“The promise of patient convenience without the extra burden has won Bright.md a growing fan club among hospitals and medical groups.
- AVIA Innovator Network

“New telepresence doctor visits from companies like ... Bright.md deliver house calls via your mobile phone or computer, eliminating the need for the elderly to travel to a doctor.
- HuffPost

“Before you actually talk to your doctor, [SmartExam] gathers basic data. The app dynamically adapts the questions according to your answers. Using AI, it will give your doctor a preliminary diagnosis treatment plan.
- Wired

“Thank you, thank you. I was able to get relief so much faster than driving to a clinic. The instructions were thorough and easy to understand. This is smart health care.
- Adventist Patient, 2018

“I have never been more excited about healthcare. We have six kids; it would be a nightmare to find sitters, wait at the office and for prescriptions. I did not feel like getting dressed let alone leaving the house! This is ingenious!
- Patient, Greenville Health System, 2018

“Very fast and effective way to get treated without going to a doctor's office and waiting. It only took about 15 minutes from the time I started the exam to get medications called into my pharmacy.
- Patient, Palmetto Health 2018

“I live 85 miles from my doctor. This service saved a long trip and I was treated properly.
- Patient, Presbyterian Health, 2018

“It was so convenient and easy to use. I didn't have to take time off work or get extra tests that were not needed. I had no waiting in a waiting room full of sick people and was able to pick my prescription up right after work. Awesome!
- Patient, Presbyterian Health, 2018

“I trust SmartExam. It never gets in a hurry. It’s the same on Monday as it is on Thursday.”
- Bright.md partner provider

“My favorite thing about SmartExam is the ability to access it from anywhere with an internet connection.”
- Provider, Providence Health Systems, 2018

“SmartExam is being used by health systems to offer 24/7 access to care for more than 470 common medical conditions.”
- The Wall Street Journal, 2019


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May 14, 2019

The Ladder of Care: Do your patients know where to go when they get sick?


When a patient isn’t feeling well, they want to get care as quickly as possible. But with primary care physician shortages, they may have to wait weeks—or even months—to see their doctor. If their condition is painful or uncomfortable, they may opt to seek treatment in the ED, an urgent care clinic or a retail-walk in clinic, all of which are more expensive for them, can create overcrowding and chaos in waiting rooms, and might take them away from their trusted healthcare provider.

To combat this, some hospital systems, including Kaiser Permanente Washington, are rethinking how they deliver primary and urgent care. Not all conditions require acute care or need the same level of treatment. This is why Kaiser Permanente Washington and others have adopted a “ladder of care” approach, allowing patients to get the most appropriate, affordable, and convenient care for what ails them.

You don't have to be as large as Kaiser Permanente to embrace this approach. The care grid below demonstrates how the ladder of care model works. As you progress to from left to right, the severity of the conditions that can be treated increases, as do the cost of care and provider time per patient.

The Ladder of Care

For low-acuity conditions, like pink eye, UTIs, allergies or headaches, asynchronous non-video telehealth platforms provide highly affordable care that doesn’t require an appointment and is available 24/7. With some virtual care platforms, patients receive care within an hour while physicians they trust can provide it ten times faster than if the patient chose an in-person or video visit.

Video visits can treat many of the same conditions, but they have limited availability for patients, cost more, don’t save clinicians time over in-office visits, and can be frustrating for both patients and clinicians.

Mobile units, primary care offices, and urgent care clinics can treat for slightly more critical conditions but tend to cost more than virtual care. Some urgent care clinics will see patients without an appointment, but patients pay even more for that extra convenience. Primary care clinics require an appointment and are rarely able to schedule patients on the same day.

Of course, there are some conditions that warrant a visit to the ED. Patients should understand that deep wounds, head injuries, and severe pains call for an immediate trip to the emergency room.

The benefits of the ladder-of-care approach are numerous. Patients and providers save time and money, patients receive the most appropriate care for their condition, and urgent and emergency care departments can more quickly and thoroughly address the needs of high-acuity patients. The right virtual care partner can help you develop a care-delivery grid that is right for your organization and your patient population.


Julia Millard

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