During the past year, I have been part of a professional team that is committed to expanding the telehealth services Vituity already provides. In January, we launched a video platform that enables physicians to see patients. By participating in this process, I have developed a deep appreciation for the clinical and business advantages of telehealth and believe it is a key strategy that will bend the healthcare cost curve.
As a Vituity leader and a physician who is embracing telehealth, I am convinced that it is a significant tool to improve healthcare delivery. I encourage you to formulate an organizational strategy to launch telehealth and begin transforming care yourself.
So, why telehealth? Why now?
1. Telehealth bends the healthcare cost curve and potentially reduces projected federal healthcare expenditures.
A convincing body of evidence suggests that telehealth deployment and use significantly reduces cost per patient without compromising care quality or clinical outcomes. Medicare, Medicaid, and Children's Health Insurance Programs, the federal funding for medical services in the United States, is predicted to double in 25 years. As the costs increase, the government will likely be forced to increase taxes, cut programs or erode the healthcare safety net.
The graph below illustrates the healthcare spending trends. The 2010 projections were daunting. Yet, when CMS began to move toward value-based purchasing, healthcare spending projections decreased from 2010 and 2014. Effective redesign of the healthcare delivery system over the next few years, will flatten the cost curve further.
2. Telehealth can be used to reduce preventable readmissions.
Because an inpatient stay averages about $2,000 per day and about one in five hospitalized patients with heart failure or myocardical infarction is readmitted within 30 days, the Center for Medicare and Medicaid Services is encouraging hospitals to admit people appropriately and ensure they are managed effectively. Hospitals are exploring many ways to meet that objective. Some of those options include shifting care delivery beyond the hospital walls by more effectively using transition clinics, patient navigators, remote patient monitoring, and skilled nursing facilities. The idea is to align the acuity of care with the appropriate care delivery location. Nearly all of these options being used have versions powered by telehealth.
A good example is the Hospital at Home program developed by the Johns Hopkins School of Medicine and Public Health. It provides older adults with common acute care diagnoses with in-home nursing care, testing, and treatment. Hospital at Home has been shown to reduce care costs by 19 percent through reductions in length of stay and testing. Patients experience fewer complications (notably delirium) and are less likely to require sedative medications.
3. Telepsychiatry manages mental health emergencies.
Patients who present to the emergency department (ED) with a mental health issue are 2.5 times more likely to be admitted to an inpatient setting than those with medical complaints. Notably, they then wait an average of 7 to 34 hours for an inpatient bed at an average cost of $2,264 per visit.
One solution is to provide ED physicians with telepsychiatry support. The off-site psychiatrist, using telemedicine technology to support the ED physician, can help ED personnel distinguish patients requiring admission from those who can be safely treated and discharged. These telehealth physicians can also assist with the adjustment of therapeutic medications and endorse the lifting of involuntary holds. In many cases, this allows the patient to be safely discharged from the ED.
4. High-deductible health plans encourage patients to seek telehealth.
Another graph from the Congressional Budget Office is compelling.
Due to the increase in healthcare costs, employers and employees are increasingly sharing those costs. With the average family plan exceeding $15,000, many employers are taking steps to restructure their health plan options by offering high-deductible health plans (HDHPs), which have lower premiums and shift more care costs to the employee. (Such plans are also common in health exchanges.) As a result, more people are paying for more of their healthcare costs out-of-pocket.
For cost-conscious consumers, telehealth is a less expensive alternative to office visits, especially for low acuity urgent care visits. A study by Red Quill Consulting found that patients with acute care complaints could save more than $100 by making a telehealth visit to a provider instead of an office visit. What's more, telehealth effectively resolved 83 percent of complaints. (The most common diagnoses were sinusitis, colds/flus, and urinary tract infections.)
5. Doctors and patients are increasingly ready to embrace telehealth.
Evidence suggests that the telehealth visit does not alter the traditional in-person provider-patient relationship rooted in trust and rapport. Instead, the opportunity to see the physician via video offers a convenient alternative to busy patients who have found office visits difficult to schedule.
Given the difficulty of scheduling an office visit, patients are quickly warming to telehealth. A study by Cisco communications found that 74 percent of patients prioritize access to the provider over a face-to-face interaction. About the same number of patients say they are comfortable consulting their doctor via phone or video.
Doctors are also on board. A survey of 2,016 primary care physicians found that about 57 percent would be comfortable seeing patients by video.
6. Telehealth strategies can help to manage complex chronic illness.
Chronic conditions like heart disease and diabetes account for 75 percent of total healthcare spending, 99 percent of Medicare spending, and 81 percent hospital admissions. Many of these diseases can be effectively managed by the patient and from the patient’s home. Instead of the ED being used to manage the momentary moment of uncertainty when blood sugar or an asthmatic attack goes awry, telehealth allows patients to check in and obtain a medical professional’s opinion about their situation.
Advances in virtual communications and wireless monitoring technologies to complete the telehealth solution make this possible. For example, the telehealth application Health Buddy allows chronic illness patients to conduct routine tests and check in daily with a physician via a smartphone. If the patient has a concern, the service alerts the patient's primary care provider. In a study conducted at two community clinics, use of the Health Buddy program reduced spending on chronic illness care by 7 to 13 percent per patient.
The Time Is Now
Healthcare cost containment is required to sustain high-quality healthcare and access to it. Telehealth shows promise in addressing some of our most pressing cost and access issues. Formulating a telehealth strategy can provide your health system with a competitive advantage and transform the healthcare system. As an enthusiastic proponent, I encourage you to begin exploring telehealth as a tool for patient care.