Virtual-First Health Plan: Another Paradox for Physician Independence

Modern Data Analytics, Big Data, and Computer Algorithms can Turn Physician Clinical Judgment against Them!

Illumination on Medium initially published his article on Medium.


Photo by James Yarema on Unsplash

For over three decades, the healthcare system in America has been through constant turmoil regarding the balance between quality of health and health expenditure. From the start of the Medicare program in the 1970s to the expansion of other management organizations are purely fee-for-service payment models to a capitation payment model; all are the epitome of trials and failures the healthcare system has encountered. That is not only in the United States but also across most developed countries. The recent transition to a value-based medical care model also has stirred the already murky waters of the healthcare swamp.

The contemporary healthcare riddles have placed overwhelming pressure on independent physicians. And all are the abrupt impact of the heavy-handed administrative mandates and cartel of the large corporations, the insurance industry, and their associated red tapes.

While independent physicians are struggling to cope with the clutter of diversity, United Health is coming up with new strategies. Those strategies will further transition the already saddled small medical practices from a diverse pool of patients to a state they will subject independent physicians to see solely complex medical cases.

The Rollout of Virtual-First Health Plan

In 2021, the American international managed healthcare and insurance company UnitedHealth Group established the first-ever concept of the "Virtual-First Health Plan." By mounting the plan, the company claims to help patients 24/7 access virtual medical care and help patients obtain quality medical care at a Lower Cost. The new service's name is "NavigateNOW."

United health's new "virtual-first" health plan offers individuals a personalized virtual care team. The service includes medical and behavioral health services from a remote location. The in-person hands-on medical only comes if the medical professional on the other side of the virtual platform feels it is necessary.

The new medical coverage comes with a selection of physicians vetted by the United Health and more unadorned experience while offering members $0 copays for standard services, limitless 24/7 access to virtual care, and reducing overall plan premiums by 15%.

According to the company's website, Optum care is the "NavigationNow" technology platform provider. They presumably have developed an integrated and coordinated healthcare system that facilitates personalized preventative care to their patients.

NavigationNow members, in addition to virtual urgent care, are also relishing most generic medications, with unlimited chat, online scheduling and on-demand, same-day appointments, and access to wearable devices. Patients can earn up to $1000 annually by simply using the wearable device and satisfying pre-determined daily activity protocols.

“Even though patients have more tendency to track their health goals on weight, physical activity, sleep, medication adherence using various apps and wearable devices, still innovator have much to do to ensure quality technology that utilizes direct physician input to deliver precision medicine” — Adam Tabriz, MD

NavigationNOW Sounds Ideal, Yet you must Read Between the Lines.

Without a doubt, evidence for the utility of virtual medical care is formidable. Nonetheless, it is not always the tactical intent of the corporation that makes the difference in the care of patients. The difference is whether the company's business strategies align with its tactical mission.

“Understanding the basics of healthcare technology is the professional rectitude, as it will prevent adverse consequences wrong technology and misfit algorithms by wrong hands” — Adam Tabriz, MD

Tandem to the refinement of healthcare software technology, so has the big data. The blowup of the fiercely competitive market has led many corporations to pivot their original tactical solutions replacing them with boundless business strategies that exclusively focus on economic success.

Indeed, the jeopardy of NavigationNow does not halt solely on redistributing more cumbersome tasks to independent physicians and assigning the more straightforward cases to the new concept. Amidst increasing interest in the value of Big Data in our digital age, health information management is the new era of Goldrush. Giant corporations such as Google, Amazon, Apple, Facebook, Microsoft, and United Health have evolved into indomitable data wealth inheritors. Their profits are streaming collectively, stretching up more than $25bn in quarterly profit annually.

In this instance, when the company offers patients up to $1000 per year for using the wearable device, it only points out the significance of the data to the insurance company and how that will translate to future patient premiums. The concept is a double-edged sword; it is not necessary that if you carry out healthy habits, you get paid more if they learn you have a sedentary life, then you may have to pay higher premiums.

Furthermore, access to the physician's clinical judgment through the retail-based virtual care and input of data generated by wearable devices serves as a limitless and invaluable source of data for computer Deep Learning (DL) and Artificial Intelligence.

It will not be long before computers replace all the physicians and clinicians in NavigationNow virtual network. But for now, the computer must learn from the decision-making capability of the physicians.

The answer rests in understanding the intention and handing back the data to its legitimate owners first, selling the data back to the corporations, and setting the value of data based on its respective proximity to health measures.

The rhetorics of NavigationNow may sound louder than its strategic clatter.

Not long ago, I published a piece titled "Physicians are working like Robots for Robots. But, convincingly, shouldn't it be the other way around?" An article takes a closer glimpse at the modern-day Healthcare Paradox.

Health information technology in the hands of corporations is utterly disrupting the physician practice. It is dictating how physicians must practice and how much they should earn. Physicians today are the subjects of mathematical algorithms. Indeed, working like a Robot is the expected attitude of physicians in developed countries.

I am not sure if NavigationNow does or will eventually use Artificial Intelligence technology. However, it would not stun me if it did!

According to some reports, United Health is infusing Deep Learning technology into its healthcare scheme.Computers require algorithms to diagnose, just like a physician needs medical knowledge.

Developments in modern data analytics and computational power have granted the computer's capability to learn, hence "Clinical Decision Support" (CDS).

Since the computer doesn't go to Medical School, with the inception of new machine learning facilities, unstructured data is becoming more convenient, particularly regarding deep learning gadgets' capability to shadow learn physicians' clinical judgment. Therefore, amidst physicians opting to be followers, it is essential to realize that they work like robots. Nonetheless, they are working for them as the instrument of in-depth learning education.

The Ideal Virtual Platform is a Hybrid with the Individuals in Control

Transparency of algorithms and operations is of utmost importance in virtual care. Notably, in the era of data insecurity, it is a fundamental necessity to ensure what happens to valuable patient information and physician clinical decision-making. On top of newer data analytic modalities like real-time data analysis, the latter offers to harvest the most up-to-date data upon its creation. That, in turn, makes it even more essential to decentralize the data ledgers.

The utility of Blockchain offers data ownership to the original proprietors first, physicians and patients. Only then, if needed, can one assign the data to others.

Handing back data to patients and ensuring that every virtual and clinic encounter is transparent, happens in tandem concordance with one another, and is in real-time will facilitate patient engagement and offers a collaborative environment to all healthcare stakeholders. That includes independent physicians.

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