Telemedicine growth accelerates

The stats on the rapid growth underscore why now, more than ever, quality, compliance, and patient outcomes should be a focus.

In 2018, the number of patients using telemedicine services surged to 7 million, up from 350,000 just five years ago. More than 65 percent of U.S. hospitals connect remotely with patients and consulting practitioners through telemedicine technology such as video, according to the American Hospital Association. That percentage is growing.

Also read: Beware the potential of telemedicine compliance missteps

The availability and adoption of telemedicine services are only expected to accelerate. Trend statistics reported by Becker Hospital Review, Willis Towers Watson and the Advisory Board found:

• More than 90 percent of health care executives say they are currently implementing telehealth services at their organization or developing telemedicine programs;
• Nearly 78 percent of employers currently offer telemedicine consultations, with another 16 percent planning or considering doing so in 2019;
• Approximately 60 percent of physicians say they are willing to conduct appointments via video;
• Approximately 77 percent of consumers would consider seeing a provider virtually—and 19 percent already have.

Additional evidence of planned growth and confidence in the role of telehealth to transform care are found in a report from Sage Growth Partners (SGP) “Defining Telemedicine's Role: The View From the C-Suite.” The report includes results from a survey of nearly 100 health care executives and quantitative and qualitative research.

Among organizations that have yet to adopt telemedicine, 86 percent call it a “medium to high priority.” Further, the executives believe telemedicine will transform the standard of care in key areas:

• 75 percent for behavioral health
• 53 percent for neurology; 70 percent believe telemedicine has already transformed the standard of care for stroke
• 52 percent for primary care
• 48 percent for cardiology 

Concern for quality

This is all great news. As you can imagine, to meet this growing demand, there's been a proliferation of telemedicine vendors. In our experience, not all are created equal. Our concern is the great diversity in clinical and business models we've seen among the more than 200 organizations with which we have already discussed accreditation. Many are good, but some telemedicine programs are not optimized to promote quality.

This rapid growth, room for improvement and the potential impact on many patients makes the case for the importance of third-party recognition. Our perspective is endorsed by Reid Rasmussen, Co-Founder & CEO of freshbenies, whose firm is one of the first and highest-usage U.S. distributors of telemedicine services.

Read: 2019: The year of telehealth?

As Rasmussen observes, “Telemedicine is in a very different stage today than in 2009, when freshbenies started distributing the service to employer clients as a tool to control health care. Ten years later, there are innumerable new entrants claiming they can provide remote physician visits better and cheaper. And yet not all vendors are the same. It takes millions of dollars and years of expertise to build out educational and tracking systems, physician networks, redundant HIPAA-secure systems, compliance expertise and high-usage member-focused applications and campaigns.”

So, how can this changing environment best be addressed? Reid suggests, “With the growth in popularity of the service and as the vendor field gets more crowded, national telemedicine accreditation is needed. The idea is just beginning to get traction, but consultants need to know how to identify credible players.”

The advantages of telemedicine

The accelerating growth and demand for telemedicine is explained by the many advantages including:

Better access to care: Telemedicine improves access to those who may have challenges receiving care because of where they live (e.g., rural areas), provider shortages, inability to travel due to mobility, time or financial issues and the stigma associated with certain types of services. This approach may be especially important for patients needing behavioral care, including treatment for substance use disorder. Not only are there severe provider shortages, the stigma of going to an in-person appointment may mean someone does not seek care. Receiving treatment services in the privacy of one's home has been shown to make a difference. With greater access to care across patient demographics, telemedicine can also help address disparities in rural and urban areas.

Patient demand: The convenience of telemedicine is clear and a major reason for strong consumer satisfaction. Allowing individuals to connect while at home or a nearby location remote from their physician removes the obstacles of travel, time and expense for a medical appointment. It may reduce or eliminate the need to take time off from work, arrange child care or take children out of school, especially for those who need specialist care that may not be in their community.

Using telemedicine, consumers can have an appointment with their primary doctor through live interactive video. The technology also lets patients receive customized health information or participate in peer-to-peer support groups online. For those who are homebound, telemedicine allows remote monitoring, sending important health status information to a care team that may replace an in-person appointment or home visit by a nurse. 

Improved quality: The quality of health care services delivered through telemedicine technology are often the same as services provided in-person, according to consistent research results. In some cases – specifically, behavioral care and ICU care – evidence shows better patient outcomes and satisfaction.

Telemedicine also enables direct and efficient care coordination and care management, allowing care teams and consulting physicians – no matter where they are – a streamlined means of working together. These services are critical, especially given the large and growing number of patients living with multiple chronic conditions. The right management can impact the quality of life of patients and their families by keeping them out of the hospital.

Cost efficiency: Reducing or containing costs is often cited as one of the major advantages of telemedicine. For health care institutions and providers, the technology delivers by allowing institutions to use shared professional staffing and physician practices to be more efficient and see more patients. This also helps with provider shortages.

Telemedicine also reduces travel time for specialists, making them more readily available for consultations, and provides a more cost-effective way for rural providers to receive continuing education. And, as mentioned, better management of chronic diseases leads to fewer and shorter hospital stays, achieving cost savings for individuals and systems. For consumers, telemedicine services often mean lower cost-sharing and, in some cases, there may be no out-of-pocket expense.

Required for value-based care: As health care continues to shift to a value-based system and away from fee-for-service, flexibility and innovation have a clear role. New payment approaches such as accountable care organizations and bundling call for efficient, cost-effective strategies that reduce or contain costs while improving quality. Keeping patients healthy is central to success and the ability to use telemedicine – especially for care management – makes a significant difference. 

The importance of accreditation

Given the rapid growth of telemedicine as well as its potential and ability to significantly improve quality, efficiency and patient outcomes, the accreditation process benefits consumers, providers and purchasers alike. Major areas of focus include:

• Workflow management: Creating an avenue for organizations to document, maintain and update their workflows, risk management programs, and quality assurance activities.
• Best practices: Empowering the use of evidence-based clinical pathways to promote better clinical and financial outcomes.
• Cost effectiveness: Promoting cost-effective programs to streamline health care services, allowing for significant improvements in operational efficiency as applicants make improvements in their operations in order to meet accreditation standards. 

Accredited organizations will be able to demonstrate to their various stakeholders that their processes and procedures promote better clinical and financial outcomes, including patient safety. In addition, having the right seal of approval is a differentiator in a crowded field and accredited organizations should be able to capture increased market share.

All of this all matters, in part, because of the enormous potential impact telemedicine services may have on individual patients and their families, and ultimately, on improving population health. Telemedicine is already beginning to transform the delivery system in meaningful ways, as recognized by the growing willingness of public and private purchasers to pay for services.

These are exciting and fast-paced times in health care, yet the stakes have never seemed higher. With patient demographics best described as aging and less healthy and rising costs that affect access to care for so many, telemedicine offers an answer, or certainly, a significant step towards addressing many problems. We're dedicated to making sure this “answer” is set up to deliver on its promise.

Michael Gomes is Chief Executive Officer of ClearHealth Quality Institute (CHQI) which focuses on promoting quality-based practices for health plans, providers and other stakeholders across the US. CHQI's accreditation and certification programs help assess, track and report on trends to enhance key insurance and provider outcomes. CHQI also offers educational programs, publishes issue briefs and underwrites research to raise awareness of patient safety issues.