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Why the future of healthcare is 'deskless'

by Gus Iversen, Editor in Chief | January 25, 2022
Health IT
Rachel Disselkamp
As healthcare moves beyond hospital walls, coordination and planning must also become more agile. That's where the concept of "deskless" healthcare comes from. To get a better idea of what that transition entails and the impact it has on patients and providers, HealthCare Business News spoke to Rachel Disselkamp, director of healthcare for Skedulo, a San Francisco-based company that specializes in cloud-based software that empowers the "deskless" workforce.

HCB News: How is the future of healthcare delivery evolving?
Rachel Disselkamp: More than ever, healthcare delivery is where services happen. For a while, delivery was all about when. For the client or patient, convenience was centered on getting your preferred time slot. But now, availability, convenience, it all extends to where the visit will occur: Will you see your provider at her normal office across town, virtually via your phone; or will she do a house-call for you?

Because of this, delivery efficiency also takes on a whole new meaning. Providers and caregivers cannot be scheduled "back-to-back" because they are often moving from place to place. Efficiency is about organizing the workday by similar type, like having all your virtual appointments in the beginning of the day and taking into account variables like routes and travel time. Now that more healthcare providers are providing care in multiple places, the evolution of scheduling has to take location into account.

HCB News: How has telehealth contributed to this evolution, and what different types of healthcare delivery can we look to in terms of the future?
RD:The pandemic greatly accelerated the stalled trend of telehealth. Even though we could do care virtually before the pandemic necessitated it, patients didn't need it, providers couldn't charge as much for it (and still sometimes cannot), and payers didn't reimburse for it — and those last two points are not insignificant.

In the past few years, it's not surprising to see that telehealth has rapidly expanded: According to a McKinsey report, telehealth utilization has stabilized at 38 times its pre-pandemic rate. Rate reimbursement is a big incentive, but there is also patient preference to continue pushing it forward. And telehealth is just the tip of the iceberg. We will continue to see new business models that provide care through a variety of channels.

HCB News: What does the term "deskless" mean in regards to healthcare and healthcare delivery? Beyond healthcare?
RD: When you think of the face or frontline of healthcare, you almost always imagine "deskless" work. The providers treating you, delivering care, performing services almost never sit at a desk–and it's unlikely they ever will. So healthcare was "deskless" before that became a buzzword. But people often forget the enormous amount of "desked" administration that (mostly) enables those services to be provided. Many people lament these "wasteful" administrative activities, but some of them, such as scheduling or hiring staff, are critical to delivering care. So healthcare is a good example of how both "desked" and "deskless" work have always complimented each other.

HCB News: What tools are making healthcare delivery "deskless," and why are they so important?
RD: Tools, while important, were more likely reactionary to the market shifts and client preference that drove healthcare delivery shifts. Our services economy is evolving. Since people can get a pizza or a plumber to come to their home, why can't their pulmonary therapist do that too? Like how we often overlook the criticality of healthcare administration, we also oversimplify the complex, interdependent requirements of delivering healthcare at home.

One example where "tools" come into play is during care coordination. A significant portion of care coordination is about ordering and structuring your services. At the micro-level, with a client or patient, providers need to plan for certain services to happen first, or limiting which caregivers should provide those services. At the macro-level, when we are looking at the schedule of care for all clients and workers, you have to consider efficiency–is this worker closer to this client at that time? Will this full-time worker get enough appointments this week to make his desired wage?

HCB News: Why is delivering "deskless" healthcare beneficial to both healthcare professionals and the patients they care for? Why should professionals and patients alike care about this evolution?
RD: Patients and healthcare professionals alike now have several options to choose from when it comes to their healthcare delivery. Whether it's in-office, the comfort of their own home or on their morning commute, the digital transformation of these scheduling tools is enabling healthcare workers to conveniently service their patients, and more importantly themselves, by having the ability to deliver healthcare anywhere and everywhere.

On the patient side, that makes for a great level of convenience and comfort. On the provider side, it allows healthcare professionals to focus on the most important part of their job: the patient.

HCB News: What other transformations do you foresee for healthcare and healthcare delivery upon the modernization of digital tools?
RD: Utilization should become less myopic–meaning we shouldn't equate utilization to business-side productivity. Utilization is very tangible for "deskless" workers too because the number of hours they work affects their pay, their time off accruals, benefit eligibility, and work life balance. The difference between two and five shifts a week can be life-changing if it's what qualifies you for health insurance.

And yet, many organizations just measure overall utilization; they don't look at the individual. But consider this: if you have a resource who is available for 40 hours a week of work, and you are not supplying them with 40 hours of work, then not only are you not fully utilizing your staff, you are creating an individual flight risk because the resource's working hours expectation does not align with reality. A stable, predictable number of hours is critical not only for productivity and operations strategy but talent retention as well. Being able to reshuffle the schedule to help ensure that each day equates to a full day's work and a full day's paycheck, is critical to hourly wage workers in the healthcare industry.

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