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Having It All: Telehealth Solutions that Enhance
Existing Doctor/Patient Relationships
Jan Oldenburg, EY Jane Sarasohn-Kahn, MA (Econ.), MHSA, THINK-Health and Health Populi
February 2, 2016
Conflict of Interest Jane Sarasohn-Kahn and Jan Oldenburg Have no real or apparent conflicts of interest to report.
Agenda • Introduction Jan O • The Telehealth Landscape Jane S-K • Consumer Issues in Telehealth Jane S-K • Provider Issues in Telehealth Jan O • Telehealth Opportunity for Patients & Providers Jan O • Q&A
Learning Objectives • Recognize the broad range of different models of telehealth services • Understand the growing evidence base for telehealth engaging patients • Discuss how trusted personal relationships between providers and patients
enhance outcomes • Provide tips for how organizations can implement telemedicine solutions or
partner with telemedicine providers to enhance care, build relationships, and save money
http://www.himss.org/ValueSuite
Telehealth Benefits Realized for the Value of Health IT
Telehealth may impact all of these step categories: • Increasing patient
satisfaction • Providing treatment at the
most appropriate location of care
• Adding patient generated health data
• Engaging patients and helping them manage care
• Lower cost than alternatives
Introduction
Rapidly changing market dynamics
Consumers and
Patients Providers
Introduction of new health technologies
Rising consumer expectations
New models of care
Telehealth capabilities have the potential to further fragment the relationship between individuals and
their doctors or enhance the partnership.
No Single Definition for “Telehealth” As technology evolves, lines blur between modalities
The use of technology to deliver health care, health information or health education at a distance (includes both clinical and non-clinical services) Use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status, including a growing variety of applications and services using two-way video, email, smart phones, wireless tools Telehealth uses computer-assisted telecommunications to support management, surveillance, literature and access to medical knowledge; telemedicine uses telecommunications solely to diagnose and treat patients*
Source: WHO based meta-analysis of 104 peer-reviewed definitions
S fo
Source: Telemedicine Predicted in 1925, Smithsonian, March 14, 2012
Source: Carlton Cards, Speed Bump, ©Dave Coverly
Source: National Business Group on Health, Large Employers’ 2016 Health Plan Design Survey: Reducing Costs While Looking to the Future, August 2015
$1 in $5 of consumer spending
Source: Advertising Age, April 22, 2013
The Patient As the Payor
Average Retail Prices of ER, Urgent Care, PCP and Telehealth Visits, 2015
Source: Patient Interest in Adopting Telemedicine, Software Advice, January 2015
76% Interested NET
Patients Are Keen On Telehealth
Consumers’ Perceptions of Top Telemedicine Benefits
Source: Patient Interest in Adopting Telemedicine, Software Advice, January 2015
Source: Patient Interest in Adopting Telemedicine, Software Advice, January 2015
71% Prefer over ER Visit (Net)
Growing Telehealth Options – On-Demand Medicine
17 Source: Selected Telehealth Vendor List, curated by THINK-Health, January 10, 2016
“Telehealth services may help patients and their primary care physicians overcome logistical hurdles to achieving the continuity and coordination of care that are among the cornerstones of primary care’s positive impact on health.” Robert Graham Center, A First Look at Attitudes Surrounding Telehealth, November 2015
The Triple Aim – M.O. for U.S. Health Care
Our Broad View of Telehealth – Clinical + Non-Clinical
Telehealth Via Email
• ARRA ID’d secure patient-physician email messaging as MU objective
• Study of 35,000+ people with diabetes +/- hypertension using email
• HEDIS scores improved • Glycemic (HbA1c),
cholesterol, and BP metrics improved
Source: Improved Quality At Kaiser Permanente Through E-Mail Between Physicians and Patients, Zhou YY et. al., Health Affairs, 29, no. 7(2010): 1370-1375
Telehealth Via Text/SMS
• Near-ubiquity of cellphones and smartphones – platform is everywhere in consumers’ lives
• > rates of mobile phone ownership among Blacks
& Hispanics vs. Whites – disparities • Texting can improve immunization rates, increase
health knowledge, risky behaviors • HHS Text4Health Task Force supporting health
texting • Growing positive findings support texting for
health for managing chronic conditions, medication adherence, and social support
Source: Using Health Text Messages to Improve Consumer Health Knowledge, Behaviors, and Outcomes. An Environmental Scan. U.S. Department of Health and Human Services, May 2014. Texting for Health, Fogg & Adler, 2009
Telehealth Via Apps and mHealth • Growing adoption of mobile health apps, but
evidence is spotty
• FDA and FTC increasing scrutiny and enforcement (e.g., UltimEyes, MelApp)
• AH(eart)A found evidence supports using mobile medical apps to address smoking, weight, healthful eating, regular physical activity, blood glucose, blood pressure, cholesterol
• Smartphone apps also were deemed useful tools at point of care and in mobile clinical communication, as well as in remote patient monitoring and self-management of disease
• Caveat: look for apps backed up by evidence and rigorous testing for efficacy
Source: FTC Cracks Down on Marketers of “Melanoma Detection” Apps: Complaints Allege Marketers’ Claims Lack Scientific Support, February 23, 2015. Promise and Realities of Mobile Technologies for Cardiovascular Prevention, AHA, August 13, 2015.
Telehealth Via Remote Health Tracking
CHF Respiratory Diabetes
Telehealth Via Remote Health Tracking Growing Evidence Base
CHF COPD Diabetes
Sources: Shown in Appendix.
Connected Cardiac Care Program associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates 120 days of the program.1 Patients with cardiac devices who use RHM have… fewer hospitalizations and lower overall healthcare costs (N=90,000 patients with pacemakers, ICDs, and CRT devices)2
Arizona Care Network ACO adopted Propeller Health platform for patients managing COPD based on Dignity Health’s positive results in reducing inpatient hospitalizations and exacerbations among patients using RHM.3
Adults with Type 2 diabetes using WellDoc’s software achieved statistically significant improvements in A1c. HCP and patient satisfaction with the system was clinically and statistically significant.4
Telehealth Via Social Media
Telehealth For TeleMental Health
>50 mm Americans live with anxiety, depression, and substance abuse – too often not knowing where to go for help.
Thinking #SDOH – Transportation Solution: Ride With Uber
Physician/Provider Perspective
Reprinted with permission
What Healthcare Executives Think Drives Consumers
Source: http://www.cit.com/wcmprod/groups/content/@wcm/@cit/documents/images/2015-healthcare-outlook-report.pdf
S fo
Differing assumptions about telehealth
Telehealth enables both convenience and better/closer relationships with my physicians and care team. Information is integrated into my clinical record and available to my care team
Telehealth primarily supports one-off relationships with care providers who are available when I need them. Convenience rather than connection is key.
N Choice may be
situational
Physician Opinions Differ on the Value of Telehealth
Healthcare is
not a spectator
sport
Some Physicians Are Skeptical of Telehealth
Physician Opinions of Telemedicine Use*
An important evolution in the practice of medicine
Good for patients
Not worth the hype
An important step to reduce costs of care
Not good for my personal income
Not good for my practice revenue
42%
39%
31%
22%
21%
19%
Source: Better Together: High Tech and High Touch, Nielsen Strategic Health Perspectives for Bipartisan Policy Center and Council of Accountable Physician Practices, November 4, 2015
S
Physician Voices
"A good doctor respects nuance. Watching a patient walk, sensing his demeanor, feeling her rash, seeing her tremor and feeling his pulse contribute to making a correct diagnosis; these physical signs cannot be ascertained by a stranger on a screen.”
Sharon Lewin, MD of New York, an internist and infectious disease specialist
Source: http://www.govhealthit.com/blog/how-do-doctors-really-feel-about-telemedicine
Physician Voices
"We have used these technologies for years… and hope to expand if reimbursement, licensing and liability concerns are addressed.“
Jules Lipoff, MD, an assistant professor of clinical dermatology at the University of Pennsylvania and a
member of the Telemedicine Task Force of the American Academy of Dermatology
Source: http://www.govhealthit.com/blog/how-do-doctors-really-feel-about-telemedicine
Physician Voices
“…For lasting value, [telehealth models] need to be woven into a more integrated approach to care in which a patient’s historical medical record is readily available to everyone caring for him or her.“
Robbie Pearl, MD, executive director and CEO of The Permanente Medical Group
Source: http://www.govhealthit.com/blog/how-do-doctors-really-feel-about-telemedicine
What Do Physicians Think of Apps?
• Only 15% of physicians discuss wearables or health apps
• Doctors in an ACO more than twice as likely to discuss
• Doctors want EHR integration with app data
• Doctors concerned that untested apps may harm patients
Sources http://mhealthintelligence.com/news/only-15-of-doctors-recommend-mobile-health-apps-to-patients. http://well.blogs.nytimes.com/2015/03/16/health-apps-provide-pictures-if-not-proof-of-health/?_r=0. http://www.marketwatch.com/story/healthcare-providers-invaluable-driver-for-mobile-health-product-adoption-2015-06-18. http://well.blogs.nytimes.com/2015/03/16/health-apps-provide-pictures-if-not-proof-of-health/?_r=0
Doctors Need Help Selecting Apps
Source: http://blog.mobiversal.com/mobile-apps-to-keep-you-in-good-health-2.html
With more than 100,000 mhealth apps, how do you choose?
New Models of Treatment Enabled by Telehealth
• Triage and after hours care
• Remote specialty care
• Virtual consults (including family and patient)
• New connected tools
• New partnerships and alliances
• Chronic care enabled by connected devices
Sources: http://healthleadersmedia.com/page-1/PHY-300035/Telemedicine-a-Win-for-StressedOut-Doctors https://www1.cfnc.org/Plan/For_A_Career/Career_Cluster_Profile/Cluster_Article.aspx?articleId=XAP2BPAXL1LmCtbp88JuDHMb7jDSgXAP3DPAXXAP3DPAX&cId=BufXemcmHBSoBjt9hbo0XAP2BPAXwXAP3DPAXXAP3DPAX§ionId=3 http://www.crowrivermedia.com/hutchinsonleader/news/local/the-doctor-s-on-the-tv-screen-and-her-patients/article_c84c9ec5-77a7-51f2-9f64-a3e92278de7a.html
Virtual Triage
20+ health system clients, including… • Bryan Health (NE) • Fairview Health Services
Group • John Muir Health • MultiCare (WA) • UCLA Health • UMass Memorial • University of AL -
Birmingham
Deploying Telehealth Models Examples of Hospital Alliances With Vendors
Unique partnerships and integration: Texas Medicare/Medicaid Partnership
The Stats: • More than 3000 Medicaid/
Medicare patients monitored • Hospitals and home health
providers are paid $9.45/ patient/ day which covers:
– $100/patient/month cost of Honeywell LifeCare Solutions HomMed equipment & software suite
– skilled nursing support. • Doctors are paid 57.20/
patient/week for oversight
The Outcomes • Reduction in ER visits of
90% • Reduction in readmission
rate from 15 to 5% • Estimated reduction in
costs per patient per year of $15,000
Source: interview with Dr. Peter Kim
Barriers to Telehealth Adoption
• Cross-state licensing requirements • Meager reimbursement levels • Only 21 states require reimbursement parity between in-person and remote
• Technology reliability • Complexity of interconnecting records and data
• Apps that don’t meet clinical standards
Source: http://www.physicianspractice.com/mobile/why-arent-more-doctors-using-telehealth
46
Source: Centers for Medicare and Medicaid Services
Telehealth Lessons Learned
• Reliable technology
• Trained staff
• Integration between in-person and remote processes
• Adjunct to rather than replacement for in-person relationship
– Works best when follow-up to in-person visit
– Telemedicine needs consistency (committed relationship rather than one-night stand, at least for managing chronic illness)
– Cultural competence is as important via telemedicine as it is in-person
• Committed business model
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751232/ http://healthleadersmedia.com/page-1/HR-307025/Weighing-Telehealths-Pros-and-Cons
Opportunities
• Collaboration with patients through:
– #WEARENOTWAITING – PatientsLikeMe – WEGO Health
• Make telehealth an extension of existing physician-patient relationships – not a replacement for them!
Source: http://www.himss.org/ValueSuite
Telehealth Benefits Realized for the Value of Health IT
Telehealth may impact all of these step categories: • Increasing patient
satisfaction • Providing treatment at the
most appropriate location of care
• Adding patient generated health data
• Engaging patients and helping them manage care
• Lower cost than alternatives
Appendix – Sources of Evidence for Remote Health Tracking, Slide 27
• 1Heart Failure Remote Monitoring: Evidence From the Retrospective Evaluation of a Real-World Remote Monitoring Program, Agboola S et. al., JMIR, 17(4), April 2015.
• 2Data Show Remote Monitoring Technologies Significantly Lower Health Care Costs and Hospitalizations for Patients, Piccini J., Presented at Heart Rhythm 2015, May 14, 2015.
• 3Arizona Care Network Is First ACO to Launch Propeller for COPD, Propeller Health press release, July 14, 2014.
• 4WellDoc Mobile Diabetes Management Randomized Controlled Trial: Change in Clinical and Behavioral Outcomes and Patient and Physician satisfaction. Diabetes Technology & Therapeutics, Vol 10, 3, May 12, 2008.
