Virtual Care Trend Watch

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Market trends (and a few bold predictions) in the evolution of the telehealth and telemedicine landscape. In this series we will examine the current state of virtual healthcare and plot a few important trends to watch.

Value-based payment
The arrival of value-based payment is no longer something of the future. 2017 will finally bring on the true age of innovative payment models and performance-based payment adjustments/incentives. These changes will not only effect physicians accepting and billing medicare but also commercial payors. These payors have already started to initiate programs modeled after CMS’s MACRA. As I have written many times, telehealth tools will be critical in achieving these performance-based incentives by cutting costs for virtual visits while increasing patient engagement and access, which are pillars of value-based care. Many that will begin down the road of value-based payment will quickly learn that deploying a telehealth program will not only make reporting, measuring and attaining incentives in these alternative payment models easier, but a necessity to compete in the healthcare marketplace. Also, pending legislation such as the Connect 4 Health ACT (which we covered in issue #6) will provide reimbursement regulations and make it attractive for entities to utilize telehealth. Though a ton is up in the air in regards to an impending ACA repeal with our new administration, legal experts I’ve talked to in D.C. say that you can count on these value-based payment reforms to stay intact. A lot of the telehealth bills like the Connect 4 Health Act that still have strong bi-partisan support are likely to be reintroduced.

Demand for interoperability will create even more strategic partnerships
The days of telemedicine solutions existing alongside a health system or provider’s EMR – rather than being fully integrated – are coming to an end. Previously, a lot of telemedicine solutions separated the EMR to avoid the time and cost associated with having a true (HL7) interface completed, which is the type of file format necessary for clinical software programs to exchange health data securely. All certified EMRs have to be HL7 compliant to achieve Meaningful Use incentives and have the ability to support these interfaces. They all can be interfaced, but the cost of integration is still enormous, especially for large health systems that have already dished out millions for EMR implementations. The hospital is then asked to spend money on another interface for their telemedicine solution, which is projected to have low utilization early on. Not surprisingly, may hospital systems saw these additional integrations not as “must haves” but as features that they could grow into.

That thought has changed. With more and more providers/healthcare systems now tied to the hip with their EMRs for Meaningful Use attestation, having integration with their telemedicine platform is going to become a requirement for many, and an industry standard. The EMR market in which EPIC and CERNER have now become the top dogs, is full of partnerships with leading telemedicine companies.  I believe this will dictate the winners of the telemedicine market share race. Partnerships like Vidyo + EPIC and CERNER + American Well are very influential.

To clarify, these are strategic partnerships that are basically agreements that have allowed the companies to begin the process of opening up the capabilities of seamless integrations between the platforms. This could become a huge competitive advantage for these telemedicine companies, having already drawn out technical pathways for integrations with the biggest players in the EMR market and easy access to those established customer bases should allow them to capture an unprecedented market share in the upcoming years. Expect many other telemedicine companies to follow suit. Healthcare providers are inundated with their electronic medical record systems; asking them to work outside these systems just won’t cut it. The bi-products of these integrations should be improved workflows, increased adoption and better continuity of care.

Virtual visits alone won’t be enough
The remote patient monitoring market saw a big jump in the last year. In 2016, 7.1 million patients enrolled in some form of digital health program featuring connected medical devices as a core part of their care plan. Swedish market research firm Berg Insight, which specializes in internet-of-things (IoT) verticals, tracked a 44 percent jump in remotely-monitored patients last year. While that’s not counting the various connected devices used for personal health tracking, the researchers predict that will begin to play a larger role in healthcare. They estimate that the number of remotely monitored patients will reach 50.2 million in the next four years, with 25.2 million comprised of those with connected home medical monitoring devices and the rest coming from personal devices. For providers, this means becoming savvy with their care plans to balance in-person encounters with virtual visits and remote monitoring. For example, healthcare providers will need to focus on patient selection in order to identify the patient profiles best fit for a monitoring program. It is not feasible to monitor each and every patient. A remote patient monitoring program has associated fixed costs. Identifying your high risk patient populations, specifically ones with chronic disease that are most likely to be readmitted, will be vital. Care teams capturing consistent data from patients, proactively catching downward trends in their conditions and swiftly intervening with virtual visits from case managers are all strategies that not only cut costs but have been proven to improve outcomes long term in patients.

Which takes us right back to the impending value-based payments mentioned earlier, which at their core are about slashing costs and reporting quality healthcare outcomes. Having the tremendous capabilities of collecting vast amounts of clinical data on large patient populations should make remote patient monitoring an essential practice at the epicenter of the healthcare ecosystem in years to come.

What’s in a name?
Digital health, telehealth, virtual health or whatever buzzword you wish to use, my position is that eventually this will all just be plain old healthcare. It will just be clinicians providing care while comprehensively leveraging technology to do so. If you haven’t planned for this or put a strategy into motion, you may already be behind the curve. Though there will be many future changes in the market, the foundational principles of these practices have been laid. The good news is that it’s just the second quarter, and there’s time to get off the sidelines and into the virtual healthcare game.


Contributing Editor / TRC Liaison
The founder of IMST Innovations, Aneel is a certified telehealth coordinator who works with organizations to develop sustainable telemedicine solutions. He is Telemedicine Magazine's liaison to The National Consortium of Telehealth Resource Centers.

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