Rural or Decentralized trials dependent upon the healthcare system
Clinical Trials are dependent upon the healthcare system. A recent HLTH session reflected The risky business of value based care. How does this impact rural or decentralized trials and could the sector take on board the learnings
Are we measuring the right things in value based care? Is there a need to measure safety, equity AND cost, but also equity.
How can we extend from metro to rural impact?
Models of value based care that have worked in metropolitan areas have relied on direct community engagement with practitioners and services. This is harder in rural areas and in rural US communities mortality rates are 23% higher. The key issue is access, and clinicians are not going to move to rural areas. We can’t just replicate the same things. There needs to be Primary care supply in places where it doesn’t exist.
There is a requirement for incentives to go into places they wouldn’t normally go.
What should happen is that everybody has a trusted relationship with their physician.
But what happens is that most people don’t have a trusted relationships with a Physician and look elsewhere for this trust such as pharmacy and digital health.
Models that have worked in rural US include having boots on the ground, eg nurse practitioners and social care. They interact with patients, including in the home, and are supported remotely by a physician. Patients can telehealth with physicians remotely, supported in person by the nurse practitioner for efficacy and efficiency. This has led to increased patient outcomes and huge uplift in engagement and has actually reduced the cost of care.
Another (high set up cost) solution has been mobile clinics connected remotely.
Value based care: where and why has it failed?
- Not meaningful incentives, trying to solve everything at once. Break specific challenges up and address them.
- Scalability
- Administrative burden – High upfront set up and change costs
How to measure patient satisfaction and how that translate to cost savings
“Value based care will continue to fail while brain and body are treated as separate”
What’s the trend in the US?
Payers used to push value based care, but now providers are asking to be paid that way.
Is Venture funding well suited for value based care?
Clinical efficacy and health economics evidence cost money to undertake, and shared saving do create good returns. So the panel felt, yes.
“Customer service, follow up, compassion, kindness and understanding are key to value based care impact” – Corbin Petro (Eleanor Health)
Practitioners prefer to deliver value based care and this is essential for supporting the workers!