docs.for All!

There are lots of big ideas being pushed these days, in partly reflecting the run-up to the 2020 elections.  There is the Green New Deal that aims to move the U.S.to a "secure, sustainable future," including (but by no means limited to) moving away from fossil fuels by 2030.  In healthcare, there's the evergreen "Medicare for All," which didn't secure Bernie Sanders the 2016 Democratic nomination but which is popping back up (although skeptics point out it is more like Medicaid for All). 

We'll see how either of those play out, especially with our divided, hyper-partisan elected officials, but instead I'll propose something that is potentially more achievable: let's ensure that every American -- at least, those with access to a smartphone or computer -- has access to their own virtual physician (both human and A.I.).

Baidu's Melody.  Creit: Baidu

Healthcare reform in the U.S. in recent years has tended to be about improving the number of people with health coverage (even ACA left some 27 million without coverage) or using more "value-based" payment mechanisms, which have yet to really shake-up our fee-for-service system.

We are a long way from getting consensus on covering everyone, or on revamping the methodologies for the incomes of all healthcare professionals/organizations, but virtual care for everyone is something we can achieve now, at a reasonable cost.

Andy Kessler, writing in The Wall Street Journal, says "it's time to fire your doctor!"  He lists many of the ways consumers can use technology to track their own health, as well as seek medical advice through "several smartphone-based platforms now function like Uber for doctors."  (He is quick to note though, that when you're really sick you'll still want a specialist).

Mr. Kessler points out: "Doctors don’t scale, so the real future of medicine is digital diagnosis...The revolution is coming.  But not from your doctor."  

Credit: Accenture

A.I. has been looming for healthcare for a few years now, with uneven results.  Babylon Health, for example, pitched its chatbot in the U.K., but ran into concerns from physicians about the advice it was giving.  In China, Baidu has been using its chatbot (for both consumers and doctors) for a couple years.  China views A.I. as an essential component of its future healthcare system.  

Meanwhile, A.I. continues to get better. A new study (from China, not surprisingly) demonstrated an A.I. that was highly accurate in diagnosing several common diagnoses.  It's accuracy rate challenged the highest accuracy rates of human physicians.  The thing to remember, as Mr. Kessler noted in his article, is that "The best doctor sees one patient at a time, but a clever piece of code can be used by countless people." 

Studies have also found that A.I. can detect heart disease and lung cancer more accurately than human physicians, and in diagnostic imaging.  There have already been FDA approved AI tools for ophthalmology and stroke detection.  

Healthcare Bot use Credit: Microsoft

In a recent Insights, Forbes cites study that indicate private sector investment in healthcare will reach $6.6b by 2021, with AI generating potential U.S. annual savings of $150b by 2026 (Accenture) or $269b (McKinsey).   IBM (Watson) and Google (Deep Mind) have invested heavily in A.I. for healthcare, and Microsoft just rolled out its Healthcare Bot Service to help spur creation of chatbots and A.I. personal assistants.  

As for virtual care from humans, it is not entirely clear that virtual visits do replace in-person ones, nor are most physicians involved in providing them, but the promise remains.  Kaiser Permanente, which has also long been an advocate of using A.I., claims over half of all visits are virtual.  Many, perhaps most, large health plans/employer health plans give their members the choice of virtual visits.   

Rock Health's 2018 Digital Health Consumer Adoption survey found continuing increases in the percentage of consumers using such services: 75% have used at least one telemedicine channel.    

If we think about it, it is crazy that when we have a health problem, the thing we are expected to do is to call our doctor for an appointment, then drive there (or to the ER/urgent care) to find out what is wrong.  This is why we end up sharing our germs with a room full of other sick people, waiting for our turn to be seen, and worrying the whole about what might be wrong and is going to happen to us (not to mention how much it will cost). 

There are too many unnecessary visits, resulting in too many unnecessary tests/procedures.  Everyone agrees on the problem, but few healthcare professionals think they are the problem.  They're just as happy to have those in-person visits, regardless of the time and money they cost their patients.  That is not putting the patient first, and that is not patient-centered care.

In most cases, the first step should be an AI-based triage to determine what is most likely to be wrong, if I need to communicate with a human physician immediately/virtually, or if I need to seek in-person care -- and, if so, from whom/where, taking into account any health plan network restrictions. 

The U.K's National Health Service reportedly pays Babylon Health about $80 per patient annually, which would equate to around $26b.  That sounds like a big number, but it's probably more like a CHIP-sized bargain.  It's much cheaper than Medicare-for-All or the ACA premium subsidies.  The cost could most likely be reduced by economies of scale, tougher competitive bidding, and, most substantially, passing off costs by requiring health plans to cover it. 

Such coverage would also let the U.S. set the standard in "licensing" AI for healthcare and end the crazy-quilt licensing of human telemedicine physicians we have now.  Both would be boons for the U.S. healthcare system. 

We're already (finally) getting more worried about China's efforts in A.I. -- as demonstrated by President Trump's recent A.I. order -- and this initiative would help us keep pace with their A.I. healthcare efforts.

Giving everyone access to a virtual physician is a good thing to do.  It's the right thing to do.  And it's not only something we can afford to do; it's something we can't afford not to do.