From Telemedicine to Telehealth: The Promise of Disruption
What used to be called “telemedicine” has now become “telehealth,” reflecting a rapid expansion in the scope and technical sophistication of health care services. Employers still scrambling to keep up with changes set in motion by the Affordable Care Act (ACA) might lament the prospect of having to cope with more systemic disruption. But telehealth may hold the promise of addressing the health care access, cost and quality concerns that were on the minds of the ACA’s architects more than a decade ago.
The value proposition
As explained by the nonprofit Center for Connected Health Policy (CCHP), the term “telemedicine” describes “traditional clinical diagnosis and monitoring that is delivered by technology.” In contrast, “telehealth” describes “not a specific service, but a collection of means to enhance care and education delivery [covering] a wide range of diagnosis and management, education, and other related fields of health care.” Those related fields include chronic disease monitoring and management, counseling, physical and occupational therapy, and dentistry.
The value proposition of the most basic form of telehealth — a patient’s phone or video-based interaction with a health care provider — isn’t hard to grasp. “Consider that the average in-office visit takes 121 minutes, including 101 minutes of commute and waiting room time, and only 20 minutes with the doctor,” according to Forbes. But there’s more to the live component of telehealth than routine care.
For example, emergency rooms use video to link providers with specialists who cannot be on the spot. Also, remote ICU monitoring units can provide around-the-clock support with interactive video communication and digital patient monitoring equipment. Additional video-based applications include enabling:
- Medical specialists (including mental health professionals) to examine patients in remote locations in nonemergency cases,
- Examination of patients with mobility issues, and
- Foreign language translation services to bridge communication gaps.
Remote patient monitoring is a basic component of telehealth. It harnesses technology to collect medical and health data such as blood pressure, weight, blood sugar, blood oxygen and heart rate from individuals and transmit it securely to providers. “This service allows a provider to continue to track health care data for a patient once released to home or a care facility, reducing readmission rates,” according to the CCHP. “Health professionals act on the information as part of the treatment plan.”
Harnessing mobile devices is an example of the evolution from “telemedicine” to “telehealth” services. This mobile health platform supports applications ranging from customized health reminders and responses to patient inquiries to alerts about disease outbreaks.
Another key component of telehealth is “store-and-forward” systems that enable electronic delivery of digital images, documents and recorded videos. Although not the same as a real-time remote office visit, the rapid dissemination of this data enables medical generalists to seek guidance from specialists, sparing the patient the need for an additional office visit.
The cost-saving potential of telehealth systems stems from several factors, according to a study published by the Cleveland Clinic Journal of Medicine. Specifically, telehealth:
- Improves patient engagement and outcomes,
- Reduces the financial impact of patient no-shows, and
- Reduces unnecessary office visits and hospital admissions.
The study also found that telehealth optimizes staff distribution and resources within a health care facility and across an entire system. In addition, it enables primary care physicians to conduct appointments without any additional office staff at any time.
Prevalence and the size factor
So where do matters stand with these advances and a burgeoning tech sector endeavoring to cash in on telehealth? Although it has advanced in sophistication, telehealth remains in the early stages of adoption by employers, health plans, providers and systems. An American Medical Association (AMA) survey of 3,500 physicians released in late 2018 revealed that:
- 15% of physicians work in practices that use telehealth for diagnosing, treating and following up with patients,
- 11% use telehealth systems for consultations with other physicians,
- Radiologists, psychiatrists and cardiologists are the most prolific users of telehealth systems, and
- Videoconferencing was the telehealth tool most commonly used in 13% of the practices, compared with only 7% who used it for remote patient monitoring.
However, prevalence of telehealth technology varies significantly by medical practice size. In short, larger practices use it much more. The AMA’s analysis of the data concluded that “the financial burden of implementing [the technology] may be a continuing barrier” for smaller medical practices. Economies of scale make telehealth technology much more affordable for hospitals and health care systems. At least half of them have made that investment, according to the Cleveland Clinic Journal study.
Other critical factors driving greater adoption of telehealth include growing state mandates that health plans cover telehealth services and an ongoing liberalization of Medicare telehealth service coverage.
Expectations and communication
If your organization has yet to add telehealth services, the costs involved are considerable. Then again, employees and job candidates will soon likely expect such functionality in their health care benefits.
For employers whose health plans already cover telehealth services, effective communication of its availability and benefits is key. Even when a more efficient and economical approach to health care delivery becomes available, old habits die hard. Make sure your participants are maximizing its value.