The Fallacy and Opportunity of Population Health

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Population health presents a seismic opportunity for the telehealth industry if we can all agree on a few things.

Buzzwords are overrated. Most executives cringe at pitches promising “disruptive” or “interoperable” healthcare solutions. They don’t want to hear how a web app “harnesses big data” or “reduces health disparities.” Just tell them what it does, and prove that it works.

Consequently, the term “population health” has garnered a bad rap. While it’s the industry’s buzzword du jour, it’s misleading at best, an outright lie at worst. The vast majority of programs marketed as population health actually deliver sub-population health.

Population health ought to refer to approaches that improve health outcomes for entire groups of people. But it doesn’t. At least not yet. Rough estimates indicate program penetration rates of less than 10 percent in any given population.

While this may appease the C-suite and shareholders, it won’t address the ever-increasing burden of chronic disease on the healthcare system. As diagnoses of diabetes and other diseases like hypertension and cancer multiply, employers, private insurers, and government-sponsored health programs are scrambling to care for their sickest, costliest members.

“Shifting age and social demographics are transforming the labor force,” says John Bigalke, CEO of Second Half Healthcare Advisors and former National Industry Leader of Life Sciences and Health Care for Deloitte. “This, combined with the increasing demand, will make the current delivery system inadequate.”

Chronic Disease Will Sink Health Systems
More than half of all Americans manage one or more chronic conditions. Naturally, older Americans have even higher prevalence rates; nearly 9 in 10 adults 65 and older manage one or more chronic disease. As Boomers age and life expectancy grows, so too will both the costs to treat these populations and the demand for technology-enabled solutions.

Already, a staggering 86 percent of the nearly $3 trillion we spend annually on health care in the U.S. is spent treating people with chronic and mental health conditions. Individuals with chronic conditions are much more likely to be hospitalized and incur far more costly in-patient stays. They also spend more on prescription medicine. They see doctors and specialist more often, and require more home health visits.
This dramatic increase in health care services results in costs 2.5 times higher for individuals with one chronic condition and 6 times higher for those with three chronic conditions. The 9 percent of Americans managing five or more chronic conditions drive a staggering 35 percent of all health care spending, up from 22 percent in 2006.

Chronic diagnoses can’t be undone, but there is a bright and achievable silver lining: With aggressive preventive care, proactive engagement, and the full application of lifestyle and behavior change science, chronic diagnoses will no longer be equated with chronic financial loss. Only then will the industry realize the full promise of population health.

“This increasing pressure on healthcare systems will require novel and flexible models of care, as stakeholders across the system look to create efficiency and better outcomes,” says Anna Grant, Vice President of Clinical Operations for HMC HealthWorks, a health management company based in Florida.

Telemedicine Places True, Total Population Health Within Reach
Valued at $20 billion in 2015 according to Grand View Research, the population health management market will swell to nearly $90 billion by 2025. This growth will be fueled in large part by a dramatic uptick in the use of remote patient monitoring (rPM) devices. In its annual mHealth report, Berg Insight pegs the current number of remotely monitored patients at 7.1 million, a figure that’s expected to reach 50 million within five years.

Telemedicine strategies including store-and-forward, real-time video, and rPM will revolutionize population health in five key ways.

1. Telemedicine will upend traditional identification and stratification models.
Identification and stratification have always been—and remain—core tenets of disease management programming. Payers weigh a variety of factors when enrolling members in these programs, but even the most advanced predictive modeling programs rely on reports of adverse health events and expenditures that took place months ago.

As a result, only a fraction of a given population receives tangible support in managing their condition. This approach naturally zeroes in on the highest-risk, highest-cost members. Programs launch with little more than the hope—and often the promise from vendors—of dramatic cost savings. Although risk and cost are great indicators of where problems have been, they are woefully insufficient in predicting where the problems will be.

Up-to-the-minute biometric data from rPM devices, wired, routed, and reported to insurers will help identify a new pool of members for program enrollment before they experience a costly medical emergency.

2. Telemedicine will enable 100 percent reach.
Technology is finally democratizing remote care management. Driven by thought leadership from organizations like the American Telemedicine Association, massive venture capital investment and frenzied mergers and acquisitions, wearables and other home health care devices are more accessible and affordable than ever.

At the same time, hardware like eDevice’s technology agnostic, cellular HealthGO and Cellgo hubs, and YOFiMeter’s blood glucose meter-hub combo are taking home health monitoring to the next level, enabling comorbid condition management at an individual and population level. Hardware like these allow members or their insurers to implement a suite of connected devices and transmit biometric data from disparate sources to the cloud at a fraction of the cost of previous solutions.

Emerging technologies like these expand the reach of population health programs, most notably to underserved populations in rural areas, which account for 20 percent of the U.S. population. Perpetuated by the inability to find and afford quality health care, rural populations face disproportionate incidences of chronic disease, according to the National Institutes of Health.

While rural and socio-economically disadvantaged populations’ access to care is limited, audio and video telecommunications abound, says Bigalke, making it one of the most viable means of connecting with them. These populations have the most to gain as telemedicine expands the reach of population health programs and delivers quality healthcare across the care spectrum.

“Hot spotting can be used to target these populations for education, and telehealth tools can enable a wide range of care from prenatal to chronic care management,” he says.

3. Telemedicine will solve the perennial challenge of care coordination.
While traditional, human-directed disease management programs yield a significant return on investment, logic demands we do more… better and faster than we’ve done it before, with an emphasis on coordinating care across providers and settings. People don’t scale; Technology does.

Physicians are unprepared and ill-equipped to manage the complex suite of health and life services their chronic patients require. While they know poor care coordination produces negative health outcomes, they feel powerless to intervene, according to a joint study by Johns Hopkins University and the Robert Wood Johnson Foundation.

To help connect the dots, most large insurers field a team of case managers who help members navigate the system while attempting to stay connected to the providers tasked with managing the same members’ diseases. Case managers often have little more to go on than members’ self-reported case histories, forcing decisions absent concrete information.

Disease managers and health coaches remain an essential part of the care continuum, but they are all too often reaching out to members who already exert a disproportionate strain on the system, utilizing telephonic communication at predetermined intervals rather than at the point of need.

Patients often go weeks or months between clinical appointments. “Having access to real-time biometric data enables meaningful connections between appointments if negative trends emerge,” says Grant.
Telemedicine can’t be simply a means to an end. It must nimbly bridge two people to each other, one with a real-time need and one with answers, on a journey towards health. It must break down silos and consistently route individuals toward the lowest-cost, most effective care in real-time, then capture and share relevant data across the care team.

“This will enable the system to optimize quality, efficiency, patient satisfaction, and financial performance under value based care,” says Bigalke.

4. Telemedicine will improve quality.
The annual growth rate of digital healthcare data is 48 percent. If that trend holds, the volume of healthcare data will reach 2 trillion gigabytes by 2020, according to a recent IDC report. But more data is only beneficial if it is effectively harnessed and meaningfully applied.

Telemedicine increasingly puts data in the hands of the individuals tasked, paid, and challenged to improve quality scores, including the historically difficult to penetrate provider network. Actionable data makes everyone’s job easier, enriches quality initiatives, and enables health plans to engage the right members at the right time based on today’s needs.

With the shift toward value-based reimbursement models, payment is increasingly tied to health outcomes rather than services provided. Savvy shoppers demand quality, too. More than ever before, they’re considering a health insurance plan’s STAR or HEDIS rating in addition to cost and the accessibility of providers as they peruse the insurance marketplace.

As important as ratings are, they only tell half the story. Utilization patterns and the elimination of fraud and abuse matter as well. So too do patient engagement rates and member satisfaction with the programs plans offer.

In the same way a handwritten note will always mean more than a mass email, the personalized intervention telemedicine enables will be better received by patients. With biometric data on each
person and interventions tailored to each individual’s communication preferences, it will enable what amounts to custom healthcare. Custom and quality always go hand-in-hand.

5. Telemedicine will make the healthcare system more nimble.
Agile and responsive have never been used to describe the healthcare system in our country. It’s arcane. It’s rigid. It’s resistant to change. It will be forced to adapt, however, and telemedicine is poised to accelerate the pace of change.

Patients’ demand for telemedicine is at an all-time high, with 65 percent of healthcare consumers  expressing interest in seeing their primary caregiver via video, according to a 2017 consumer survey by American Well.

Startups in particular play an increasingly important role in dragging Luddite systems into the 21st Century. The big players in the space recognize this, which is why more than 40 health systems have started their own venture funds, including Kaiser Permanente and Mayo Clinic.

“Entrepreneurs are empowered to innovate and adjust to shifting winds,” says Chris Knotts, CEO at SimpleVisit, a platform-agnostic video conferencing service for telemedicine. “This changes the ecosystem in the health tech industry. Organizations with established research engines and market share gain a competitive advantage in collaborating with startups. Big health systems and large insurance companies are essentially outsourcing R&D to inspired teams developing innovative solutions.”

Progress is slow, but there are promising signs of adoption. Pennsylvania-based Geisinger Health System was an early adopter of telemedicine and has led the way with its collaborative teleICU approach. Avera Health has reached more than 1 million patients with its expansive telemedicine initiative called eCare. The program, which reaches eight Midwestern states and many with large rural populations, offers emergency and pharmacy telehealth services, among others.

Looking toward 2018, population health will continue to headline both agendas at healthcare conferences and in-depth stories in national and trade publications. It will drive new market movement and dictate
C-suite conversations. Meanwhile, chronic disease will continue to overwhelm the healthcare system until we can figure out how to develop and deploy technology-enabled programs across entire populations,
not just the lucky few.

“We have to all be on the same page with the same goal in mind,” says Grant. “To utilize technology to connect patients with caring professionals who are driven to improve outcomes.”

Bigalke agrees, and notes that telehealth companies ought to focus on the value proposition. “Their goal is not solely to avoid admissions but to find the right point of care,” he says. “They must make the case
that their solution not only increases consumer satisfaction but also defines a business case for improving the economics for all parties involved.”

We owe it to the people we employ, insure, and treat to deliver solutions that provide help to individuals in need at precisely the right time, technologies that scale to meet increasing demand, and most importantly, programs that work.

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