The fiscal challenges confronting the healthcare industry around the world requires shifting the delivery of care from expensive centralized settings to lower cost settings while seeking to improve quality and patient experience. Organizations such as hospitals, Integrated Delivery Networks (IDNs) and newly created Accountable Care Organizations (ACOs) are trying to find the right mix of technology, facilities, clinical personnel, and information sharing to address these issues.
Telehealth and “connected care” experiments have shown that many types of expensive care that had been, in the past, reserved for office visits or hospital attendance can easily be done in the home or a lower cost setting. It seems every year at the American Telehealth Association (ATA) conference we see new technologies, creative solutions, and a strong desire to have Telehealth succeed.
Unfortunately, reality has not lived up to expectations. Until now.
So what have been the challenges faced by Telehealth? For starters, everything around healthcare revolves around reimbursement. Until recently, reimbursement structures for Telehealth services have been limited and spotty at best. The biggest payer in the country, the Government, is changing that. For example, on July 6, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule, which goes into effect on January 1, would for the first time would cover the following additional services would be covered when provided using telemedicine (with special qualifications):
Alcohol and/or substance (other than tobacco) abuse structured assessment and brief intervention;
- Alcohol misuse screening;
- Behavioral counseling for alcohol misuse;
- Depression screening;
- Behavioral counseling to prevent sexually transmitted infections;
- Behavioral therapy for cardiovascular disease; and
- Behavioral counseling for obesity.
Given how common the services listed above are and how many patients don’t get these kinds of services because they were harder to schedule office visits for them or most costly to deliver in person, many care delivery organizations can offer these kinds of services over telehealth solutions next year and increase business and effectively treat patients.
With Medicare’s lead and other commercial payers taking notice, more changes are coming as our healthcare system shifts from a volume fee-for-service to value pay-for-performance model. This is evident in the shared risks and transferred risks models that are now becoming prevalent with consolidated large healthcare system like IDNs and the ACOs nationwide. More recently both Medicare and the Veterans Administration have now come out with strong, robust guidelines for the use of Telehealth in everyday care, with Medicare also providing a thorough reimbursement structure.
So is Telehealth only for rural patients who cannot get to a major medical center? Not necessarily. Yes, rural medicine will see the greatest benefit but with all-in-one, easy to use, intelligent multimedia systems like all-in-one PCs or similar portable tablets like the iPad, the opportunity exists to look at your regular doctor visit in a whole new light. With built in Bluetooth capabilities in most computers today, you can easily connect home based medical devices that can record and track your vital signs, medication regimen, and even conduct genetic or molecular based testing from the comfort of your home. Telehealth can also be used to manage post hospital discharge care by providing timely interactions for any emergent situations that may arise.
Does this means we are ready for Telehealth is a runaway success? Not exactly, there are still issues around verification of service, technical complexity of solutions that will be used by patients at home, and general reconditioning of how we approach our healthcare interaction. For example Accenture conducted a Connected Health Pulse Survey of 1,110 U.S. patients and found that 90% of patients want to self-manage their health online but that “85 percent of respondents preferred to see doctors in person when needed rather than relying on alternatives such as telehealth consultations.”
While the 85% seems high, it means that already 15% of patients are fine with just telehealth solutions. The good news is that innovation is healthy and abounds with creative start-up companies that are taking on many of the usability and interaction challenges voiced in the Accenture survey. Enhancements in technology and patients getting accustomed to remote care will mean more patients will accept telemedicine over time, especially when they realize the immediacy of the interactions.
How Telehealth and Telemedicine should become part of your revenue streams
Having launched many healthcare technology solutions, my experience shows that probability of success of major patient-focused transformations at care delivery organizations is usually quite low unless you buy into the future of healthcare.
So if you are one of these institutions that is being asked to take on more risks and provide more care with fewer dollars, Telehealth is an option you should evaluate, keeping in mind the following considerations:
1. Technology Partner – the success of any efficient clinical delivery system is based on the information management infrastructure you deploy. This ranges from servers, client computers, and the software solutions you integrate into your clinical workflow. Make sure you pick the right partner that has shown a consistent commitment across all of their business units to support new delivery concepts like providing Telehealth and mobile healthcare. Every technology company wants to sell into healthcare, it’s a big industry where vendors see serious dollars. Pick a vendor that has shown vision, works with startups to bring new technologies to market and understands where healthcare is going from a real dollars and business model perspective.
2. Takes two to tango – remember for a successful Telehealth solution to work two parties have to work together toward mutual benefit; your patient and you. With the acceptance of smart and tablet based devices and Cloud based solutions, your patient’s expectations of your Telehealth solution will be fairly significant. So again, look for a technology partner that has demonstrated an understanding of how people like to work and interact from home. This way your hospital and/or clinic based solutions will be deployed in a manner that will be seamless to use for your patients and provide a high degree of customer satisfaction.
3. Minimize change to workflow – your clinical staff has been trained to take care of patients in the safest manner possible. Don’t turn the cart upside down by bringing to bear revolutionary changes. Technology for the sake of technology is not a good thing in healthcare. Smart technology that understands how your people work and provides better clinical care and services without overhauling how your staff works, will provide the greatest ROI as it will be adopted much more rapidly and efficiently by your staff. And remember, if your staff does not like the new solutions, they have no qualms on telling the patient on how the new system has made their work environment worse.
4. Educate clinicians on value of preventive care and wellness – as you take on more fiscal responsibility for your patients, promote preventive care and wellness activities. Preventive medicine can significantly lower the cost of chronic disease management and when combined with wellness care like obesity management services, can provide improved patient satisfaction and additional revenue streams. Telehealth is the most efficient way to provide these services.
Thanks to technology advances coupled with reimbursement changes, Telehealth has now become a viable option for hospital looking to extend their business model to the patients home, while decreasing their cost of delivery care. Just keep in mind common sense considerations on the impact to your clinical staff and choose a partner who has shown a commitment to the future of healthcare.