Telehealth: Augmenting Population Health

Telehealth is quickly being adopted by many healthcare practices. If you’re familiar with Face Timing with your family, then it shouldn’t be a difficult adjustment to using telehealth. CMS is excited about the prospects of telehealth, and they created the Telehealth Expansion Benefit Enhancement waiver in 2018 which allows for equal to, or greater, reimbursement for telehealth visits for Medicare Part B services as an incentive for Next Generation ACOs and attributed providers. Why all the excitement behind it?

For those who live in rural areas with decreased access to primary care and urgent care facilities, telehealth has become a great option where a patient can visit a physician via laptop or mobile device. While it initially started as a way to increase access to care in rural areas, it can also be a great option for those who lead busy lives. Those committed to telehealth have found different ways of utilizing the service. At the University of Wisconsin-Madison, students who need to go to the clinic have been given the option of a telehealth appointment right from their dorm room. UW even offers contraception visits via telehealth. For those students, in most cases a telehealth visit actually costs them less than a typical student clinic appointment.

Telehealth

Not only does telehealth create an opportunity for those who are healthcare access challenged, or burdened with time constraints, but the quality of care via telehealth is improving every year. While some fear that a telehelath visit won’t be as effective, according to a 2018 article by Steven Findlay of the Washington Post and Kaiser Health News, “There’s no evidence so far that your risk of being diagnosed wrongly or treated inappropriately is any greater with an e-visit compared to an in-person visit.”

SOME OF THE BENEFITS

When provider organizations consider the Triple Aim (access, quality, and cost), then they will see that now is the time to implement telehealth with their providers. The uses for this technology continue to expand. Transition care management visits are a major deterrent to hospital readmissions. Surprisingly some TCM visits can now be performed by telehealth. This allows for medication reconciliation without having to force a recently discharged patient to get out of their house to see their provider when it might be difficult during the healing process.

Most electronic health records offer telehealth capability including eClinicalWorks, AthenaHealth, Modernizing Medicine, and NextGen. Considering that HealthcareIT News says that 65% of consumers want to use telehealth, it stands to reason that not only can this be good for quality of care but as a potential incentive for beneficiaries to utilize your services. Another positive is the potential for less no-shows because telehealth eliminates the need for people to leave work to visit the doctor.

SOME OF THE DRAWBACKS

There are a handful of drawbacks that don’t get mentioned very often. Policies behind telehealth aren’t as clear as they could be. In the case of the above-mentioned Telehealth Expansion Benefit Enhancement waiver, the option isn’t available to all ACOs involved in Pathways to Success just yet. Part of that is because telehealth is in its infancy, and not enough research has been done on it (another drawback in itself).

As it stands, there are only 29 states that have telemedicine parity laws that require private payers to reimburse in the same way that they would for an in-person visit. This means that only about half of the United States is able to implement telehealth practices. Finally, because telehealth is predicated on technology, for those who don’t already have the technology in place it could be an expensive proposition.

One of the last drawbacks is that telehealth isn’t for everyone. While it has been shown to be good for psychiatry, dermatology, ophthalmology, and a good number of primary care services, it’s probably not great for people who have significant behavioral health issues. Those are much better served face-to-face.

WHERE DO WE GO FROM HERE?

If practicing better population health, improving quality, and improving access to care is of upmost importance to your organization, consider telehealth to be towards the top of your “To Do” list for 2020. Just understand there are still some limitations at this stage of the game. Where I think you’ll see telehealth fit in with ACOs is when primary care offices are closed. Often times patients see that their PCP is closed, and then they head straight to the ER. If practices have access to telehealth, and they can have a provider available to do after hours care via that technology, it stands to reason that unnecessary ER visits could be avoided.

This is certainly something to keep an eye on because as technology becomes ever more pervasive, telehealth will, too.

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