Can Telehealth Move Past Regulatory Troubles and Find Success?
For decades, the Veterans Health Administration has pioneered the use of telehealth to provide services to veterans in remote or rural areas. Thanks to a confluence of factors — decreasing technology costs, wider availability of the technology and on-going healthcare reform — telehealth appears poised to continue its upward trajectory. The rapid expansion has resulted in some growing pains, however.
Healthcare providers must overcome disputes with state officials over regulatory guidelines and reimbursement barriers in order to scale up use of telehealth. In addition, healthcare providers must identify which consumers are most likely to benefit from long-distance care relationships. Psychographic segmentation could help provide the insights needed to target the right patients for telehealth services.
Hurdles Slow Telehealth’s Progress
In February of this year, Health IT Outcomes reported that a recent iData Research survey predicts that the patient monitoring market will surpass $5 billion in the next five years, with more than half of that figure related to chronic disease management. Dr. Zamanian, CEO of iData notes, “The goal of telehealth is to prevent hospital readmissions, reduce in-office visits, better manage health of individuals with long term conditions and reduce costs for more remote and isolated health care providers.”
Sounds like just the prescription for the positive health reforms that have been mandated.
Yet, despite telehealth’s potential for reducing healthcare costs while improving patient care, the current environment restricts growth. Three major issues must be addressed:
1. Defining what constitutes an acceptable physician-patient relationship.
According to mHealth News, Teladoc’s four-year battle with the Texas Medical Board is intensifying. The Board’s ruling requires telehealth providers to have at least one face-to-face visit with patients to establish a physician-patient relationship before prescribing of controlled substances. Teladoc, one of the largest telehealth providers in the nation, argues that its online questionnaires, complemented over the phone or through digital conversations, create that relationship without necessitating an in-person meeting.
2. Unifying licensure requirements across state lines.
Reporting on the 2014 U.S. News and World Report “Hospital of Tomorrow” event, Fierce HealthIT quoted panelist Jonathan Linkous, CEO of the American Telemedicine Associations, who said, “The fact that every state medical board decides on their own what they believe best practice in medicine is, which is going to vary from state to state, presents a real problem.” A single set of federal standards may be the best solution. Just as drivers do not need to carry a license for each state they travel through, physicians implementing telehealth solutions need the flexibility to practice across state lines.
3. Removing restrictions on reimbursement for telehealth services.
Provider adoption of telehealth is also hampered by restrictions on reimbursement. Federal law currently limits reimbursements based on location. Virtual care is approved for rural clinics, for example, but not for metropolitan areas. Health IT Outcomes noted that Governor Andrew Cuomo recently signed a law requiring Medicaid to cover telehealth service costs in New York, regardless of where the service takes place. And late last year, the CMS increased payments for telehealth services, tacit acknowledgement that telehealth is a viable, cost effective means of providing healthcare.
Larry Vernaglia, chair of law firm Foley & Lardner’s Health Care Practice told Health IT Outcomes, “The smartest thing organizations can do now is to continue developing programs, and be ready for the law to catch up — because it will.”
Connecting the Right Patients with the Right Care
If telehealth is to truly have the positive impact healthcare providers expect, however, it must be utilized correctly. A mHealth News blog highlights the value of effective telemonitoring in the real-life anecdote of a patient suffering from congestive heart failure (CHF).
A continuous care approach — daily monitoring of the patient’s weight — enabled his care team to identify a “clinical management rule” based on biometric feedback that has enabled the patient to avoid re-hospitalization for 22 months. It’s a major step forward considering that same patient was admitted to the hospital three times in the six months prior to implementing this new approach.
In addition to improving the patient’s health outcome, the costs of the telehealth approach — $200 for an Internet-enabled scale, a prescription for a diuretic and the expenses of his remote care team — represent a fraction of the more than $150,000 in costs accrued during his hospitalizations.
Of course, not every patient with CHF is likely to respond in the same way. Healthcare providers must identify the candidates whose attitudes towards wellness, motivations and lifestyles make them most suited to this approach to care.
PatientBond just received the results of its PatientBond Consumer Diagnostic, a national study fielded in January 2015 to a representative sample of adults age 18+ (n=4,039). A portion of the study was dedicated to understanding message receptivity and fatigue, and health care consumers’ preferences with regard to communications vehicles and media. This included phone communications and a variety of other patient outreach methods.
It was clear that two psychographic segments — Willful Endurers and Self Achievers — were most likely to prefer phone outreach and a higher frequency of engagement. However, these two psychographic segments have very different motivations and approaches to health and wellness, so care must be given to delivering the most effective, segment-specific messages to activate these patients.
PatientBond is partnering with a technology company that has developed a targeted, health care engagement platform that enables hospitals and health systems to improve care coordination and patient loyalty using a preference based, personalized communications framework. This application can be used for a variety of use cases including Readmission Avoidance, Discharge Management, Health Reminders and Patient Surveys.
Unlike a one-size-fits-all approach to all patients, this application leverages PatientBond's psychographic segmentation model within configurable workflows to deliver targeted content to patients (and their caregivers) in the context of their individual motivations and communication preferences. Communication channels (voice, email, SMS, secure message, smartphone apps, etc.) and messaging are set for patients based on their segment-specific preferences, but can be over-ridden for critical messages.
Download our whitepaper on using psychographic segmentation to increase patient engagement and activation or contact PatientBond for more information on our capabilities or applications to telehealth.