How telemedicine is evolving to support variety in care delivery

Telemedicine is nothing new; former American Telemedicine Association CEO Jonathan Linkous estimates that it’s been around for about 40 years, ever since doctors started doing two-way telephone consultations.

What is new is how telemedicine has grown exponentially in the past five years. Simply put, more sophisticated and cheaper telecommunications, mobile device and remote monitoring technologies are empowering telemedicine to substantially bridge the gap, quite literally, between the physical locations of doctors and patients, anywhere in the world.

This progress is just the tip of the iceberg. In terms of efficiently and economically integrating multi-disciplinary treatment and establishing interoperability across the continuum of care, telemedicine is just beginning to realize its vast potential.

Increasingly sophisticated virtual medicine technology and mobile health devices are leading the way into telemedicine’s future.

The Electronic Health Record system's capability to schedule in-office appointments now extends to video visits as well, where patients can receive an e-mail link to the visit and can join it from their web browser or an EHR sync-up mobile app.

New mobile health devices can also measure a patient’s vitals or scan the patient’s health data in the home. Instead of driving long distances every week to see maternal-fetal care specialists, women with high-risk pregnancies now can be monitored in their obstetricians’ offices by these specialists, who enter a video conference and provide onsite treatment.

The most successful deployments in telemedicine, however, must be closely modeled after traditional care models.

An AMD Global Telemedicine survey of several dozen telemedicine programs found that the best telemedicine care delivery closely parallels traditional care delivery, since it minimizes the amount of change necessary and, consequently, the potential for failure.

Accordingly, written standard protocols for equipment use, documentation and exams should track non-telemedicine protocols. For example, the consulting physician should get the same patient chart upon entering telemedicine consulting rooms.

Additionally, the best programs are very accessible, with equipment close to where patients receive care and the consulting physician’s workplace. The sending room, where the patient and the caregiver are located, should resemble the patient exam room and have enough basic tools and competencies to let a consulting physician, who is located at a remote receiving room, know what they can request and the sender’s capabilities.

Telemedicine programs that have nobody to coordinate daily operations are prone to failure. Someone must be responsible for scheduling sessions, encouraging system usage, troubleshooting problems and removing impediments that make it hard for people to use the system.

New telemedicine programs with too many sites spread across too large a patient population and with too few technological capabilities also risk failure. It’s difficult to train, support and treat many patients when you only offer, say, a single service like video conferencing. Conversely, new programs with few sites and users and very advanced capabilities can become financially unfeasible.

The most effective telemedicine strategies, however, will solve what may be healthcare's greatest challenge—reimbursement. Successful telemedicine providers are embracing the trend away from fee-for-service to value-based care formats such as bundled services by altering their emphasis from traditional reimbursements to new revenue streams.

Here are alternative telemedicine revenue-generating structures that are opening up these revenue streams.

• Institution-to-Institution relationships enable academic medical centers with large communities of specialist physicians to contract with other institutions, such as rural hospitals in distant markets, to provide them with specialized expertise. Compensation could involve hybrid payments, fee schedule menus for a range of specialist services, a monthly rate or cafeteria arrangements.
• In an Employer Workforce Offering, a primary care physician network can provide telemedicine services to employees of a business or other organization at the workforce site and online. The provider and employer could agree on compensation formats that include a per-encounter fee, a shared savings fee model, or a base services rate/reduced per-encounter fee combination.
• By collaborating with telemedicine technology companies, Accountable Care Organizations could make quality-of-care and cost-saving improvements that would bring them Medicare incentive payments.

Sustainable telemedicine business models conveniently deliver affordable services that patients need, with cost structures and revenue streams that furnish providers with the necessary financial compensation and program support.

• Mercy Virtual Health Center, outside St. Louis, delivers virtual medicine services to Mercy’s 43-hospital network. Through partnerships with other healthcare organizations, it is offsetting costs and boosting program capacity. Its services are structured to follow the kind of risk-based revenue model where payers furnish the cash flow through formats like shared savings on reduced hospitalizations.
• The Arizona State Telemedicine Program brokers rather than provides medical services by sharing the costs among its client institutions, which include schools and hospitals. This lets them lower the cost of developing and providing e-networks.
• Myca Nutrition’s Canada-based web/mobile communications platform has doctors and patients pay a monthly fee for teleconsultations with nutritionists.

Mergers and acquisitions will increasingly play a growing role in the adoption of telemedicine, providing a much-needed boost to technology innovation, resources, and expertise.

In announcing its planned acquisition of telemedicine software provider REACH Health last year, InTouch Health cited its ability to help REACH’s customers make its telemedicine services more widely available through InTouch’s fully integrated virtual care platform.

Soon afterward, American Well said it intended to merge with acute care telemedicine solutions provider Avizia so that Avizia’s cart and custom software offerings could empower American Well’s client base, including health systems, to serve patients across more than 40 clinical telemedicine specialties.

Telemedicine is creating a powerful alternative to traditional office visits, bringing remote care to those who need it most. Through strategic alliances, innovative technology breakthroughs and carefully planned models of adoption, it has the potential to disrupt care delivery as we know it, but methodical and strategic adoption must be the watchword.