Telehealth: Redesigning the Patient Experience

If there were ever an innovation whose time has come, it's that of telemedicine –recently rebranded as "telehealth". It comes at a time when the greatest challenges in healthcare delivery include cost, access and quality of care.

By definition, telehealth is the ability to provide care anytime, anywhere, via a variety of technological devices such as computer, tablet, cell phone, or a standalone kiosk. Better yet, patients can engage in a virtual visit with any number of appropriate professionals, including a nurse, doctor, or mental healthcare provider from the comfort, convenience, and privacy of their home, place of business, or even while traveling.

Telehealth offers a wide range of functions. For example, it can be used:

• For routine, scheduled visits and checkups
• For minor ailments, such as when a child stays home from school
• To reduce the spread of contagious conditions by limiting exposure at doctors' offices
• To assess serious or complex cases for immediate referral to urgent care
• To facilitate more frequent check-ins with chronically ill patients
• To streamline the insurance mandate for a primary care physician consultation before making a specialist referral
• To consult with a specialist "on the fly" for assistance with a patient's diagnosis and treatment
• To allow specialists to participate in bedside consults and "virtual" rounds without having to travel between hospitals
• To check-up on patients who have been discharged from the hospital to reduce the risk of re-admission
• In crisis situations for immediate assessment and triage to handle large numbers of patients – even at the site of the emergency
• To enable mental healthcare providers to conduct "tele-psychiatry" with patients in their own home where they are likely to be more open and less  anxious,  not to mention worried about the public stigma that can accompany mental health care
• For "aging at home" patients, who may need frequent monitoring

While the business of healthcare has changed dramatically since the start of the millennium, telehealth represents one of the most useful tools benefiting both patients and healthcare providers. It does not require excess administration and offers convenience, speed, flexibility and cost savings – all at the same time. As such, telehealth is experiencing rapid growth and deployment which is driven by more by market demand than economic forces. This growing consumer desire for more affordable and accessible care is pushing healthcare providers to incorporate the telehealth delivery channel into their practice model.

Access
In an effort to control healthcare costs, insurance companies have raised premiums, co-pays, coinsurance percentages, deductibles and narrowed their provider networks. The net result for consumers is a higher share of costs and fewer providers from which to choose. For people in large metropolitan areas, smaller networks can create an inconvenience, but at least there are providers in the general vicinity. However, the problem of access is much more dire in rural communities. Only 10 percent of physicians practice in these areas, with about 40 specialists per 100,000 people.

Telehealth consultations between doctors and patients via smartphones, tablets and desktop computers can help bridge this gap in access. High-demand specialists can be brought in immediately to a rural bedside case for a brief consultation. In fact, an enterprise telehealth network is better able to balance workloads among providers. For example, if there is an excess of patients in one locale, underutilized providers elsewhere can be dispatched to provide telehealth services to those outside their geographic location.

However, geographical distance isn't the only access problem for patients. About 41 percent admit that they forgo seeking medical services simply because they don't want to leave home. Anyone who has felt "under the weather" can likely relate to this sentiment, but imagine how much stronger it is for people who suffer from chronic, painful, or debilitating conditions. Elderly people "aging in place" are less inclined to make the effort for a long wait at an office visit, and those without convenient or affordable transportation options are remiss to seek care as well.

In 2015, many states worked to simplify physician license requirements so that more doctors could practice across state lines, facilitated by telemedicine. This offers a significant advantage to Americans – particularly retirees – who wish to relocate but not lose touch with a trusted physician. This type of medical care portability also aligns with the trend for Americans to purchase health insurance policies on marketplace exchanges, which allows them more opportunity to sever ties to employers without sacrificing health insurance or medical care from long-time physicians.

In 2016, efforts have moved the practice further than that, with many U.S. hospitals and healthcare providers creating telehealth consultation partnerships with medical institutions abroad. According to the American Telemedicine Association, at least 200 academic medical centers in the U.S. currently provide offer video-based consulting in other parts of the world.

Quality of Care
How well can a healthcare provider assess a health condition without a physical exam? Apparently, quite well. Many studies have revealed no difference in a provider's ability to obtain the patient's information, make an accurate diagnosis, and develop a treatment plan that produces the same desired clinical outcome whether via a telehealth device or an in-person visit. Patients have reported that 91 percent of outcomes were equal to or better than an in-person visit. Moreover, studies have shown that only six percent of telemedicine patients required follow-up care compared to 13 percent of in-person patient visits. The reality is that shorter, more frequent telehealth follow-ups can result in a better outcome than longer intervals between office visits.

Quality of Patient Experience
Any patient who can see a doctor while in his own home is apt to report a better quality experience. In some cases physicians can even get a glimpse of the home environment and potential risk factors that could exacerbate a patient's conditions, which would not be evident in an office visit. Telehealth has not been found to diminish the personal relationship between doctor and patient, which might explain why telemedicine patients report a 95 percent satisfaction rate with the experience.

Apart from the actual time spent with the doctor, telehealth can improve the overall provider experience. For example, the average time a patient has to wait for a telemedicine call was 20 minutes, but that's time he can spend doing something else at home or at work. When the physician gets on the line, the average telemedicine call is only two minutes, and both patient and physician can move on without the usual check-out procedures.

Cost Savings
Obviously, given the speed with which telehealth offers services, physicians can charge less and see more patients. Today, the average cost for a telemedicine consultation is $40. Moreover, there are many times when a two-minute telehealth call could help avoid an expensive and time-consuming trip to the emergency room or an urgent care center, such as in the case of a serious cut or burn.

As for physician overhead, studies have demonstrated an average of 11 percent in costs savings, with a $3.30 return on investment per dollar invested to implement a telehealth program.

Coverage
Among patients, the biggest concern is whether or not these types of consultations are covered by their insurance policy. Fortunately, while telehealth may be driven by consumer demand, the fuel is provided by healthcare insurers. Anthem, Aetna, UnitedHealth Group, and most Blue Cross and Blue Shield plans now cover the substantially lower costs of telemedicine services. Furthermore, 29 states and Washington DC require insurers to provide the same level of coverage and reimbursement for telemedicine services as in-person services – a number that has doubled over the last two years.

Acceptance
After two years of debate, the American Medical Association (AMA) just recently adopted the following set of ethical guidelines to help facilitate safe and effective digital interactions:

• Inform users about the limitations of services provided
• Advise users how to arrange for follow-up care
• Encourage users to inform their primary care doctor when they engage online with a telehealth provider
• Advocate for policies and initiatives to promote access to telehealth/telemedicine services for all patients who could benefit from receiving care electronically

Today, 30 percent of patients report using some type of telemedicine experience, and 75 percent of Americans say they are interested in utilizing the option. Among employers, 35 percent of those who currently provide onsite health facilities offer telemedicine services, and another 12 percent plan to add these services in the next two years. More than 70 percent of employers report that they plan to add telemedicine to health plan benefits by next year.

Some experts have projected that about 75 percent of healthcare services could be handled effectively via telemedicine. Much like online shopping, telemedicine continues to be an innovative alternative to traditional brick-and-mortar healthcare. In 2016, the number of providers offering telemedicine-based services is rapidly increasing, even at retail minute-clinic locations such as CVS Health and Walgreens.

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