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A KPMG expert discusses the biggest drivers and challenges for expediting the adoption of virtual care.
Payers have a vested interest in the adoption of this technology to help lower the costs of care. Meanwhile, managed care organizations have started to incorporate online telehealth service options as part of their benefits packages, according to a survey.
A KPMG survey found that a quarter of healthcare providers surveyed found that their virtual care programs-telehealth and telemedicine-were sustainable, while 35% of providers have not yet launched programs. Approximately 40% of respondents were either in the pilot stage or starting early program investments with fewer than three full-time employees engaged in telemedicine-telehealth.
KPMG’s poll found that the biggest drivers for expediting adoption of virtual care were:
• Increase patient volumes and loyalty (29%)
• Care coordination of high-risk patients (17%)
• Reduce costs for access to medical specialists (17%)
• Meaningful use and payer incentives for adoption (13%)
• Patient requests/consumer demand (13%)
“The biggest drivers for adopting virtual care are increasing patient volumes, coordinating care and reducing costs for access to specialists,” Richard Bakalar, MD, managing director at KPMG and a member of the firm’s Global Healthcare Center of Excellence, tells Managed Healthcare Executive. “The biggest barriers to implementing telemedicine are tied to the number of technological priorities among providers [19%], organizational readiness [18%], and sustaining the business model [18%].”
Healthcare providers are having more financial risk imposed upon them by payers, according to Bakalar. “CMS has made it clear that it would like a higher proportion of value-based payments for providers and many commercial payers are following suit with bundled payment arrangements or other approaches that move away from ‘fee-for-service,’” he says. “Healthcare providers need to figure out how to become more efficient and the technology behind telemedicine allows caregivers to connect with patients remotely, efficiently and effectively.”
Telemedicine and telehealth have been used in urgent care settings and connecting patients and clinicians in remote settings with specialists.
“Telehealth has gained a great deal of acceptance in urgent care, since it is efficient and the conditions are not terribly complex,” Bakalar says. “Also, it is helpful in settings where a doctor can offer a remote consult to guide clinicians about treatment plans, such as having a neurologist help emergency room doctors with a stroke patient or a geriatrician helping nursing home staff members determine whether a resident should get treatment in an emergency room.”
Certain specialties really lend themselves to telehealth, such as dermatology and psychiatry.
“The technology can help with guiding people to more appropriate care settings or helping clinicians make better-informed decisions,” he says. “Situations where a specialist needs to directly intervene with medical procedures, such as a skin biopsy or with laboratory tests in the delivery of care or when the patient has a high-risk problem such as chest pain telehealth online assessments are not appropriate. Healthcare professionals need to be mindful of their own scope of professional practice and appropriate use of the online technology services.”
Bakalar is also seeing telehealth increasingly used in follow-up visits and chronic disease management, since it is “more efficient and convenient than in-office follow up visits,” he says.
Regulators and payers are beginning to recognize the value of telemedicine by changing how it is reimbursed and also how it is implemented, according to Bakalar. “More states are allowing doctors to conduct video consults or requiring insurers to cover them,” he explains.
The technology behind virtual care has reached a point where mobile and broadband connectivity is reliable and relatively affordable, Bakalar says.
“A provider can conduct a video consult and pull up an electronic health record that provides a high degree of engagement and quality care,” he says. “If the situation warrants, the clinician can refer the patient to get onsite care. But that only occurs in less than 15% of the telehealth online encounters.”
Time-sensitive tele-stroke and behavioral health psychiatric assessments from the hospital emergency department are common examples of telemedicine services applied with great effectiveness, according to Bakalar. It is also being used in a variety of settings and medical specialties by the U.S. Department of Veterans Affairs and Department of Defense, including by U.S. Navy ships, and in rural areas, and where specialists are needed to consult with other clinicians for underserved patient populations.
“Radiology has been among the earliest adopters of telemedicine and telemedicine is embedded as standard of care in this field,” Bakalar says.
Some of these early adopters of telemedicine are proving that it works and that it is a sustainable element in the delivery of care, Bakalar says.
“We expect that some of the other providers who are making initial investments will soon realize the benefits,” he says. “With the changing payment models in healthcare and the advances in technology, the 35% of providers who have not yet embarked on a virtual care program need to at least start examining this now as reimbursement becomes less connected to fee-for-service and moves to value-based care.”