How Telehealth Pays Off for Providers, Patients

Mainstream healthcare is seeing returns on virtual care investments. Banner Health, which identifies itself as "one of the top three performers for tele-ICU systems in the country," is just one provider that has reported major gains in quality and lower costs since adopting telemedicine.

If you need any further evidence that the world has gone online, consider this: According to a story in the August 22 issue of the Wall Street Journal, the Home Depot is now selling actual bricks and mortar over the Internet.

So is it any wonder that healthcare, a profession with more than its share of services that are rendered by listening to people and talking to people, is inevitably transitioning into an online experience?

The standard response from providers at this point would be, 'the physical exam can never be duplicated by an online encounter'. But before I address that point, let's consider for a moment all the other ways in which technology has been busily laying the groundwork for telehealth to dominate healthcare.

1. Hospitals, clinics and the public in all urban areas now have broadband Internet. More and more rural hospitals have broadband, aided by public/private partnerships from Vermont to Nevada and in between. Costs are falling: Expensive leased lines for telehealth can be switched off. Expensive proprietary telehealth gear can be retired and replaced by iPads and other relatively inexpensive mobile devices.
2. Mobile monitoring devices continue to also shrink in size. For that all-important physical exam, sensitive auscultation devices permit doctors at remote locations to hear heart, lung, and bowel sounds as if they were in the same room as the patient.
3. Team-based care allows the vast majority of listening and talking tasks to be assumed by nurses, nurse practitioners, and physician assistants, who do not have to be in the same room as the patient.
4. Scheduling technology permits freer flowing of patients and providers to available exam rooms, arrange for consulting physicians and specialists to join an exam, and even permit family and loved ones to join visits from remote locations, asking all-important questions which can directly benefit with increased patient adherence to medication regimens and other clinician directions.
5. Silicon Valley retains a deep, abiding interest in building innovations on top of telehealth platforms. Witness Google's latest initiative, Google Helpout, where Google offers video visits to doctors from One Medical Group during a Google user's symptom search.

Mainstream healthcare is also seeing returns on telehealth investments. On September 16, Banner Health reported that participants in its Pioneer ACO program enjoyed major gains in quality and lower costs in the program's second year, at a time when other participants were dropping out of the Pioneer ACO program.

Telehealth is the key enabling technology along with accompanying people and process initiatives, according to Deborah Dahl, vice president of patient care innovation at Banner – also a participant in HealthLeaders Media's HLM Live event on December 5.

Dahl also believes that telehealth enables standardization of care across large systems such as Banner. A preview of the HLM Live event in the October issue of HealthLeaders magazine identifies best practices that a dedicated team of tele-ICU nurses and intensivists can play in standardizing 24-by-7 ICU care.

Dahl elaborates on this in my brief conversation with her. "The ICU RNs have an average 21 years of ICU experience, and what a great opportunity to continue using your brain in a very physically demanding job to bring improvements in patient care to the bedside. Having the intensivists and the nurse practitioners combined with the ICU RNs has made a huge difference."

"We look at the processes within Banner as ways to reduce variability and improve reliability in the care, so whether they're the clinical consensus groups, which get together on a monthly basis and say, if we have a patient with Ebola, for example, this is the treatment protocol we're going to use, this is how we're going to go about doing that care, and that is hardwired into our electronic medical record."

Dahl expands on the report with numbers released in September that prove her point.

"We've been one of the top three performers for tele-ICU systems in the country for 10 out of the last 12 quarters. For ICU length of stay, that's 20,000 fewer ICU days than were predicted, and for patients that come from the ICU into the med/surg environment, that's more than 40,000 fewer med/surg days than were predicted, so on a very conservative model, that's about $68 million cost that was avoided."

"So if you go back to the triple aim, we've improved the clinical outcomes, we've improved the patient satisfaction, and we have seen a significant reduction in the cost for that patient population."

The HealthLeaders story also mentions Banner's partnership with Philips, which used Banner as a proving ground for its eICU technology. Technology alone didn't do it all, and Banner has augmented monitoring with health coaches who determine, for instance, that a patient might skip her congestive heart failure medication because a side effect is swollen ankles, preventing that patient from wearing her dress shoes to church on Sunday.

"When that person would see a physician, either telehealth or in the office, those providers don't have time to get into that conversation," Dahl notes.

Despite Banner's successes, many barriers remain to deploying telehealth everywhere successfully. The importance of the fifth sense—touch—during a physical exam does indeed remain a barrier, one that has contributed to the slowness of telehealth reimbursement policies to catch up with practice. The move from fee for service to value-based care will take care of some of that. But for the reasons outlined above, telehealth and the bigger movement of virtual care will not be stopped.

Telehealth can be a moneymaker and game-changer. Each telehealth success story is different, but like Banner, two other providers seem to have cracked the code that unlocks the value that lies waiting inside other healthcare systems:

Join me on a webcast at 1PM ET today as leaders from Mercy Health System and Nemours reveal how they are using internal telemedicine and remote monitoring to reduce medical errors, improve response times, and alleviate alarm fatigue in frontline healthcare personnel.