Learn about the next generation of programs from leading health systems.
The stars are aligning for the next phase of growth in telehealth. Many states have resolved parity issues, CMS is proposing payment changes in 2019 to accommodate telehealth visits, and Next Generation ACOs include a telehealth waiver.
With significant progress on the reimbursement front, the door to innovation swings further open.
In this month's edition of "Need-to-Know Leaps," I explore how telehealth is changing at health systems and take a closer look at some of the novel approaches two leading organizations, Banner Health of Mesa, Arizona, and The University of Mississippi Medical Center, (UMMC) in Jackson, Mississippi, are using to launch the next generation of virtual care.
First, a quick look at the trends:
Telehealth is experiencing explosive growth. The virtual healthcare market is expected to reach revenues of more than $3.5 billion by 2022, according to Verify Markets, as reported in March 2016 by HIT Consultant.
The 2018 U.S. Telemedicine Industry Benchmark Survey produced by REACH Health, which surveys health system professionals, physicians, and nurses, indicates:
- 45% rank telemedicine as a high priority
- 86% want to use telemedicine to improve patient outcomes
1. The Age of the Enterprise
As the practice of telemedicine matures, one of the biggest health system trends is that telemedicine is moving from fragmented, departmental initiatives into an enterprise approach, pulling disparate elements under one single umbrella for the entire system.
"This opens up a whole new world for health systems to scale and find margin in the business model behind it, so it's sustainable and optimizes resources," says telehealth consultant Matthew Rumbaugh, executive director of TeleHealth Suite.
The REACH Health survey indicates almost half of respondents are taking an enterprise approach to telemedicine, a 23% increase compared to 2017. More than 50% of hospitals that started with a departmental approach are evolving toward or have already transitioned to a holistic operation.
There's a reason to do so—organizations that operate their telehealth program as an enterprise are almost 30% more successful in achieving their objectives than those managed out of separate departments, according to the benchmark report.
Organizations are examining the benefits of merging resources under single management, sometimes bringing all elements together in one physical facility. A few have taken their programs on even broader ventures, contracting with outside hospitals and health systems to expand their scope of influence and revenue potential.
- After 12 years of successful growth in a variety of departments, Banner Health is adopting an enterprise approach, falling under the purview of CEO of Telehealth Mark VanderWerf, who was hired earlier this year.
Examples of systems already operating telehealth as large-scale enterprises include:
- UMMC's Center for Telehealth was named a National Telehealth Center of Excellence by the federal Health Resources and Services Administration last year. It has established telehealth locations at 234 sites across the state, including hospitals, clinics, private physician's offices, colleges and universities, corporations, prisons, and federally qualified health centers, nearly all in collaboration with outside entities and even competitors.
- St. Luke's Health System in Boise, Idaho, which recently opened a 35,000-square-foot Virtual Care Center
- Mercy Virtual, in Chesterfield, Missouri, which opened in 2015 and provides services not only to the 40-plus hospitals in the Mercy health system, but contracts with outside organizations to provide telehealth services in more than 20 states
2. Discovering New Applications: ED Teletriage
Telehealth is not new to the emergency department, but at least one health system has found a novel way to deploy it. Next month Banner Health is launching a teletriage program in its high-volume emergency departments in the Phoenix area with a threefold mission: to relieve pressure on staff, to make sure patients don't leave without service due to long waits, and to provide the most appropriate treatment at the lowest cost.
When patients visit the triage nurse, low-acuity individuals also interact with a nurse practitioner via a telehealth monitor located in the same room. The triage nurse takes vitals and observes interactions, so the patient won't have to repeat information should they require traditional emergency services. If appropriate, patients are treated on the spot or redirected to urgent care services provided in a separate area of the facility.
A pilot study demonstrated that the program could reduce time in the department by two hours, says Natalya Faynboym, MD, CPE, executive director of Banner's innovation think tank, Imaginarium.
This approach will offer "substantial cost reduction for almost everybody involved, " says VanderWerf, including the patient, provider, and payer. While the pilot demonstrated significant savings, he says, figures have not been projected due to the short time frame of the test period.
Banner also plans to test a completely different concept in emergency care: at home observation. Somewhat similar to hospital at home programs, the pilot will send home select Medicare Advantage patients who have been assigned observation status. In addition to a home visit by healthcare personnel, the patient will be monitored via a tablet and peripheral devices, and have two-way communication with telehealth providers.
The goal is to provide care in an environment where the patient is more comfortable, evaluate the financial implications, and possibly eliminate the unexpected charges the patient bears when assigned observation status.
3. Expanding Specialty Access: Child Abuse Assessment
Specialty services are one of the greatest areas of growth in telehealth. While some specialties are a natural fit for telemedicine, others may be more difficult to adapt. Sometimes, innovation is required to change the dynamic.
In Mississippi, "we have exactly one pediatric forensic medicine specialist in the state," says Michael Adcock, FACHE, executive director for UMMC's Center for Telehealth. "This is obviously a very needed resource, and he was spending a lot of his time driving." Time on the road meant fewer patient encounters.
Converting his practice to a telehealth operation proved to be a challenge. The specialist needed secure 4K video combined with the ability to capture high-resolution still images from a remote-controlled tripod.
"There was nothing encrypted to the level needed," says Adcock, so the Center devised a solution combining a variety of technologies. Three clinics across the state are now outfitted with the equipment, the physician is able to serve more patients, and families aren't as inconvenienced by long distance driving either.
4. Employing New Technology: Teleophthalmology
Ophthalmology is another specialty now positioned for rapid growth, thanks to the development of inexpensive specialized equipment that can be employed at the point of service.
This year Banner Health launched teleophthalmology services in 12 of its emergency departments in the Phoenix metropolitan area with an investment of about $2,000 per facility, plus licensing fees with Verana Health (formerly DigiSight Technologies). The equipment includes an Apple iPod, with a special scope that slips over the device's camera to take high-resolution pictures of the eye. The portable device provides image quality as good as specialized equipment that could cost as much as $35,000 per location, says Deborah Dahl, vice president of patient care innovation at Banner Health.
Images taken in the ED are sent directly via a secure transmission to the 24/7 on-call ophthalmologist, who determines whether to visit the patient immediately, advise the emergency physician what services to provide, or schedule an immediate or follow-up appointment in one of the specialty practice's clinics.
For a relatively inexpensive investment, Banner is able to expand its scope of service, improve patient care, and offer more convenience to ophthalmologists, says Jean Schmitz, RN, CDE, director of teleambulatory services at Banner.
The system is exploring an additional way to use teleophthalmology services by having primary care physicians use similar devices to screen diabetic patients for retinopathy during their regular checkups. Dilation is not required, ophthalmologists will screen results within 24 hours, and it's expected that 20% of patients will require a follow-up visit.
Schmitz says this will help improve patient care and outcomes because "80% of patients with diabetes will develop some type of diabetic retinopathy. Up to 95% of those cases can be prevented through early detection, yet it's documented that less than 50% of diabetic patients actually comply with getting an annual retinal exam. With this technology, we can move these patients toward getting the care that they need."
5. Enhancing Population Health: Preventing Low-Birth Rate Babies
Low-birth weight is the second-leading cause of death during the first year of life and also increases the risk for chronic disease in later life, according to UMMC's Center for Developmental Disorders Research.
Because Mississippi has the highest rate of low-birth weight in the United States (11.6% versus the national percentage of 8%), and the rate within the state's African-American population is even higher, at 16.3%, the health system is working with other state government resources and a foundation to develop a telehealth solution. They plan to address this concern and other issues related to perinatal health, as well as help provide support to mothers during the first year of their infant's life.
The virtual perinatal program for high-risk pregnancies has launched a pilot, says Adcock, and the post-natal program is in development. "It's very simple," he says, "and allows [participants] to be educated in their homes."
Participants receive the same single-app iPad UMMC provides to patients in its chronic disease remote monitoring program. In addition to the ability to interact with providers, the solution also delivers educational content each day, broken into mini five- to seven-minute installments that include videos, slide shows, animation, Q&As, and self-tests. As the program progresses, the hope is that the efforts will result in healthier babies.
Mandy Roth is the innovations editor at HealthLeaders.
Reimbursement progress paves the way for innovation.
An enterprise approach helps health systems achieve scale, enhance margins, and optimize resources.
Technology developments enable further specialty growth.
Telehealth can address ED overuse and support population health initiatives.