July 17, 2018
The Promise and Obstacles of Telehealth

Can telehealth enhance patient experience, reduce costs, and improve population health? In other words, is it the quintessential answer to the 21st century’s “Triple Aim” of health care delivery?

As technology marches forward, and the reimbursement landscape shifts away from traditional fee-for-service care, the potential to effectively treat patients in ways that require neither travel nor face-to-face interactions could profoundly influence health care delivery.

Live and recorded virtual interactions, remote patient monitoring (RPM), and mobile health (mHealth) are already beginning to change the landscape for providers, patients and payers, and the early assessments are favorable. Still, a large number of questions and potential obstacles remain.

Positive outcomes

A June 2016 analysis by the federal Agency for Healthcare Research and Quality cited significant research showing that telehealth interventions for patients with various chronic conditions produced positive outcomes, especially for patients with cardiovascular and respiratory diseases. For those patients, communication and monitoring improved outcomes related to mortality, quality of life, and hospital admissions. The same study found that telehealth also produced positive outcomes related to psychotherapy.

As a means to save money, the potential advantages seem self-evident. Among other cost-saving benefits, telehealth can reduce office and emergency room visits, provide more timely access to providers (thereby reducing or preventing complications), and reduce the need for institutional care. When it comes to something as straightforward as adjusting medication, a virtual encounter is likely to be much more cost-effective than a trip to the provider.

But conclusions about the third prong — enhancing patient experience — remain uncertain, as only a small minority of health care consumers have taken advantage of telehealth services. A 2017 white paper pegged the number at 18%, with the other 82% saying they’d either never heard of telehealth, or didn’t fully understand the concept. Additionally, nearly half (46%) said they’d be less comfortable conversing with providers via video than they’d be during an office visit.

For physicians, telehealth may also be a potential remedy for burnout, says Sylvia Romm, MD, a New York pediatrician. “When I want to see patients, I log into a platform and parents can see that I am available to offer urgent care services to their children,” says Dr. Romm, part of what she calls, “a reputable online physician group” that provides urgent care via video. “I see as many patients as I want, and then log off the website when I am done. … I’ve eliminated my horrible commute and opened up time to see my family. … The ability to take control of my schedule while still practicing medicine has given me a new sense of purpose and a feeling that work/life balance is actually possible.”

Growing numbers

As the post-Baby Boomer generations account for proportionately higher percentages of health care encounters, the number of consumers who are familiar and comfortable with technology will undoubtedly grow. Younger generations may even demand such convenience. And in fact, 42% of executives at leading health systems expect patient demand to be the primary driver for the adoption of RPM technology. The surveyed executives also cite quality and safety as potential drivers, as well as the potential to reduce costs.

As Lewis Levy, MD, FACP, the chief medical officer of Teladoc, points out: “There’s a quality aspect as well. [Patients don’t] have to be in a waiting room where people may be suffering from flu or other illnesses.”

Growing recognition

Washington, too, is beginning to acknowledge the inevitability, with a nod to the potential benefits. Congress recently expanded Medicare telehealth policy, adding provisions that will, in the next couple of years, eliminate geographic restrictions on telestroke consultation services, expand telehealth coverage for Medicare Advantage enrollees, give ACOs more flexibility to use telehealth services, and increase the options for telehealth assessments among dialysis patients.

Recent reimbursement trends are also encouraging: 49 states and Washington, DC, now provide reimbursement related to live video in Medicaid fee-for-service. The numbers of states reimbursing store-and-forward services and RPM are smaller, but growing.

Hurdles to clear

Many challenges remain, however. For one, in most locations, reimbursement rates fall short of the reimbursement rates for inpatient and primary care.

And naturally, patients and providers both need reliable access to high-speed Internet service, something that millions, especially in rural areas, still lack.

Additionally, while the proliferation of wearables and mobile health apps among consumers represents a potentially promising development, the large volume of data such devices provide may also present challenges. Providers and payers will need to figure out what data is useful and how to integrate it in such a way that it adds value.

And of course HIPAA is always a concern, since it applies whether providers see patients in person or use telecommunications technology to treat them.

A matter of time?

Combine all those factors with the relative immaturity of the technologies needed to make telehealth a seamless proposition, and it’s reasonable to assume that wide adoption is still at least a few years away.

But the combination of technology that’s advancing at breakneck speed and evolving emphasis on value over volume suggests that it’s a matter of when, not if, and that providers would be wise to start preparing now.