- For telemedicine to truly contribute value to healthcare delivery, it has to be invisible.
That is, in a nutshell, the goal for Dr. Randall S. Moore, MD, MBA, president of Mercy Virtual.
Billed as the nation’s only hospital without beds, the four-story virtual care center located outside St. Louis is the hub in a hub-and-spoke telemedicine network that includes health systems in Florida, North Carolina and Pennsylvania, as well as Mercy’s own four-state region.
Mercy began investing in virtual care in 2006. The $300 million, decade-long journey culminated with board approval for a $54 million Virtual Care Center that opened in October 2015. The facility sits at the center – literally and figuratively – of the value-based telemedicine movement in the U.S.
But for this movement to succeed, Moore says it has to disappear.
“It’s not virtual care – it’s just care,” he says. “And if we’re going to build a continuum of care, virtual has to disappear within the framework of that continuum.”
That’s the challenge facing many telemedicine and telehealth networks these days: Developers and digital health champions have spent so much time and effort building them up, getting them noticed and proving their worth, it’s difficult to switch gears and integrate them into the fabric of the healthcare system.
That’s why Moore, who will give the closing keynote on day one of next week’s Xtelligent Media Value-Based Care Summit in Chicago, would rather talk about Mercy than Mercy Virtual.
“We’re not a silo,” he pointed out during a panel session at this year’s American Telemedicine Association Telehealth 2.0 conference in Orlando. “We can’t be a silo.”
Perhaps ironically, Moore noted at ATA that mobile health is part of the foundation of the Mercy health system. The organization was founded by the Sisters of Mercy, among the world’s first religious orders not to be cloistered, or confined to a convent. Instead, they were known as the “Walking Sisters,” because they went out into the communities they served to offer help, education and healthcare.
Moore sees Mercy Virtual carrying on that tradition.
He sees the program evolving – Mercy Virtual 2.0, he calls it – as the nation’s healthcare ecosystem tries to evolve as well. Instead of standing alone, he sees telehealth and telemedicine figuring into every aspect of the Mercy health system, branching out even more from its high-tech hub in suburban Chesterfield, Mo.
It’s a tough challenge. Healthcare isn’t shifting easily from episodic care to value-based care, and healthcare providers are wary of a system that shifts payment from procedures to outcomes. They need to be convinced that the continuum of care is a good thing, and that telehealth and telemedicine are important drivers toward a more efficient healthcare ecosystem.
“People want to buy health,” says Moore. But in a crisis-driven, intervention-based system of care, he says, it’s difficult to push that concept on doctors. “We’ve got to be, at Mercy, both a health and a care system. Right now we’re mostly just a care system.”
So far, Mercy Virtual has proven its value for providers like Penn State Health and the University of North Carolina Health Care system, both of which have contracted with Mercy for telemedicine monitoring of ICU patients. Moore says another dozen health systems have expressed interest in joining the network, and others are looking at Mercy Virtual as a model for other hub-and-spoke networks across the country.
But while the earlier partnerships have focused on the sickest patients in the health system, those responsible for an overwhelming percentage of healthcare expenses, Moore sees Mercy expanding its reach to larger populations, chronic care and care management.
That’s where integration with other aspects of the Mercy health system come into play. No longer will this be just about taking care of patients in ICUs and critical care areas of the hospital; it will include post-discharge care, home-based care, even health and wellness.
“There are different areas of health and care out there that we have been moving into,” he says.
This also involves redefining the revenue stream. Sustainability in these programs is far different from a well-functioning tele-ICU program.
“If it can’t go to a cash flow model … you’re going to have a cool thing shut down” he said at the ATA conference earlier this year, during a session on scaling up telehealth programs.
It’s a theme he takes up again as he prepares for next week’s Value-Based Care Summit.
“Everyone – the vast majority – believes it will be better,” he says of the shift to telemedicine and telehealth. “But you have to figure out how do I get from here to there without imploding and going bankrupt in between?”
It’s a journey he’s eager to continue.