By Arin Sime, CEO/Founder of

The ideal outcomes of any healthcare initiative are to reduce costs and improve patient outcomes at the same time. If we are to make healthcare more sustainable, efficient, and effective, then we must accomplish both of these goals, even if they seem in conflict many times.

A recent article in Harvard Business Review lays out a path to meeting that lofty goal. In this blog post, I’ll discuss some of the telehealth-specific initiatives they highlight that can support their plan.

Learning from Kaiser Permanente

In the January/February 2020 issue of Harvard Business Review, authors Robert Pearl and Philip Madvig write about “Managing the most expensive patients:  A new primary-care model can lower costs and improve outcomes.” Pearl and Madvig draw on their experiences as former CEO and former Associate Executive Director, respectively, of the Permanente Medical Group and its health care system, Kaiser Permanente.

The problem they discuss is that the sickest 5% of US patients consume 50% of healthcare spending in the US. Clearly, if you want to make healthcare more efficient, then you must address this imbalance. The authors break this 5% out into three different cohorts. They show how this deeper understanding of the sickest 5% of patients helps us to see why other efforts at wellness and disease-management programs have not led to significant cost reductions or better patient outcomes.

I recommend reading their full article in order to fully understand their argument. The essence of it is there is no single solution to address all of the sickest 5% of patients. They are a mix of patients with chronic conditions that can be improved, one-time catastrophic health problems, or chronic conditions that are so far progressed they cannot be improved. The patient profiles and treatments for these distinct groups are not homogenous. This is part of the reason that controlling costs while improving care is so hard.

The “Leveraged Primary Care” model

Much of the article describes the “Leveraged Primary Care” model at Kaiser Permanente, which they have found to lead to dramatically better results. One impressive example given is that, as a result of their leveraged primary care model, “90% of [Kaiser Permanente’s] patients with high blood pressure have it under control, compared with only 54% across the United States.”

I’ll focus on two aspects of what makes their primary care model “Leveraged”:

  1. Medical assistants
  2. Healthcare technology (including telehealth)

In this context, “medical assistants” refers to humans, not an artificial intelligence or bot. Patients who manage chronic conditions can have better outcomes through more frequent follow-ups with medical staff. Unfortunately, doctors and nurse practitioners are very busy and very expensive. It’s not cost-efficient for them to call patients weekly to check on their medications, lifestyle habits, and medical conditions.

A medical assistant, however, costs half as much as a nurse practitioner, only needs a year of training, and can handle more frequent contact with patients to check on their progress. This frequent contact leads to fewer emergency room visits and reduced need for doctor’s office visits. This reduces the overall costs of treating that patient even after factoring in the modest salary of the medical assistant.

How telehealth helps

Here’s where telehealth comes into the picture. If the assistant needs to frequently contact patients for follow-ups, this doesn’t need to be done at the medical clinic. The medical assistant’s frequent contact with patients for follow-ups doesn’t need to be done at the medical clinic. That will become burdensome and expensive for both the patient and the care provider. This is a perfect use case for telehealth.

Video in telehealth

The authors call out a number of ways telehealth technologies could be used by medical assistants or doctors. In the case of ongoing diabetes treatment, the authors imagine a medical assistant using a telehealth video call to observe a patient’s ulcerations on their lower limbs. That image could then be shared with the doctor, especially if flagged by the assistant as troubling. Seeing this more frequently can allow the medical assistants and doctors to catch deteriorating conditions before amputation might be necessary.

Integration with remote patient monitoring devices

Beyond video, there are many other ways that telehealth can help medical assistants efficiently keep tabs on patients’ treatment plans. This could involve integration with blood pressure monitors, step counters, or other remote patient monitoring devices.

Medical forms in telehealth

Our telehealth platform allows for real-time collaborative medical form editing on a video call between the care provider and patient. This means that the medical assistant can update medical history forms and record information about the patient’s condition on a more frequent basis, for additional review by the doctor or nurse practitioner at the next in-person visit.

Using AI and bots in telehealth

Looking further ahead, the authors also imagine that artificial intelligence and bots can be used to support this model and take some of the burden off the human medical assistants by providing automatic text messages, reminders, and voice messages to patients about their treatment.


Telehealth is just one piece of the Leveraged Primary Care model Pearl and Madvig describe, but it’s an essential element. It doesn’t necessarily require additional training or time spent by doctors and nurse practitioners, especially if medical assistants are employed to maintain that contact with patients. The authors make a compelling case for Leveraged Primary Care in general as a way to improve healthcare delivery in the US, and unique telehealth solutions are part of that case.

The authors state that in a value based payment system or capitated reimbursement system, it’s worth it for medical systems to invest in medical assistants and telehealth technology to reduce costs and provide more effective care. This is an important distinction and shows the importance of aligning healthcare reimbursement laws with patient outcomes in order to spur innovation in healthcare and healthcare IT. But even without full alignment on reimbursements, forward-looking private medical clinics, hospital systems, and direct primary care can all look at integrating medical assistants and telehealth technology in order to provide more effective and cost-efficient care to their most expensive 5% of patients.

Regardless of the size of your medical clinic or system and whether you employ the Leveraged Primary Care model, our team can help you build a telehealth solutionContact us for more details!

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