Assessing Telehealth’s Value

A typical value-based care contract (VBC) is extremely complicated, but gauging the overall value something brings is much easier – and telehealth delivers amazing value.

Recently, at the American Association of Nurse Practitioners’ Specialty & Leadership Conference, family nurse practitioner Thanh Nguyen from Providence Health Express in Oregon noted that “we don’t know” what telehealth’s return on investment will be in the new value-based care model. Only about 40% of providers are even using VBC contracts, which means that six out of 10 providers are still using the fee-for-service approach.

But Nguyen is certain about one thing: telehealth is providing undeniable value every day. In her view, it’s saving lives and improving access to care while offering growth opportunities for nurse practitioners.

Nguyen feels that it’s now time for legislators and regulators to bring more telehealth value to clinicians – namely, getting paid for every hour worked.

In a recent speech, the American Medical Association’s immediate past president, Dr. Steven Stack, spoke about the need for a “quadruple aim”: adding “clinician satisfaction” to the current trio of improved access, better care and lower costs. “We need to restore joy to the practice of medicine,” he said – one way to do that is fair compensation for the long hours worked.

Current reimbursement policies don’t allow telehealth providers, like Nguyen, to get paid a penny for the time it takes to respond to patients’ emails. She’s licensed to practice only in Oregon and Washington, and she recently got burned by a Nevada patient who claimed to be visiting friends in Oregon. Ultimately, Nguyen had to waive her fee for the 20-minute session.

The healthcare industry’s journey to value-based care is a worthy effort, but it will only succeed when it brings real value to the clinicians who make it happen – and when it fairly compensates them for the care they provide via telehealth technology.

Survey Reveals Positive Views For Telehealth, Part II

From Ross Perot to the fictional J.R. Ewing from Dallas, business people rule the roost in Texas. And their powerful voices are providing strong tailwinds for telehealth in the Lone Star state.

The Texas Association of Business (TAB) recently published a report called “Telemedicine: The 21st Century Answer To The Call For Better Healthcare.” In our previous blog, we discussed why patients across Texas are pumped about the prospects for telehealth. Now let’s take a look at what influential business leaders are saying:

  • A Texas-size 77% favor using telehealth to diagnose common medical conditions.
  • 70% feel that access to providers has gotten more difficult in recent years.
  • 18% of Texas companies surveyed already offer telehealth as part of their health benefit programs.
  • Of that 18%, a unanimous 100% of the companies plan to continue offering telehealth benefits – and 24% plan to expand their current programs.
  • 66% received positive feedback on telehealth from their employees – and not a single employer received negative feedback.

States like Texas, California and New York are early adopters who greatly influence initiatives in the other 47 states. It’s not surprising that those three states have already passed telehealth parity laws, encouraging holdout states like Utah and Wisconsin to join their ranks.

When the Texas business community wants something, they get it – usually without delay and they’re demanding a wider use of telehealth technology. Why would J.R. Ewing drive from Dallas to Ft. Worth to see a specialist when telehealth is available?

Survey Reveals Positive Views For Telehealth, Part I

Texas has long been a bellwether state, just like California and New York. All three of those states have large cities plus sizable rural stretches. Think Houston/Amarillo, L.A./Modesto, New York City/Syracuse.

That’s why the new Texas Association of Business (TAB) report on telemedicine is so encouraging. Entitled “Telemedicine: The 21st Century Answer To The Call For Better Healthcare,” it provides ample proof that states with both megacities and wide open spaces are fertile ground for telehealth.

The report contains so much good news that we’re devoting two blogs to what it highlights: first from the patient perspective, then from the employer angle.

The report begins with a sobering overview of the current state of Texas healthcare, where physician shortages, rising healthcare costs and poor patient outcomes have become the norm. The report estimates that one-third of medical issues now resolved in doctors’ offices, urgent care clinics or EDs could be handled effectively via telehealth.

TAB surveyed 600 registered Texas voters to get their opinions on telehealth, and their answers may surprise you:

  • 70% of those surveyed favor the use of telehealth to diagnose common medical conditions.
  • 51% of those Texans feel that access to providers has grown more difficult in recent years.
  • 24% of rural Texans surveyed have to drive 30 minutes or more to visit a doctor’s office.
  • 23% of those surveyed have to wait 14 days or more to see their doctor.

The TAB survey shows that Texas patients are clamoring for fresh solutions like telehealth. To use a popular expression in the Lone Star state, they’re “chompin’ at the bit” for change.

In the next blog, we’ll discuss why Texas employers are equally excited about what telehealth can deliver.

Solutions To ED Boarding

Telebehavioral or telemental health care took center stage at the 10th InTouch Telehealth Innovation Forum. Presenters demonstrated how telemental health programs are improving outcomes and lowering costs – from Critical Access Hospitals all the way to the nationwide HCA network.

A recent study by The Commonwealth Fund found that about 80 percent of mental health or psych patients present at EDs and primary care offices, where providers often lack the training to effectively treat them. And a study by the IAHSS Foundation revealed that many Emergency Departments board mental health patients for 24 hours or more. Some rural hospitals have wait times as high as 18 days.

At the InTouch Telehealth Innovation Forum, three providers outlined their solutions to this growing problem:

  • The 25-bed Illini Community Hospital in Illinois showed how telemental health technology is linking its community with a tertiary center 50 miles away – and with mental health practitioners as far away as Kansas City. Illini has already achieved a Press Ganey patient satisfaction score of 99 percent.
  • At the other end of the scale, HCA annually conducts 17,000 telemental health or behavioral care consultations across its vast network. The hospital giant has already dramatically reduced the ED backlogs of mental health patients.
  • The PeaceHealth system in Oregon now provides telemental health care to four hospitals – bringing pediatric services to one facility that had never offered them. PeaceHealth plans to widen its program to provide behavioral telecrisis consultations for two other Oregon hospitals.

Studies show that outcomes improve significantly when a behavioral care patient is seen within four hours. These three programs are providing much-needed guidance to other hospitals that are currently overloaded with mental health ED patients and are looking for both clinical and financial solutions.

TeleBehavioral Session

TeleBehavioral Session

Telehealth Lessons from Space

Providing telehealth services to the International Space Station, 250 miles above the earth, circling the globe every 90 minutes, is about as “remote” as it can get –. That’s why the World Health Organization is using the lessons learned from telehealth in space to improve remote care in some of the world’s most underserved areas.

In a recent WHO bulletin, Dr. Alfred Papali concludes that medium-tech works nicely when high-tech isn’t available. The first responder in space is typically a crew member whose training is comparable to that of a paramedic – and there’s no advanced diagnostic equipment on board. Astronauts use a point-of-care ultrasound device to diagnose ailments, then seek the counsel of earth-bound physicians. Data transmission from space, however, isn’t continuous.

Papali notes that those same constraints are common in many impoverished places on earth. The WHO is already using the equivalent of paramedics to provide antiretroviral medications in sub-Saharan Africa. Plus it’s easy to get portable ultrasound devices into remote areas where it’s impossible to lug a CAT scan machine.

NASA has begun to address data transmission lagtime by providing astronauts with “virtual remote guidance” – a fancy name for pre-recorded instructional videos.

The WHO will soon use the same approach in Haiti, where caregivers will receive just-in-time instructions on how to perform endotracheal intubation and other difficult procedures.

Whether in space or Himalayas, some patients don’t have the luxury of getting transported to a fully equipped medical center. It would take 24 hours and millions of dollars to get a sick astronaut back to earth. Likewise, it’s usually impossible to airlift a patient from rural Nepal to a hospital in New Delhi. Providing the best available care on-site – aided by telehealth technology – can still be a lifesaving option.

Telehealth in spcae

Telehealth in space

Five Encouraging Trends

In certain fields, things seem to continuously trend upwards. That’s true with smartphones, where device ownership increased 30% in just the last four years. It’s also true for the Golden State Warriors basketball team, which saw its win totals increase from 51 to 67 to a record-setting 73 over the past three seasons.

We can now add telehealth to that list, where usage has increased by an astonishing 50 percent since 2013. Nearly 15 million people used telehealth services last year.

The ATA recently identified five trends that are creating favorable tailwinds for our industry:

  • More telehealth legislation – To date, 29 states and the District of Columbia have passed laws requiring commercial payers to cover telehealth. Eight more states are considering legislation this year.
  • Employers jump on the bandwagon – Telehealth is rapidly gaining popularity with employers like Nissan and Google that offer onsite health clinics. By 2018, many of these companies will use telehealth.
  • Older adults see the value of telehealth – People approaching Medicare age are quite comfortable with web surfing and smartphone apps. More than half of older adults say that “health information” is one of their primary reasons for digital engagement.
  • App adoption has doubled in the last three years – In 2013, only 16 percent of Americans had a health app on their smartphone. Now that number has doubled to 32 percent.
  • Medicaid is loosening distance requirements – 86 percent of states now cover Medicaid telehealth services statewide rather than imposing distance restrictions.

Many industries are envious of these positive trends. Fax machine manufacturers are no doubt having a lousy year. But things are definitely looking upbeat for the telehealth sector.

Five Telehealth Trends

Five Trends

Embracing The Network

There have been dozens of books published on how to “fix” healthcare, but probably one of the best is “Where Does It Hurt?: An Entrepreneur’s Guide To Fixing Healthcare” by Jonathan Bush (who also happens to be CEO and co-founder of healthcare software giant athenahealth).

In a recent article, Bush proclaimed that the “future of the hospital is the network.” He praised Mt. Sinai Hospital in New York for its marketing campaign headlined “If Our Beds Are Filled, It Means We’ve Failed.” Those ads show that Mt. Sinai is serious about moving away from isolated, intermittent care to continuous, coordinated care – a shift that Bush feels all hospitals should make.

Bush believes that successful hospitals are rapidly moving from the EHR-centric model, to the patient-centric world of cross-continuum connectedness, a/k/a the network. Telehealth is an integral part of that brave new world.

Telehealth is the arterial system that can connect acute care specialists, home health providers, Ambulatory Surgery Centers, imaging centers, and all points between. Bush foresees a day (coming soon) when a patient can get an immunization at a retail clinic, an outpatient surgery at an ASC, and a telehealth consultation at home all in a single week.

That’s the “right care, right time” mantra that has long been the guiding principle of telehealth.

Bush sees a bright future for telehealth because relying on a robust network is the only way to “unbreak” our healthcare system.

 

Telehealth Network

Telehealth Network

 

 

Oasis In The Desert

In a recent MarketWatch report, Phil Miller, from the physician search firm Merritt Hawkins, said that 65 million people in the U.S. live in what’s “essentially a primary care desert.” According to the latest Kaiser Family Foundation research, it’s not just a rural phenomenon. Rhode Island and Connecticut are struggling to find primary care physicians just as much as North Dakota and Nebraska.

 Telehealth technology and osteopathy may soon be providing an oasis in that desert. Telehealth can help improve primary care access in struggling states like Missouri, by leveraging the expertise of first-line physicians in states like Delaware, which are amply supplied. Meanwhile, osteopathic schools are starting to create long-distance alliances to solve the primary care shortage.

The educational requirements for an osteopath are nearly identical to an M.D. program – and more than half of young osteopaths go into primary care. That’s one of the reasons why the New York Institute of Technology recently created an osteopathic medical campus at Arkansas State University in Jonesboro. The first group of 115 students will begin classes this fall.

Innovative programs like these can go a long way toward reducing the projected primary care shortfall. The Association of American Medical Colleges estimates this could be as high as 31,000 physicians by 2025.

Telehealth technology is already helping to improve access to specialty care nationwide, which may encourage more medical students to consider a career in primary care. There’s still significant pressure on medical students to forsake primary care for the higher paying specialties in order to pay back six-figure college loans.

Until there are more incentives to enter primary care (perhaps government funded), telehealth can bring “water to the desert” by connecting patients with physician assistants, nurse practitioners and osteopaths who are ready to help.

 

Telehealth

Oasis in the Desert

Telehealth Serves The Neediest

Yenagoa, Nigeria, is about a 7-hour drive from Nigeria’s largest city, Lagos – and many of its residents weren’t able to get high-quality specialty care close to home. That is until the InTouch 7 (previously, RP-7) arrived.

Thanks to a grant from the Sonoma West Medical Center Foundation (SWMC), the Sebastopol, Calif., Sunrise Rotary Club and InTouch Health, who donated the robot and connectivity services, there’s now an InTouch 7 on-site at Federal Medical Center in Yenagoa. The Sonoma West grant also paid for six Nigerian doctors to travel to SWMC in Sebastopol for eight days of intensive InTouch 7 training.

The Federal Medical trainees can now consult easily with colleagues in California (and vice versa). SWMC Medical Director, Dr. James Gude, also taught the visiting group how to set up grand rounds training sessions so the students can return the favor and train others in Nigeria.

This type of transcontinental collaboration, though not yet common, is helping to save lives in some unlikely settings. Fast Company reports that Dr. Rogy Masri recently used telehealth technology to make a difficult diagnosis at a Syrian refugee camp in northern Lebanon.

The Syrian patient presented with an incredibly red lesion on one hand. The patient was suffering no pain or itching, yet the condition never improved. So Dr. Masri posted a photo on a telehealth app called Figure1 – and within hours, internal medicine resident Yusuf Dimas at St. Paul’s Hospital in Vancouver offered a diagnosis of Leishmaniasis, which soon proved correct.

The World Health Organization estimates that at least 400 million people worldwide lack access to basic healthcare – and some organizations feel that the actual number might be as high as 1.3 billion people.

By delivering expert care to underserved communities around the world, telehealth is making access more timely and affordable – especially for those most desperate for that care.

 

Refugee telehealth

Refugee Telehealth

 

 

“Discharge” Is An Illusion

Health systems and regulatory agencies compile mountains of hospital discharge data – and too often they consider a discharge to be a one-and-done event worthy of a marching band. But some health systems have realized that many patients are never fully discharged. They often move quickly – and invisibly – between inpatient, outpatient and post-acute settings.

Telehealth technology is proving to be a game-changer in this new world where hospital discharge is just a recovery phase, not a grand finale.

According to Modern Healthcare, the Hospital for Special Surgery in New York has developed a telehealth app that allows the staff to easily monitor patients after discharge. For example, clinicians can see how well patients are walking – and that visual confirmation is much more effective than a phone-based check-in.

Telehealth is also the ideal technology for connecting the dots. There are a lot of simple reasons why many patients boomerang back into acute care: not having a primary care physician, not sticking to a medication regimen, etc. A 30-year-old might be able to get away with that, but for seniors it can be a one-way ticket to readmission.

Telehealth technology ensures that physicians, case managers. pharmacists and patients are on the same page (or home page as the case may be).

For a patient recuperating from a stroke, pneumonia or heart attack, discharge isn’t a red-letter day like a college graduation. In the days and weeks following discharge, the care team has to share information every bit as effectively as a coaching staff in the Super Bowl. Every coach wears a headset – and every care coordination team should be using telehealth.

 

Hospital Discharge

Hospital Discharge