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Emerging opportunities for telehealth in the shift to value-based care

Sheri Stoltenberg, Founder CEO Stoltenberg Consulting

Written by: Sheri Stoltenberg

As the healthcare industry becomes more competitive in the push toward value-based care, providers are turning to telehealth for expanded patient-care opportunities. Through the consideration of the legislative progress, technology use and successful case studies surrounding this care-delivery option, we gain a deeper understanding of emerging opportunities for providers. Moving forward, healthcare providers who understand the potential of telehealth, as well as the direction of the marketplace, will have a key advantage.

Patient Perception

As telehealth evolves, one of the most noticeable changes we’ve seen is the increasingly positive perception among patients. Every year, more patients and their families look to telehealth services for convenience, comfort and decreased out-of- pocket costs. In a small qualitative study published in the May/June issue of Annals of Family Medicine, all patients surveyed were satisfied with video physician consultations, while a majority of patients said they are open to provider follow-ups with virtual visits.

In comparing in-office visits with offsite video “visits,” some patients said they would potentially feel more comfortable with video conferencing to receive a diagnosis, since they would be in their natural support environment.

Additionally, through this new virtual care option, patients benefit by elimination of traditional in-office visit costs like travel expenses or lost time and wages from work.

Rural Health

For isolated patients in rural areas, telehealth prevents the need for multi-hour drives for physician interaction. This is especially pertinent when rural provider closures require alternative care options. For example, within the past seven years, 79 rural hospitals have closed.

For community leaders facing rural hospital closure, a report by Texas A&M University Rural and Community Health Institute suggests working to expand the breadth of telemedicine services offered, and negotiating with the closest healthcare systems for specialist collaboration. Partnerships with academic health centers can also increase education and support for isolated primary-care providers.

In addition to utilizing remote consultations, rural patient communities also benefit from in-home monitoring for chronic disease management for those diagnosed or at risk of COPD, heart disease and diabetes.

Legislative Support

Across the country, states are backing telehealth legislation, keeping in mind rural areas that can benefit most from the care option.

Notably, Texas legislators recently joined all other 49 states by signing the Telemedicine Bill into law to allow videoconference-based patient visits, even to establish physician- patient care. The law, which abolishes the need of an in-person visit prior to a virtual visit, tackles care disparity across the state, which ranks 46th in the country for physicians per thousand people.

In Vermont, meanwhile, a new law expands telemedicine technology while requiring insurers to pay providers comparably for using it. The law enables expanded care without the need for more facilities or physicians and is being used to increase mental health treatment capacity as well.

Support for telehealth initiatives spans beyond individual states with federal legislation like the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. Backed by the Finance Committee’s bipartisan Chronic Care Working Group, the CHRONIC Care Act (S. 870) recently advanced in the Senate. The legislation aims to expand Medicare telestroke reimbursement for accountable care organizations (ACOs) and Medicare Advantage telemedicine services. The act would also enable Medicare reimbursement for home dialysis treatment through telemedicine.

Project ECHO, a foundation for successful telehealth programs, is an example of another federally expanded initiative. Congress passed the Expanding Capacity for Health Outcomes (ECHO) Act (S. 2873) to extend Project ECHO’s model across the country, pairing academic medical specialists with primary-care providers through virtual clinics. The goal of this initiative is to provide care mentorship and behavioral and population health management.

Project ECHO began in 2003 in New Mexico to treat the underserved Hepatitis C patient population. Today, in New Mexico alone, 24 clinics provide program treatment, aiding more than 6,000 patients. The program model has expanded to other population health opportunities, including pediatric and autism care.

Pediatric Care

In a recent survey, Nemours Children’s Health Center found that 64 percent of parents have or plan to use telemedicine for their children within the next year, while awareness of telemedicine services increased 88 percent.

For busy families, telemedicine offers added convenience for child healthcare. Parents are most willing to utilize the option for cold and flu (58 percent), pink eye (51 percent), rash (48 percent), or additional well-child visits (41 percent). For families who have already tried telemedicine, 98 percent deemed the experience equal to or better than a traditional doctor visit.

Autism Treatment

One niche within pediatric care where telehealth is seeing a lot of success is autism treatment. The University of Missouri, one of the leaders in this area, uses a version of Project ECHO’s model, which has spread to 14 other academic facilities for autism treatment.

Within the program, clinicians with similar patient types participate in 90-minute biweekly “telementoring" online presentations, covering patient case studies with question-and- answer sessions. The case studies serve as virtual clinics led by an interdisciplinary team of specialists advising providers with best practices in autism care for medical, behavioral and education concerns. The team even includes a parental representative, so participating providers can consider possible family challenges, questions and care concerns while treating patients.

Through initiatives like Project ECHO and legislative support like the CHRONIC Care Act, the reality of telehealth as a viable care-delivery option is spreading. With its application, providers across the country can overcome physical isolation while gaining mentorship and educational resources. Patients, meanwhile, gain more convenient, cost-effective care from the comfort of their homes. Positive patient perception, including that of busy parents, is also fueling the push for this alternative care method in the competitive healthcare marketplace.

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