Three notable trends offer a glimpse into where the telemedicine market is heading.
During the latter half of 2016, key industry reports published by the likes of Kaiser Permanente Medical Group (KPMG), American Telemedicine Association (ATA), American Well and Zeigler showed telemedicine making a significant positive impact on healthcare and the economy. Depending on the report you read, projected growth ranges between 13% and 19% per year over the next five years. At the ATA Conference in Orlando this April, that market optimism was palpable, and was demonstrated in three key trends: Increased patient demand for telemedicine visits, increased telemedicine investment by health organizations, and transition from fee-for-service to value-based healthcare payment models. A large percentage of the consumer market is aware of telehealth. Again, depending on which report you refer to, 68%-75% of those polled said they would prefer a telehealth visit over an in-person visit. This is huge! Virtual visits are no longer an option of last resort. Many survey participants cited convenience as the number one factor that makes telemedicine attractive.
As the costs for infrastructure decrease, expansion of wireless and internet communications into rural communities increased. According to the 2010 U.S. Census, 46.2 million people occupy rural areas, and 72% of the land is rural. Across the country, many rural hospitals are closing because they’re unable to attract the specialists and advanced care technologies of urban medical centers. This is making access to health services even more strained for people.
Health organizations want to adopt telehealth to meet consumer demand, and there are investment dollars available to help them. For instance, if you visit the Rural Health Information Hub website, ruralhealthinfo.org and search for “telehealth grants,” you’ll find funding opportunities from various government agencies, such as the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), for Federally Qualified Health Centers, (FQHCs), critical access hospitals, rural hospitals, schools, and senior care organizations. Last September, the C. L. Brumback Primary Care Clinics, FQHC in Palm Beach County, Florida were awarded $93,476 to help pay for a wireless network and telemedicine services by HRSA.
Across the board, payers and regulatory agencies are constantly pressuring health care systems and providers to improve quality and lower costs. Health care administrators and physicians have been looking for a solution to this problem for a long time.
As more accountable care and merit-based incentives are introduced for Medicare recipients, we can expect telehealth to be more widely utilized to conduct routine follow-ups, specialty consults, patient education, and remote monitoring. Value-based healthcare payment models (VBCs) support and reward the optimal use of Health IT through up-front bundled payments for patients in specific diagnosis-related groups (DRGs). Merit-based incentive payments are another option for reporting core measures that demonstrate positive health outcomes.
Since the elderly and chronically ill use a large amount of the health care resources, the Centers for Medicare and Medicaid Services (CMS) developed the Chronic Care Management Program and together with the American Medical Association adopted CPT codes 99487, 99489, and 99490 to indicate 20 minutes of monthly non-face-to-face follow-up consultations with their Medicaid or Medicare patients who have two or more chronic diseases. CMS offers to pay one member of a patient’s health care team an incentive bonus per ranging from about $35-$45 a visit, per patient per month for these monthly communications in order to reduce hospitalizations and improve population health. Non-face-to-face visits can be conducted via telephone or live video conference. CCM can add up to significant new revenue upwards of $200,000 for a private practice. To learn more, visit www.cms.gov and search in the Medicare Learning Network for “chronic care management.” With increased use, chronic disease management is expected to generate revenues for doctors and better health for patients, and less spending for health care payers.
Industry Supports the Trends
Convenience, high quality experiences, and improved health outcomes continue to propel telehealth technologies into the future. Companies such as Care Sync and Smart Link are helping doctors track their time and ensure they can be reimbursed for CCM efforts as they strive to keep patients healthy at home. Commercial insurance payers like Aetna, Cigna, Anthem have developed provider networks designed to deliver telemedicine as a benefit to their members.
Private businesses are also offering provider networks who exclusively practice telemedicine to help hospitals, nursing homes, and rural hospitals improve access to care. These provider networks can be multi-discipline practices, or all from one specialty. For example, Iris Telehealth supports the increased demand for mental health services by providing locum tenens and supplemental telepsychiatry professionals. CEP America provides a range of health care specialists who work together to care for patients with acute medical conditions through post-acute care, to include: emergency, hospital, urgent care, anesthesia, and post-acute care physicians who work together as a patient-entered health care team.
Many virtual services have been developed to cater to the specific needs of their populations. At the conference, I saw Laurence Girard of Fruit Street demonstrate their interactive diabetes education and self-management software solution, designed to meet Center for Disease Control guidelines. eCare21 is a mobile health application that features patient-centered monitoring, lifestyle tracking, and communication designed for seniors. Honeywell remote sensing technologies can detect falls, abnormal daily living patterns, or important vital sign changes.
The telehealth industry is changing to improve care by addressing real problems and providing real business and technology solutions. As the novelty fades, and these tools are used on a normal basis, health organizations will realize higher revenues. This is because each role will be redefined and normalized to incorporate digital health operations in to the continuum. Presenting patients with turnkey solutions that require little more than wearing a sensor and having the device turned on and wirelessly connected will become commonplace. Health care spending will be normalized and more predictable, improved communication of health information will advance the practice of medicine and push towards personalized medicine.
The next logical trend that will become prevalent is big data analytics. Integration of telehealth and EMR data to gain a better understanding of cause and effect for patients will better inform clinical decision making, because health care teams will be able to see the cause and effect relationships more readily, and learn the whole story of what happened to the patient.