We’re not exactly living in The Jetsons, with flying cars and floating cities. But video chats as a means of having a doctor “visit,” also predicted in the 1962 series, are a very real thing in 2019.
There is a new wave of healthcare that is taking advantage of video chat and similar technologies to advance its delivery — “telehealth,” which is “the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration.” Telehealth can be delivered via streaming media, the internet, “store-and-forward imaging,” and, yes, video conferencing.
This is not to be confused with “telemedicine,” which refers to remote clinical or non-clinical services and might typically refer to training and education for healthcare providers and administrators.
According to some experts, the “next big thing” in hospital care is that less care will actually be delivered in brick-and-mortar hospitals. We’re not talking about “home care” in the traditional sense, but rather “hospital-standard care” that would provide all the same access to equipment and caregivers within the comfort and convenience of a patient’s home. Telehealth uses existing and emerging communications technology to set up more like “mini-hospitals” at home, and it is a rapidly-growing approach to curtail costly insurance obligations and patient co-pays, overcrowded hospitals, and overworked physicians, while increasing patient engagement.
How rapidly is telehealth growing?
Physicians who take advantage of telemedicine advances may enjoy benefits such as: work-life balance and decreased stress and burnout, while reaching more patient, and making it easier to maintain those relationships.
Individuals from Bridge Connector were lucky to have hometown access to the America’s Health Insurance Plans (AHIP) annual conference in Nashville recently where top health insurance company executives’ shared “stories from the front line.” In this blog, we’ll highlight 4 telehealth trends from the conference, and how these trends have the potential to shape healthcare.
Since the Centers for Medicare and Medicaid Services (CMS) policy was created in 2010, telehealth popularity has been on the rise. Perhaps the most notable telehealth trend from the conference was that payers have reinvented how to bring tertiary care to rural areas. According to Raad Joseph, Senior Vice President of Blue Cross Blue Shield (BCBS) of South Carolina, payers commonly enlist partners to help develop strategies to drive telehealth adoption. The idea: you can lower costs for the patient, and lower the copay by convincing employers to participate.
“This isn’t a ‘build it and they will come’ sort of thing,” said Joseph. Rather, payers need to provide incentives to drive telehealth adoption, particularly in rural areas.
Some incentive strategies Joseph says they have used with success in South Carolina include awarding a $75 gift card to employees who register for the BCBS telehealth option online, which has resulted in a 22% utilization rate from this promotion.
Another unique challenge to rural areas is the lack of access to behavioral health facilities. BCBS of South Carolina further enlisted a digital telehealth option for behavioral health and rolled this program out to 35 groups. Halfway into 2019, they have already experienced a 15% increase in utilization in these services.
According to Joseph, there are at least 12 BCBS partners with the National Alliance for Mental Illness organization. This not only makes BCBS a formidable player in the behavioral health space but also underscores payers’ expanded focus to now include behavioral health as part of their benefits. For comparison, and with the largest employers who carry more patient risk, AHIP estimates that 56% of large employers now offer behavioral telehealth options.
Since the health insurance providers’ perspective was VIP at AHIP, it is interesting to note that AHIP estimates:
The ailments most commonly treated via telehealth are sinusitis, conjunctivitis, urinary tract infections, and upper respiratory infections.
96% of large employers make telehealth services available as part of their insurance plans; 56% of large employers offer behavioral health options as part of these offerings.
93% of consumers who have participated in telehealth said it saved them money — up to $100 compared to visits in other care settings.
Another common telehealth trend that circulates many payer conversations is risk management. You may be familiar with this statistic: The sickest 5% of patients account for half of all healthcare spending in the U.S. These patients are sometimes referred to as “super-users” because they suffer from comorbidities and have complicated treatment plans.
How does that translate into the payer world? According to Danielle Phelps Swartz, Senior Director of Care Coordination and Integration at Geisinger Health Plan: Just 1.2% of high-risk patients drive approximately 30% of costs for payers. The Geisinger Health Plan provides coverage to over 2.4 million members in central Pennsylvania and New Jersey. In her role, Swartz oversees strategic initiatives, focused on complex case management, to help mitigate risk with these sorts of vulnerable patient populations.
As early as 2008, Geisinger began using remote patient monitoring (RPM) when it supplied patients at high risk of heart failure with Bluetooth scales equipped with interactive voice technology. They have since expanded such RPM capabilities by providing members with “radar vests which detect other heart failure symptoms, such as fluid build-up in the lungs.” Geisinger estimates they have saved $3.30 on every dollar spent on the RPM initiative, and have reduced admissions for these patients at risk of heart failure.
In another telehealth effort, Geisinger partnered with Force Therapeutics in 2016 to enhance orthopedic care for patients undergoing hip and knee surgeries. Patients are provided with educational and exercise videos, prompts, and forms to provide information about their progress, and a portal to communicate with their clinical teams. The Force Therapeutics telehealth partnership alone has resulted in a “30% reduction in hospital length of stay, a 56% reduction in skilled nursing facility utilization, and an 18% reduction in readmissions.”
AHIP, in a related report, says that by preventing unnecessary and costly emergent or acute care, telehealth has the potential to save more than $6 billion annually.
California wildfires in Butte County in 2018 destroyed the largest of three Paradise Valley medical buildings, and the remaining two structures did not have adequate clinical space to accommodate the 10,000 area residents who typically use their services. More than 85 died and over 18,000 buildings were destroyed during these fires. Area physicians found themselves with nowhere to practice, and many patients lost their healthcare facilities.
David Goldberg, Director, Product Line Evolution with Blue Shield of California, explained how they recently pitched in $2 million to help rebuild facilities. Blue Shield also partnered with the Teladoc Health platform to allow displaced residents, many of whom went to neighboring communities, the same access to their Paradise Valley physicians, but via telephones, smartphones, tablets, and laptops.
Virtual care became a necessity in these catastrophic circumstances.
Erik Glazer, vice resident, client experience and innovation for Teladoc Health says Teladoc’s goal is to provide a “virtual first door into healthcare to triage (patients) to necessary brick-and-mortar locations or other online options.” If “virtual-first” platforms are already enacted, it puts first responders and emergency preparedness that much farther ahead during natural disasters, such as the wildfires in California. This successful use case could be extended with other payers and locales who are at high-risk for various other natural disasters.
Convenience: perhaps the most commonly-discussed telehealth trend. Have you noticed that many marketing emails now come with handy Google Calendar or iCal invitation “attachment” files, to make adding events to your personal calendar more convenient? And that work calendar invitations may now contain links for Zoom, Skype, or similar video conferencing plug-ins? The “consumerism of healthcare” refers to the idea that patients are beginning to expect these same types of conveniences, including when it comes to scheduling — and conducting — their health appointments as well. The time and cost savings aren’t limited to patients and payers, however.
Imagine the time saved for employers if their workforce no longer has to take PTO for routine or sick doctor visits. No more driving to and from appointments in the middle of the workday. And reduced wait time to see physicians means employees can be treated sooner and recover more quickly.
Further, studies show that readmissions are reduced when patients receive clear communication about their discharge instructions and follow-up care plans via telehealth. For example, with heart failure patients, telehealth education, and remote monitoring have reduced readmissions by 19%, and post-op vascular surgery patients who have used telehealth report higher satisfaction, higher physical and mental health.
We’ll continue to hear much more about how innovations in telehealth are causing the industry to re-think where patients are receiving care — whether it’s that telehealth serves as the “virtual first door” to an eventual brick-and-mortar care location or to broaden access for underserved patients in rural or tragedy-stricken areas. In the meantime, who among us has received physician care instructions, or has “seen” their doctor on a “screen” yet (as opposed to within the traditional hospital or clinical setting)? It’s a safe bet that you can expect that number to climb … long before you’ll be living in a floating city, or than you can remember the entire Jetsons theme song.