A new foundation to the medical triage pyramid

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When we consider how to access medical care, we have traditionally used a triage pyramid. They are based on three levels of care.

Base Level: The base level of the traditional triage pyramid consists of the Primary Care Physician’s office, Urgent Care Practices and the Emergency Rooms. Usually, when care is needed, entry to the pyramid occurs at this level. An assessment of condition, identification of treatment, and prognosis for recovery are conducted. If treatment resolves the issue, the patient is released, sometimes with prescribed follow-up appointment, and the episode is closed.

In cases where treatment at this level do not (or would not) adequately deal with the patient’s issues, the patient is moved up the pyramid to a higher level of care.

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Second Level: The second level of the traditional triage pyramid includes Specialists and Hospitalization. This level is characterized by much more extensive testing, advanced diagnosis, and usually extended periods of treatment. Efforts become much more focused on specific needs of the patient and typically involve more expensive (and invasive) treatments. When the efforts for treatment are successful, patients may be released from care, or in the case of specialists, may continue with monitoring and maintenance for an extended period of time.

Third Level: The top level of the traditional triage pyramid is Long Term Care. This level of care is typically the most extreme and costly. In many cases, this is palliative care focused on comfort and not recovery.

As we view this traditional Triage Pyramid, a patient can enter at any level as symptoms demand. We also see that costs typically increase as we spend more time in and we move up the pyramid. Further, we find the increasing costs of the pyramid can be attributed to the fact it is reactionary, not preventative.

Controlling costs – A new foundation

To control and/or reduce costs, we need to impact the Triage Pyramid at the lower levels in ways that effectively reduce the number of patients that need to migrate upward within the pyramid. What if we created a new foundational level?

Telehealth Access can become the new foundation to your Triage Pyramid. Telehealth offers access to qualified medical personnel in a more timely fashion and at a reduced cost. When this care is effective, the patient exits the Triage Pyramid very quickly and at a lower cost than any of the options on the higher levels. The ease of access and reduced cost, if properly promoted, can result in increased utilization at an earlier point of identified need. In other words, patients will access care earlier, avoiding the higher costs created by delayed treatment. As with all levels of the pyramid, patients can exit when treatment is successful or be elevated to a higher level as needs dictate.

Can this new foundation be effective in controlling costs? Let’s take a look at a recent study by the University of Rochester Medical Center in Rochester, NY. The research, begun in 2010, involved more than 1,500 older people including residents of independent and assisted living facilities, and evaluated over 500 telemedicine encounters.

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Results indicate that telemedicine eliminated nearly one in five ER visits. Ninety percent of the cases required no additional care by a primary care physician, and in 97 percent of the cases doctors, physician’s assistants or nurse practitioners were able to make a definitive diagnosis and treatment recommendation.

Engagement is the key
It is not enough to simply make this new level of care available to patients. As with any change, the benefits must be promoted. For this reason, the new foundation level shown is not simply Telehealth, but an engagement management system that achieves the requisite 20% to 30% utilization or more. Surveys have shown that once used, most patients have favorable impressions of a telehealth consult. Engagement becomes the critical factor to the success of adding this new foundation to your Triage Pyramid.

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