May 14, 2019

The Ladder of Care

elderly women coughing at home, while looking at her tablet

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.

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