By Dr. Vidya Raman-Tangella, Chief Medical Officer, Teladoc Health
It’s the annual dentist visit. It’s the long bus ride to the doctor’s office. It’s the role your local pharmacy plays in your health. It’s considering the well-being of the mother when conducting a well child visit. All these things, and more, are critical to understanding the power and potential of integrated care.
At this year’s AHIP meeting, I had the pleasure of discussing what integrated care means—and how it’s being used to make a real impact on health—with two healthcare leaders I admire, Rutu Ezhuthachan, MD, Chief Medical Officer at Meridian and Donna Milavetz, MD, Chief Medical Officer at Regence Health Plans. Our definitions may vary based on the audiences we serve, but we agreed on one thing: the importance of keeping the person at the center.
Of course, this concept isn’t new, but this panel highlighted more creative ways we can all use integrated care to bring better outcomes to the people we serve.
Integrated healthcare is generally understood to be a collaborative approach that combines general, primary and behavioral healthcare. At Teladoc Health, we go further by integrating these with urgent, chronic and hybrid care for a unified consumer experience through a single application.
An important part of that integration is using it for earlier identification of conditions and disease. For example, Dr. Milavetz cited that 70% of primary care visits are related to behavioral health issues and an estimated 9-17 percent of total healthcare expenditures could be eliminated with medical and behavioral health integration. Her organization is working towards collaborative care models that address behavioral and physical health in the same office visit setting.
Meanwhile, we’ve found that about 60% of patients who seek out our primary care services have never seen a primary care provider! And in about 25% to 30% of these cases we diagnose hypertension or diabetes for the first time in these patients—who can then, through the power of integrated care, be connected with mental health resources as needed.
Integration may also mean rethinking who’s part of the care team. For example, Dr. Milavetz made the point that many of us see our dentists more than our PCPs—a potential opportunity to integrate care with the community health partners patients already know and trust. Whether it’s integrating marriage counselors to support behavioral health interventions, school programs that advocate for better health, pharmacists who are the face of hyper-local care—the potential to include a broader range of allied providers is exciting to think about.
Another point we all agreed on is that integration simply isn’t possible without data, technology and the insights they offer. For us at Teladoc Health, that of course includes claims data and clinical data. Then there's consumer generated data—everything from sensors and devices to what people share during their virtual visits. And then, importantly, is the context. Who's this person? Where do they live? How much do they travel? What's their life like? Knowing all this, we can build a better picture – or model – of each member. This makes us smarter about what we recommend and gives care providers great insight into what these patients need from them.
Dr. Ezuthachan explained how Meridian uses dashboards including critical quality measures and social determinants of health to better serve its patients. For example, by layering data from integrated care and with social drivers of health, her organization learned that a group of women weren’t getting their breast cancer screenings because of childcare issues. Recognizing the need for that kind of intervention can help people get to a better outcome. And that's where that value lies for the member, and for the organization.
Similarly, Dr. Milavetz explained how Regence is investing in gathering REL (race, ethnicity, language) and SOGI (social needs, sexual orientation and gender identity) data to support health equity, identify disparities, and connect members to culturally responsive care. It’s gratifying to see so many health organizations using data to identify opportunities for change, while being careful to engage authentically and personally, rather than relying on stereotypes.
We also discussed wanting patients to have a seamless journey, without needing to know the integration is happening on the back end. This includes care providers too—Dr. Ezuthachan stressed the importance of getting them on board with integrated care and giving them real-time access to patient information to help them drive engagement.
Dr. Milavetz shared how Regence is expanding its definition of when and where care happens, by partnering with services that bring urgent care straight to the patient’s home or expanding access to virtual care and collaborative care models.
At Teladoc Health, elements of our next generation integrated care experience are already making an impact on things like risk stratification. For example, our integrated chronic care programs have helped move the percentage of high-risk registered members from 66% to 8% in one year alone, while the number of low-risk members increased 50%, from 24% in one year. Meanwhile, Teladoc Health members who also engaged in mental health services experienced a greater than 80% improvement in blood glucose, a more than 30% decrease in blood pressure, and a more than 10% increase in weight loss.
In the end, we all agreed that the challenges of integration—and there are many—are also opportunities. Individualized care is a journey, but this panel’s message is to just get started, because you can begin to make an impact on day one. And that makes all the effort worthwhile.
