Why Telehealth, Why Now?
Healthcare In Crisis
Modern healthcare is a minefield of challenges. Patients lack access to care, choose between food and medication, struggle with high deductible health plans, or have no insurance at all. Clinicians are stretched thin by exhaustive documentation requirements and dispersed geographic coverage yet obligated to provide the highest quality medical care. Hospitals and health networks must meet increasing pressure to improve care outcomes while lowering operational costs. Medical debt is the leading cause of bankruptcy.
Does anyone want to be in the same healthcare system 10 years from now?
Healthcare leaders are calling for new care delivery models that can triumph over challenges such as:
Lack of access to quality care. Remote communities suffer from provider shortages and a lack of medical expertise. When the closest specialists are hours away, many people delay traveling for services until a problem or condition reaches a more serious stage. Patients may skip annual screenings and ignore early disease symptoms – narrowing their chances for positive outcomes.
Provider burnout. Many clinicians spend hours every day on regulatory documentation and traveling between multiple clinical locations, which limits their revenue and the number of patients they can see. If patients can’t schedule an appointment during the provider’s limited presence at the nearest clinic, consultations can be delayed for weeks.
Care gaps in chronic disease management. When patients see multiple providers who aren’t aware of each other’s prescriptions or diagnoses, clinicians can miss relevant symptoms and dangerous drug interactions. Healthcare complexity silos valuable information in disparate EHR and other systems, limiting insight into patient needs.
Capacity management. Hospitals struggle to balance staff utilization and resources with a shifting volume of admissions, outpatient, and emergency department visits. Health networks are asked to reduce operational costs while investing in the right medical innovations.
Escalating costs. Providers are caught between payer fee schedules and limited patient incomes; many write off balances for no-show visits or uninsured patients. Insurance premiums have risen dramatically in recent years, with many patients opting out of care when faced with high deductibles, coinsurances, and expensive medications.
The Rise of Telemedicine
As a sustainable care delivery model, telemedicine is taking patient outcomes and cost savings to a higher level. In the industry’s search for fresh approaches to the above challenges, virtual care has become a clinically and economically successful option alongside acute and ambulatory care. Reimbursement is increasing as parity laws and state regulations catch up to telemedicine’s efficacy – helping healthcare professionals partner productivity with patient convenience.
Why is the adoption of virtual care accelerating? One answer is that it puts the right patient in front of the right clinician at the right time. Patients can communicate in real-time with clinicians, pharmacists, laboratories, and therapists, whether they’re traveling across rural Africa, on a plane at 30,000 feet, or confined to their home by an acute or chronic condition. Location ceases to be a limitation with telemedicine, which can bring specialty services and valuable care coordination to patients who would normally go without treatment.
By partnering immediacy with medical expertise, telemedicine solutions are improving patient outcomes, reducing healthcare cost reduction, and increasing physician productivity. They’re also setting the stage for a future where today’s crowded waiting rooms are yesterday’s healthcare. Patients are demanding more accountability and convenience from their health plans and providers; digital titans like Amazon, Google, and Apple have entered the market specifically to disrupt existing delivery models.
While those proposed changes are still taking shape, one conclusion is undeniable: medicine is merging with technology. Patients have already adopted wearables that track their vitals, body functions, and sleep patterns. Artificial intelligence, nanobots, and genomic-based precision medicine dominate healthcare research. As we move into a future where technology renders many in-person visits irrelevant, the ascendancy of virtual care looks inevitable.
The Clinical Evolution of Virtual Care
Modern telemedicine represents a quantum leap from the early days of virtual care. Initial telemedicine solutions offered simple video calls where a clinician would diagnose patients based on their symptoms. Typically, those services treated uncomplicated, acute conditions like ear infections or influenza.
The next stage in telemedicine offered store-and-forward tools that allowed a provider in one location to share clinical data with a specialist in another location. After sharing x-rays, ultrasound images, or photos of skin lesions, the provider waited for a later result or recommendation.
Today’s virtual care delivers sophisticated evidence-based medicine. Although real-time treatment of acute conditions via video platforms and store-and-forward models of telemedicine still exist, increasingly secure and intuitive platforms integrate with the provider’s workflows and EHR systems for efficient data sharing. Providers can collaborate with PCPs and specialists in real-time and integrate valuable evidence into the care continuum for faster treatment.
Transcending Traditional Treatment Barriers
Telemedicine can dismantle traditional healthcare limitations in several ways:
Synchronous telemedicine. Advances in real-time videoconferencing and communication mean a patient or clinician in one location can communicate directly with clinicians and patients across the world.
Evidence-based clinical care. Providers can obtain the data and evidence they need to make a differential diagnosis and deliver a research-based consultation. Interoperable devices help them address a variety of needs such as blood glucose monitoring, blood pressure, and other vital sign measurements, heart ECG data, ultrasounds, x-rays, retinal examinations, periodontal care, and more. Doctors can complete Healthcare Effectiveness Data and Information Set (HEDIS®) measures and gaps in care, such as directing the patients to have a diabetes A1C test.
Remote patient monitoring (RPM). While considered a separate discipline from traditional telemedicine, RPM is a form of virtual care that can improve outcomes for patients with chronic conditions, as well as elderly and disabled patients who find it difficult to leave their homes. Innovations in biosensing, wireless, and other technologies can keep patients out of the hospital while providers guide their treatment plans from afar.
Immediacy of care. Instead of scheduling a doctor appointment in the future and waiting for an examination and treatment, patients and their clinicians can connect immediately – giving the provider instant clinical data to prescribe medications or make recommendations in a care plan. Patients receive treatment sooner, reducing the cost of care, lowering readmissions and emergency room visits, and helping them recover faster.
Translating Technology into Stronger Patient Outcomes
An ever-increasing body of medical literature is showing that telemedicine improves healthcare outcomes in diverse fields such as management of strokes, high blood pressure, diabetic retinal disease, pediatric intensive care, and other disciplines.
A Kaiser Permanente study showed an almost 75 percent increase in the timely use of the clot-dissolving drug tPA following a telemedicine consult with a specialist. Stroke patients received a diagnostic imaging test 12 minutes sooner, and the drug was administered 11 minutes sooner – reducing the door-to-needle time to less than an hour. And in stroke care, “time is neurons” and minutes can make the difference between little or no impairment versus devastating paralysis and other stroke complications.
Telemedicine has also shown a reduction in PICU admissions. Pediatric telemedicine patients are 2.55 times more likely to triage to a non-ICU level of care, while providers rated the accuracy of their assessments higher in telemedicine consultations.
Virtual care decreased wait times by 89.2 percent for diabetic retinopathy screenings in one underserved community. By reducing the wait time from 158 days to 17 days, telemedicine helped preserve patients’ vision through earlier diagnosis and treatment.
A 2018 peer-reviewed analysis of Nemours Children’s Health System’s pediatric telemedicine program in Telemedicine and e-Health Journal found 67 percent of parents who used telemedicine services reported they otherwise would have visited an emergency room, urgent care center, or retail health clinic; 27 percent would have visited an ER. The analysis suggested a savings of $113 million out of the $480 million the Florida health system spent in pediatric ER costs that year. Another benefit of telemedicine demonstrated by this study is that patients with communicable diseases can often be treated at home, limiting exposure to others and thus reducing transmission of illness.
The Care Beyond Walls and Wires (CBWW) remote monitoring program improved outcomes for patients suffering from chronic disease in rural communities and remote Native American reservations. Over a six-month period, readmissions dropped by 44 percent, patients were hospitalized 64 percent fewer days, and hospital charges were reduced by $92,000 per patient.
The Telemedicine Advantage
In addition to its clinical value, telemedicine provides multiple advantages by empowering healthcare systems to:
Provide access to quality care. Rural patients can receive specialist care and focused medical expertise that wouldn’t otherwise be available in their community. Rather than delaying annual exams and screenings, patients can receive timely preventive care and maintain consistent relationships with PCPs.
Manage capacity. Virtual services can avoid unnecessary hospital and emergency room visits while opening up capacity for patients who do need inpatient care. Hospitals can extend services beyond their walls through remote ICU and specialist consultations, rather than paying doctors to be on call without clinical need.
Meet patient demand. 92 percent of Millennial and Gen Z patients want telemedicine capabilities from providers. Instead of driving 40 minutes to a hospital to wait another 30 minutes for a 10-minute exam, these “digital natives” demand the immediacy and convenience of virtual care from their healthcare experience.
Fill care gaps for aging populations. In Japan, more than one in four people are at least 65 years old. The United States will have 78 million people 65 and older by 2035 – outnumbering children – and half a million centenarians by 2060. Given that elderly patients often require frequent care while finding it difficult to attend in-office appointments, telemedicine is the most seamless delivery model to provide thorough and consistent senior care.
Offer a 360-degree view into patient care. By inserting telemedicine at the right touchpoints across the continuum of care, providers can improve care coordination, spot evolving issues, accelerate interventions, and reduce treatment costs. Treating patients in their home environment can help providers gain deeper insights into their social determinants of health and address barriers related to economic challenges, family environment, and personal behaviors.
Offer faster urgent care. Telemedicine can save lives by having doctors remotely evaluate patients in those critical minutes after a heart attack or stroke as paramedics treat them in their homes. Lower-acuity patients can virtually consult doctors to determine if a clinic or ER visit is necessary, freeing up exam rooms for patients with truly critical issues, and limiting the transmission of illnesses such as colds and flu.
Boost provider productivity. Clinicians can expand their geographic service coverage without driving to different offices in different cities. Instead of hours wasted on the road, providers can drive higher revenue by seeing a higher number of patients, eliminating appointment delays, and offering extended service hours.
Bring care to the patient. Instead of forcing disabled patients to visit a doctor’s office or requiring parents to travel with sick children to distant specialty clinics, telemedicine brings medical care to where the patient is. Remote doctors can connect to patients on naval ships and oil rigs, in prisons and remote villages, or at the site of a natural disaster. Behavioral health patients wary of the stigma associated with mental health facilities can receive therapy at home.
Solve physician shortages. Scalable and flexible, telemedicine solutions can help recruit and retain physicians, while filling care gaps in rural areas and small hospitals. Clinics and hospitals can also create a sustainable income stream by offering virtual services that connect their local patient base with remote specialists.
Reduce the carbon footprint. Transportation to traditional medical visits can generate carbon dioxide (CO2) and other greenhouse gases. Just one health network can involve thousands of providers, staff, and patient car trips each day. Virtual care can dramatically reduce that number and mitigate the industry’s carbon footprint.
Virtual Care: Saving Lives and Saving Money
The Centers for Medicare & Medicaid Services (CMS) reports that U.S. healthcare spending reached $3.5 trillion in 2017. Of that amount, Americans paid $365.5 billion out of pocket – which is perhaps why 66.5 percent of all bankruptcies are caused by medical bills.
Lack of care and catastrophic medical costs can have a domino effect across every player in the healthcare universe. When a patient doesn’t want to drive to a hospital two hours away – or pay a high deductible – they skip preventive screenings until their condition worsens and they’re forced to undergo complex treatment with a higher price tag. A patient who can’t afford to miss work or find childcare during a doctor’s appointment may be a no-show, with the provider often eating the cost.
Providers spend so much time fulfilling documentation requirements that they often cut back on the number of billable services they can deliver. Hospitals are expected to invest in the latest medical innovations while cutting operational costs and fighting off cyberattacks that can cost millions in compliance fines and lawsuits.
With policy experts predicting that U.S. health expenditures will climb to almost $6 trillion by 2027, it’s clear that radical cost savings are desperately needed.
New Revenue, Smarter Savings
Telemedicine can lower patient spending and drive provider revenue in a number of ways, such as:
Reduce no-show appointments
Prevent the patient’s wage loss, childcare, and transportation costs of visiting a distant hospital
Boost downstream referrals, patient retention, and patient acquisition without building new facilities
Help providers in oversaturated or dispersed clinics see more patients through virtual care sessions with flexible hours
Virtual care can also drive down the cost of healthcare through shorter hospital stays, shared staffing, and better chronic disease management. One percent of the U.S. population incurs 20 percent of health care costs – and more than 90 percent of those high spenders have chronic illnesses such as high blood pressure, diabetes, and high cholesterol.
Remote patient monitoring at home, with interventions such as treating a blood sugar spike, can help many of those patients avoid expensive ER visits and hospitalizations. Virtual care collaboration between providers such as exchanging discharge care plans and medication histories can create a 360-degree view into the patient’s story that eliminates fraud and connects symptomatic dots.
Another immediate cost-saving is the elimination of medical air transport, which can run $40,000 or more per flight. A small hospital without inpatient dialysis service and local nephrologists, for instance, may need to fly in patients with kidney issues to other hospitals. Oils rigs, military stations, and remote villages may also need to transport patients by plane to mainland or city hospitals. Telemedicine can reduce or eliminate those expenses by connecting the patient and local provider to virtual specialty care. Telemedicine is also providing a new revenue stream for many providers. While physicians weren’t always compensated well for remote services in the past, today’s parity laws and regulations are beginning to honor the role of virtual care. Providers are using telemedicine to attract younger patients, increase referrals, and recoup weekend and evening services from patients who would otherwise go to urgent care centers. They’re also expanding into their communities without increasing their need for facility space.
3 Stories of Virtual Care Value
Telemedicine Eliminates 93 Percent of Air Evacuation Flights
Telemedicine helped Brazilian petroleum giant Petrobras dramatically lower costs with telemedicine with fewer urgent helicopter evacuations. With Hospital Israelita Albert Einstein providing virtual care for their rig workers using GlobalMed connected devices, Petrobras avoided helicopter trips for 93.2 percent of 965 telemedicine visits – and of the remaining 6.8 percent, most required non-urgent and less expensive flights.
Reducing Hospitalizations at the VA
Because many veterans live in rural areas, they often travel long distances for medical appointments – a major expense for the Department of Veterans Affairs. In addition to controlling travel costs, telemedicine also helped the VA save an estimated $6,500 per telemedicine patient by expanding care access and decreasing hospitalizations:
40 percent reduction for mental health patients
25-30 percent reduction for heart failure and hypertension
20 percent reduction for diabetes and COPD
Texas Saves $780 Million on Prisoner Healthcare
Inmate healthcare is costly. Many inmates enter prison with chronic health conditions, while longer sentences have created an aging population who need extensive services. Telemedicine can reduce the number of inmate trips to outside emergency rooms. The Texas Department of Criminal Justice (TDCJ) invested in a telemedicine program that stopped 85 percent of Texas inmates from leaving the prison for healthcare. With guard and transportation costs estimated at $350 per visit, the telemedicine program ultimately saved the TDCJ $780 million over 14 years. Delivering care at the correctional facility also prevents accidents, escape and other risks associated with transporting inmates.
Vision of a Virtual Future
Telemedicine isn’t just redistributing care delivery – it’s reinventing the relationship between patients and providers. Virtual care can dissolve barriers to responsible medicine, liberate patients from current access limitations and open the door to cost-effective care. It’s time to transform momentum into action and change healthcare outcomes across the world.