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For Telehealth and mHealth, Value-Based Care Takes Time to Work Out

This week's Xtelligent Media Value-Based Care Summit offered plenty of examples of new programs slowly proving their worth. The challenge lies in finding the right fit.

By Eric Wicklund

- Healthcare providers are gradually coming to realize that telehealth can be a key component in the transition to value-based care. But not everyone’s definition of value will be the same.

With roughly six out of 10 U.S. health systems now using telehealth, it’s safe to say there are more doctors using new technology than shying away from it. But as Danielle Louder, program director for the Northeast Telehealth Resource Center, points out, each is using technology differently. One may be looking to expand a behavioral health platform to residents in rural counties, on islands or even cruise ships and oil drilling platforms. Another might be using an mHealth-based remote monitoring platform to connect with a population of diabetic patients.

“The space of telehealth is growing exponentially,” she told an audience at Xtelligent Media’s recent Value-Based Care Summit in Boston.

At UMass Memorial, Senior Medical Director Thomas Scornavacca, DO, relies on mHealth tools to help a network of physicians “keep the patient in the middle of care.” That means giving physicians the tools they need to connect and collaborate with patients when they need advice and reminders, or when the doctors need data ahead of the next in-person appointment.

Without those touches, Scornavacca says a physician might very well lose his patients to the retail clinic down the street or a competing telehealth platform that promises on-demand care.

READ MORE: ATA Survey: Parents Like Telehealth for Primary Care Needs

“Can you push the clinical system out to the patient? Yes, you can,” he says. The key is helping patients “adopt a new paradigm of care delivery” that they can feel comfortable using, and “getting them engaged in their own care.”

Sarah Pletcher, MD, on the other hand, doesn’t have to worry about patient engagement. The medical director and founder of Dartmouth-Hitchcock Medical Center’s Center for Telehealth, which serves a vast swath of New Hampshire, Vermont and Maine, runs a network of telehealth programs that push care out to people who can’t easily get it. That includes providing resources for smaller hospitals and clinics to care for patients who would otherwise have to go to a larger facility.

Pletcher’s network enables small providers to treat patients in their communities, keeping care local and preventing a strain on Dartmouth-Hitchcock’s resources. Just as important, if not more so, it enables local providers to treat patients more quickly, with online access to specialists and services that boost outcomes and improve health and wellness.

A person in upstate New Hampshire suffering from a stroke doesn’t care much about engagement, she points out. But he or she does care that the local hospital has access to a telestroke network that can save his or her life.

The three primary challenges in developing a telehealth or mHealth platform are physician buy-in, reimbursement and sustainability. Nearly all who spoke about telehealth at the summit said they had to work to convince their staff of the merits of a platform that shifts the doctor-patient dynamic away from the in-person encounter. But no one said physicians weren’t convinced once they used the technology and could mold it into their own workflows.

READ MORE: mHealth Games Offer a 'Fun' Way to Boost Patient Engagement

“Education goes such a long way,” says Nikhyl Jhangiani, MBA, MPH, program manager for distance health at the Cleveland Clinic. Echoing Louder’s observation that starting with the technology is “a losing battle,” he said both providers and patients need to be shown how telehealth or mHealth will work, and what it can do. This paves the path to acceptance.

But it’s still a long path.

“Telehealth is still in its infancy,” says John Campbell, the Spaulding Rehabilitation Network’s chief information officer. Its goal, he said, is to “create alternative pathways to care” that work better and more efficiently for both patient and provider.

For Campbell, that pathway was physical. When his physician office, once located across the street from UMass Medical Center, moved several miles away, they needed a telehealth hook-up to enable specialist consults.

Campbell advises providers looking for an entry to telehealth or mHealth to start small, focus on a specific need or use case and make sure you know what results you’re looking for. A program can’t prove its value if no one knows what that value will be.

READ MORE: Telehealth Experts at ATA: Direct-to-Consumer Care Takes Time

Even then, there’s no guarantee that a program will be reimbursed or sustainable. Steven Strongwater, MD, president and CEO of Atrius Health, notes his Massachusetts-based health network isn’t being reimbursed for its telehealth programs, even though an asynchronous teledermatology program has reduced office visits by some 40 percent.

Massachusetts, in fact, is one of 19 states that doesn’t mandate that payers reimburse providers for telehealth at the same rate as an in-person visit, putting pressure on the provider to prove the program’s value. Scornavacca says it’s a challenge to bring a new program up to speed, run it long enough to gather good data, then convince insurance companies that they should be paying for this program.

And what works in one state doesn’t always work in another.

Added Louder, who works in eight different states: “If you know one state’s telehealth policy on reimbursement, you know one state’s telehealth policy.”

But value is … valuable, as long as its definition is fluid. A health system using an mHealth program to reduce hypertension in a large population will see noticeable results in clinical outcomes, as well as patient satisfaction. And a hospital using a telehealth platform to treat more ED and ICU patients rather than transporting them to the big health system down the road will keep more of its care at a local level, boosting the hospital’s bottom line and improving the quality of care and life for residents who’d prefer to stay closer to home.

“It’s a collaborative network,” says Louder, who’s armed with dozens of telehealth and mHealth success stories from across New England, New York and New Jersey. She says providers don’t need to “:reinvent the wheel,” just find the right connection between needs and resources.

And sooner or later, it will work. 

Dig Deeper:

Using mHealth to Vault the Barriers to Value-Based Care

How Nighttime Telehealth Services can Improve Overnight Care


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