Webinar – Telehealth 2018: Healthcare Beyond the Exam Room

In this webinar, Chilmark President John Moore presents key findings from our report, Telehealth 2018: Vendor Assessment and Market Impact. Afterward, he discusses broader telehealth opportunities and challenges with special guests Ann Mond Johnson (CEO of the American Telemedicine Association) and Dr. Brian Zack (Medical Director of Telehealth Services at University Hospitals Cleveland).

Key topics addressed:

  • Drivers and challenges to telehealth adoption
  • Greatest opportunities for telehealth to impact care delivery and outcomes
  • Current market segments
  • Potential disruptions to the telehealth market

You can also read some of the report’s findings in our blog post on provider adoption of telehealth.

To access the slides, please enter your email address in the video form or at the bottom of the page. To learn more about the report or to purchase it, please click here.



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Did You Know?

How Health Systems and Health Plans Are Leveraging Each Other’s Strengths Through Telehealth

By Mike Baird, President, Customer Solutions, American Well

 

telehealth consultationThere are over 5,000 hospitals in the United States, each caring for the country’s growing population of more than 325 million people. Aside from integrated health systems, many of these organizations are operating independently from health plans or other health systems. This type of siloed care has become the norm in the healthcare industry, and while EHRs have improved care continuity over the years, health organizations are still largely operating on their own.

The same can be said for these organizations’ telehealth programs. More than half of healthcare executives say they have implemented some sort of telemedicine service into their organization. Many health systems and health plans launch with a direct-to-patient urgent care telehealth service, before expanding to other service lines including behavioral health, specialty care, chronic care management, follow-up appointments and more. These telehealth programs leverage the healthcare organizations’ provider expertise, clinical services, technologies and unique ties to their communities. While telehealth is helping these organizations deliver more convenient and affordable care, their programs, too, have been historically siloed. Until now, that is.

Today, some of the top health systems and health plans in the country are utilizing their telemedicine programs to connect and exchange services instantly online. Health systems or hospitals who supply healthcare services are partnering with health insurers who generate consumer demand to leverage each other’s strengths.  This sharing of patient demand and provider supply is key in driving telehealth and patient success.

Two of the nation’s top healthcare organizations provide a perfect example of this type of telehealth care convergence. Cleveland Clinic, one of the largest and most well-respected hospitals in the country, offers its telehealth services on Anthem’s telehealth platform, LiveHealth Online. Consumers in Ohio, West Virginia and Pennsylvania who use Anthem’s telemedicine platform can connect with Cleveland Clinic physicians and nurse practitioners through the LiveHealth Online mobile or web platform for live on-demand video consults.

For Anthem, this collaboration offers its members unique access to providers from one of the nation’s leading institutions, and for Cleveland Clinic, it allows the health system to extend its telehealth service visibility to Anthem’s 38.5 million members — ultimately increasing usage and attracting new patients.

health plan health system shared telehealth platform

New-York Presbyterian offers another innovative example of care collaboration and integration through telehealth. New-York Presbyterian is one of the nation’s most comprehensive, integrated academic healthcare systems. The system has ambitious goals for telehealth and has already integrated virtual care into its emergency rooms to provide effective behavioral health treatment and to triage non-urgent patients to reduce wait times. Through its direct-to-consumer telemedicine program, New-York Presbyterian makes its providers available on the Samsung Health Ask an Expert app, which is preloaded onto Samsung Galaxy smartphones. Through this telemedicine exchange, a consumer with a Samsung phone can have an urgent care video visit with a New-York Presbyterian provider from within the Ask An Expert app. For New-York Presbyterian, partnering with Samsung gives their telehealth program unprecedented exposure to consumers across the country, while Samsung can offer consumers access to New-York Presbyterian’s renowned providers.

New-York Presbyterian, Cleveland Clinic and Anthem are the trailblazers for this type of virtual care collaboration, and more healthcare organizations are following suit as focus shifts from fee-for-service to value-based care.  These partnerships help accelerate telehealth adoption through greater platform utilization, increased healthcare specialty choices for patients, and expanded access to care.

Recent regulations have also helped make telemedicine collaboration more appealing for healthcare organizations. The Interstate Medical Licensure Compact allows expediated multistate licenses for physicians, which means health systems wanting to extend their services over state lines can expect expedited, multistate licensure for their physicians.

Health systems and health plans have their own unique strengths; by lifting the virtual barriers of telehealth care delivery, they can leverage these strengths through thoughtful telehealth collaborations.  In turn, this is transforming the way care is delivered and received for the benefit of both patients, providers, and health systems.

This post originally appeared on September 5, 2018, as the first in a series of sponsored guest blog posts on our Convergence conference blog. 

Telehealth’s Ongoing Efforts to Support Care Beyond the Hospital

Key takeaways:

  • Providers are adopting telehealth only when it directly contributes to revenue with a proven business case. This will not change for two or three more years.
  • Vendors are positioning telehealth as a complement to care, not a direct competitor to care, to address increasing competition for low-acuity care.
  • Whether telehealth does in fact complement clinical workflows will depend on whether the technology avoids becoming yet another silo of care delivery and clinical data creation.

Where are we on the hockey stick trajectory?

The growth of telehealth adoption has embodied the classic hockey stick graph. For decades, organizations such as the American Telehealth Assoc. (ATA) and a few market forecasters have touted telehealth as the next big thing in healthcare. Nothing, nada outside of a few, very limited use cases and what the Veterans Administration has been able to accomplish.

It’s not that other use cases didn’t emerge, or that other patient populations would not have benefitted from telephone- or television-based care. Rather, several obvious factors stood in the way – the cost of technology acquisition and maintenance, the opportunity cost of providing care that is not reimbursed, the complexities of licensing and credentialing across 50 states, and the difficulty of scaling what was, in many cases, a cumbersome if not fly-by-night program. Above all, it represented “A New Way of Doing Things”, and we all know how well received these are in healthcare.

Providers will not invest in telehealth technology unless there’s a clear indication that it will add revenue or generate savings in a value-based care model.

Today, of course, hundreds of vendors offer a range of technology solutions to support telehealth, both in the hospital and in the home. The cost of such technology has dropped; in the case of many direct to consumer (DTC) telehealth apps, it’s essentially free, as many consumers already own a smartphone and/or laptop and pay for Internet access and/or data plans. The difficulty of implementing and scaling programs has dropped as well. Reimbursement parity is not universal, but barriers are slowly falling – Medicare Advantage plans can start covering telehealth in 2020, and restrictions on telestroke coverage end in 2019.

The key question, though, is where on the hockey stick are we today. Is the market at the tip of the stick’s blade, with adoption destined to remain at its current level in the single digits (according to multiple metrics)? Or is the market still at the beginning of the blade, near the shaft, with adoption poised to peak at a much higher rate?

At the risk of answering questions with more questions, figuring out the exact spot that telehealth occupies on the hockey stick graph means asking two key questions:

Chilmark Research’s forthcoming Market Scan Report, Telehealth Beyond the Hospital, addresses these underlying questions as part of a greater focus on the state of telehealth adoption and the potential for telehealth market growth over the next 10 years. We examine the impact on providers as well as payer, employer, and patient stakeholders.

Providers catch up, where there’s money

Provider organizations are warming up to telehealth. Efforts to support acute care within the hospital are expanding, especially amid growing demand and shrinking supply for key medical specialists. Efforts to augment low-acuity care are also expanding, partly in a nod to improved customer service / patient satisfaction and partly to beat back the rising tide of retail health and urgent care competitors.

Not surprisingly, providers’ warm feelings towards telehealth are directly proportional to the amount of money to be made.

  • Interest in telehealth for outpatient care is tepid and limited to scattered pilots for high-acuity remote patient monitoring (RPM), condition management, and orthopedic procedures covered under bundled payments. Without proven value-based care (VBC) reimbursement models, most providers are not willing to take their chances.
  • DTC telehealth is pitched primarily as a tool for patient acquisition and retention so providers do not lose (or stop losing) business. While the benefits of improved care coordination and data-sharing are implied, the marketing message for DTC services typically centers on the low cost and high convenience of care.

Expect this trend to hold firm for at least the next two to three years. Most providers will not invest in telehealth technology unless there’s a clear indication that it will add revenue or generate savings in a VBC model. It clearly makes business sense to avoid such financial risk, especially in times of tight margins – but it leaves an opening for payers and employers, and their clearly defined financial risks, to fill in the blanks with their own telehealth programs.

Doors open up, where there’s a strategy

As hinted in the paragraphs above, telehealth is opening new front doors to care. This is true for the three broad types of telehealth technology defined and examined in our report.

  • DTC vendors can offer anytime access to care.
  • RPM vendors can support patients on care plans.
  • Acute care vendors can expand access to services, as well as expand the breadth of services available.

 

As for whether telehealth will create yet another care silo, our research suggests that vendors as well as providers hope to avoid this fate. Hospitals are increasingly centralizing telehealth operations, which brings consistency to the user experience but also allows executive leadership to pursue a clear strategy for telehealth implementation and expansion. Executed properly, this makes telehealth a complimentary service available across a system’s care venue, not an add-on available only in limited settings to a limited number of patients.

Meanwhile, vendors seem to be embracing the idea of telehealth as a complementary service, not a standalone one:

  • EHR integrations are increasingly common among vendors of all types – and while a visit summary isn’t ideal, it’s better than no information at all.
  • DTC offerings are being added to those centralized telehealth departments, and most vendors are more than happy to white-label their solution on a hospital’s behalf.
  • Acute vendors are seeking to apply their experience supporting complex inpatient workflows to outpatient and in-home care coordination.
  • All stakeholders identify long-term, post-acute care and skilled nursing facilities as key areas of future growth, both for monitoring residents and for providing remote care that would otherwise require an emergency department transfer.

The challenge lies in the execution. It’s one thing to espouse a strategy of telehealth across business units; it’s another thing entirely to take the tactical steps necessary for that strategy to become part of the everyday practice of medicine. If execution falls short, the strategy rings hollow.

A complement to care, not a competitor

If we were to hazard a guess, we’d say that telehealth adoption today sits somewhere in the middle of the hockey stick’s blade. Providers remain risk-averse, taking action only when all barriers to success have been removed and the path forward has been nicely graded and paved. Payers and employers are more willing to stand up telehealth programs, but their struggles to members/employees to use telehealth benefits to achieve broader adoption is still very much a work in progress. As stakeholders keep waiting for national licensing, credentialing, and reimbursement standards to replace a patchwork of state regulations, expansion plans are put on hold.

All that said, interest is growing. Healthcare business models increasingly demand the shift of care to lower-cost care venues, and telehealth provides such an option. Patients appreciate the convenience of remote care, both to avoid a single ED visit and to prevent repeated trips to outpatient facilities for follow-up care.

Whether adoption reaches the tip of the stick’s blade, or whether it fails to move beyond the tape on the middle of the blade, will depend on the ability of stakeholders to position telehealth as a complement to care, not a direct competitor, and to position growth strategies accordingly. Telehealth will not serve all healthcare use cases, and it will not serve all patient populations, but mounting evidence suggests that it can support care beyond the hospital – and beyond the few use cases of yesteryear. Stakeholders that fail to take note can expect to fall behind no matter their business model.

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