As Telehealth Tech Matures, Can Providers Catch Up?

HIMSS18 offered evidence that the telehealth market is beginning to mature, but it remains to be seen if providers are ready to implement what vendors are offering – and what patients are asking for.

One of our key takeaways from HIMSS18 was that the slow but steady maturation of the telehealth market has finally started to speed up. The key question, which this post will examine in greater depth than our HIMSS recap, is whether the maturation of vendor offerings and patient expectations can match provider willingness and ability.

Many direct-to-consumer (DTC) vendors are starting to address care coordination, which seems like the natural step forward from low-acuity care but has proven to be a rather tough nut to crack. At the other end of the spectrum, inpatient telehealth vendors are examining whether the same platforms that support teleICU, telestroke, or physician-to-physician consults can work in outpatient or even home-based settings.

Are providers really ready to use telehealth for care coordination? As with so many other healthcare issues, it all comes down to money.

It’s refreshing to see these pivots. For years, consumer and clinical telehealth have evolved on parallel paths; advances in products used by patients seemed destined not to cross paths with advances in products used by clinical staff within the hospital. This raises concern, as parallel paths fail to meet the needs of patients “in the middle” – those who require less attention than high-acuity patients but risk becoming high-acuity patients without some degree of vital sign or activity monitoring in between care episodes.

Patients increasingly show interest in digital health solutions that can support this degree of monitoring. A recent Accenture survey (PDF) found that 25% of patients are using telehealth (which Accenture calls virtual care), up from 21% just a year ago, with desired use cases ranging from after-hours appointments and follow-up visits to discussions with doctors or educational classes about specific health concerns. Meanwhile, an EY survey found that 63% of consumers would be comfortable using technology to track health and exercise, while 56% would use technology to interact with care providers.

One step forward, one step back

Some evidence suggests that providers are beginning to catch up with vendors and patients.

• Mass General is sharing its strategy for telehealth program implementation, emphasizing the importance of allowing providers to remain within the workflow of providing patient care.
• Intermountain Healthcare has launched a virtual hospital that pulls together 35 telehealth programs, with an emphasis on team-based, outpatient care access.
• Covenant HealthCare (Michigan) has partnered with Shriners Hospital to provide pediatric post-acute care coordination. Shriners’ virtual clinics are located across the U.S.; the Honolulu location, which serves remote South Pacific islands, serves as a model.
• LaSalle Medical Associates (Southern California) is an early adopter of ConsejoSano, a telehealth startup targeting Spanish speakers. The independent physician association is focusing on preventive care among Hispanic patients, who make up a majority of its patient population.

Other evidence, well, says otherwise.

• A HIMSS Analytics provider survey (PDF) showed that providers primarily use mobile health solutions for secure messaging. This is a start, but it ignores the more sophisticated capabilities of today’s smartphones and their potential use in virtual care delivery.
• A HIMSS18 presentation by Northwell Health listed several important stakeholders for driving telehealth strategy in an integrated health system – service line leaders, nursing leaders, marketing, legal/compliance, executives, business strategists, etc. Not on the list? Patients.
• A news story highlighted how two health systems plan to put self-service telehealth kiosks in retail locations. While this improves access to care and leverages existing telehealth programs (both of which benefit the provider) there’s no evidence that it improves outcomes or lowers costs (both of which benefit the patient).
• Despite the efforts of organizations such as Mass General, 38% of providers don’t even know where to start with telehealth, according to a MGMA report. Another 30% find telehealth insufficient to meet their care delivery needs.

Money talks…

Taken together, the evidence above begs a clear question: Are providers really ready to use telehealth for care coordination? After all, payers and employers are increasingly willing to support this use case, as a means of both controlling costs and improving outcomes – and, for employers, improving productivity and output.

As with so many other healthcare issues, it all comes down to money. DTC telehealth brings in revenue out of patients’ pockets (and payers’ pockets if visits are covered by insurance). Inpatient telehealth lets hospitals expand the reach of specialty service lines, which brings in revenue.

On the other hand, telehealth for care coordination only brings in revenue if providers have entered risk-based contracts (bundles, ACOs, and so on) and the patients being cared for have shown improved outcomes. Not surprisingly, this limits a providers’ willingness to devote already-scarce resources to a product or service line that may not contribute to ROI.

That may be changing. As Foley & Lardner pointed out, the recent budget bill expands Medicare coverage of telehealth; in particular, the bill targets remote dialysis for end stage renal disease (ESRD), a condition on which Medicare spends more than $30 billion annually and can reduce treatment costs by moving dialysis out of the inpatient setting.

In addition, CMS has updated CPT code 99091 for 2018. Physicians or other qualified health professionals can now reimburse for remote patient monitoring, a process roughly defined by the code as collecting and interpreting patient-generated health data. (This doesn’t include phone- or video-based virtual care, which is separately covered under CPT code 99040.) This presents a clear opportunity to increase reimbursement (and improve overall care quality) through the direct support of telehealth for care coordination.

…but patients walk

Finally, there’s always the possibility that market forces will push providers to expand their telehealth offerings. An NTT Data survey found that half of patients would leave their current doctor for one with a better digital customer experience.

Granted, such an experience includes patient engagement functionality such as finding a physician, refilling a prescription, and paying a bill in addition to participating in telehealth. However, it reflects that patients increasingly come to expect digital services – and telehealth is an important part of those service offerings.

As our forthcoming report on Telehealth Beyond the Hospital will further examine, we expect providers to spend the next 18 to 24 months taking a two-pronged approach to telehealth expansion: 1) Where reimbursement allows for it but also 2) where market pressure demands it. These efforts won’t fully meet patient expectations or fully utilize vendor capabilities, but they will help providers catch up.