Telehealth yields value in managed care

March 1, 2009

The potential is there if you only seek the benefits

Connecting healthcare providers to patients at home for remote monitoring and direct care via televisits yields substantial reductions in emergency department and inpatient utilization and costs. Optimal results are achieved when telehealth care teams implement redesigned care processes and coordinate with primary care physicians to watch over, improve and maintain the health of patients, especially those with complex chronic conditions.

Current research continues to validate the effectiveness of telehealth even in programs without extensive process re-engineering. For instance, a study of 17,025 Veterans Health Administration (VHA) patients in the VHA national telehealth program reported a 19% reduction in hospital admissions and a 25% reduction in total inpatient days of care.

How can managed care attain the benefits of telehealth?

Thus, advanced telehealth technologies are clinical applications not just telecommunications systems. And as the burden and complexity of disease increase, so too does the value in the level of connectivity and degree of telehealth-supported interaction between patients and providers.

Second, the right technology is important and necessary but not sufficient. It has to be used to implement new systems of connected care that establish and maintain ongoing monitoring of patients at home, timely detection of potential acute events, and prompt intervention by care teams with the requisite knowledge and skill to attain positive clinical, health status and financial outcomes.

Care teams must be created to use telehealth to supplement primary care with redesigned models of care management. Regional tertiary health systems and integrated delivery systems can identify physicians who have demonstrated proficiency in caring for patients with the most complex, difficult conditions. Care teams can include a physician plus four to six providers (nurses, nurse practitioners, physician assistants) who have relevant clinical experience, such as working in ICUs, CCUs or in homecare with technology-dependent patients.

Third, it is essential to target telehealth to the segments of health plan populations that have the highest need for telehealth-supported connected care - patients contending with multifaceted medical problems that make their conditions exceedingly complicated and difficult to manage and whose health status can fluctuate and deteriorate rapidly. Telehealth should be used to initiate and sustain ongoing care with highest-complexity, highest-cost members for whom it can help attain the most immediate and biggest gains in clinical, health status and financial outcomes.

Fourth, how telehealth is reimbursed will go a long way toward determining if managed care gains its benefits. The history of managed care is replete with examples of new technologies that offered the promise of cost reduction - promise infrequently fulfilled. Extending fee-for-service reimbursement for new technologies as a general benefit has proven time and again to increase demand, utilization and costs. Instead of paying fee-for-service for telehealth services, managed care must pay for performance. We should not pay for telehealth processes but reward health systems for the results care teams attain with telehealth for patients with the most complex conditions.

In conclusion, a winning strategy to achieve the value of telehealth includes:

Randy Moore, M.D., M.B.A. is chairman and chief executive officer of American TeleCare, Inc.