Telehealth: Ready for Prime Time
By Jonathan Leviss, MD
Telephone rings. “Hello?” answers Sonia, age 73 with heart failure and living at home.
“Hello, Sonia. It’s Linda, your telehealth nurse. I received an alert that you gained two pounds a day for the last three days.” Further assessment reveals that over the last few days Sonia has eaten more salt than usual and has leg edema. Linda prescribes furosemide under protocol, educates Sonia about her diet, establishes a plan of care, and sends a report to Sonia’s cardiologist.
Why is Sonia’s tale becoming more common? Accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and other models of value-based care and bundled payments require reducing readmissions, addressing problems before they require more expensive interventions, and reducing high cost utilization. Telehealth is now a proven solution for all three.
Telehealth means robust, real-time, patient management solutions including remote patient monitoring of blood pressure and glucose; self-reported symptoms and medication compliance; live video visits with clinicians and health coaches; alerts for risks of clinical compromise; the ability to organize actionable information into dashboards or into a provider’s EHR; and the power of analytics to predictably detect problems earlier and develop new treatment approaches.
These real-time tools connect patients to the right care in the right place at the right time, and most commonly, that connection occurs in the patient’s own home. Not only does this save provider, payer, and patient resources, it’s most convenient for the patient and often most effective.
The effectiveness of telehealth is no longer a matter of speculation. There is a growing body of rigorous research published in peer-reviewed journals that validates these benefits, including the following findings from AMC Health programs. This sampling of peer-reviewed studies demonstrates the significant value that evidence-based telehealth programs provide across care settings, disease states and patient populations.
- Medical Care, January 2012. Geisinger Health Plan reduced all-cause 30-day hospital readmissions for high-risk patients by 20 percent by adding interactive voice response calls to their care management outreach.
- Journal of Managed Care Medicine, November 2012. New York City Health & Hospitals Corporation combined personalized case management and real-time patient management solutions to enable Medicaid patients with poorly controlled Type 2 diabetes reduce HbA1c levels by a mean of 1.8 points.
- Journal of The American Medical Association , July 2013. When Health Partners of Minnesota added telehealth and pharmacist management to their usual care for hypertension, 71.2 percent of the patients participating in the program had their blood pressure well-controlled after 12 months versus 52.8 percent of the control group.
- Population Health Management, December 2014. Geisinger Health Plan significantly reduced hospital readmissions and cost of care for patients with heart failure. For every $1 spent to implement this program, GHP saved about $3.30, which translated to 11 percent per patient per month between 2008 and 2012.
As the healthcare market continues its transition to value-based care, this compelling evidence combined with exciting new technologies that expand how patients can engage in care virtually is fueling demand for customized telehealth programs ranging from full turnkey programs to the ability to seamlessly augment existing care management resources. To facilitate the adoption of telehealth, legislative and regulatory barriers are also being addressed:
- The Tele-Med Act of 2013 (H.R. 3077), introduced to the House in September 2013, amends title XVIII of the Social Security Act to permit certain Medicare providers licensed in a state to deliver telemedicine services to Medicare beneficiaries in a different state.
- The companion Telehealth Modernization Act of 2013 (H.R. 3750), introduced to the House in December 2013, calls for states to authorize health care professionals to deliver healthcare to individuals through telehealth.
- The US Department of Veteran Affairs (VA) regularly offers telehealth services to qualifying veterans. In the just-ended federal fiscal year 2014, the VA’s national telehealth programs served more than 690,000 veterans and accounted for more than 2 million virtual visits.
- The ACO Improvement Act (H.R. 5558) introduced on September 22, 2014, would permit ACOs to use remote patient monitoring and store-and-forward technology that delivers images to remote providers. The bill also strives to improve care coordination by improving the process through which data are shared between ACOs and the Medicare administration.
Not having visibility into a patient’s condition in real time when the patient is at home and outside of a clinical setting is like a chef overseeing a kitchen, but not being able to view the prep line. In the era of accountable care and pay for performance, the primary objective for patients with chronic conditions is to keep them healthy with fewer high-cost visits to the hospital or other clinical settings. Therefore, gaining at-home visibility is critical.
By incorporating proven telehealth services as part of a well-designed care plan, the entire care team can work with a patient to manage a chronic condition between clinician visits, altering treatments or creating early interventions to keep a patient healthier and reduce the spiraling cost of care.
As healthcare reform continues to drive providers to share risk and deliver greater value, understanding what is happening with their patients with chronic conditions outside the clinical setting is no longer a nice-to-have. It’s a must have. It’s time for telehealth to go mainstream.
Jonathan Leviss, MD is SVP/medical director of AMC Health; staff physician at Thundermist Health Center; and assistant clinical professor of health services, policy, and practice at Brown University School of Public Health.