An aging population, increasing chronic illness, the importance of self-care, accelerating health costs, regulatory reform, and new payment models are driving interest and growth in telehealth. Under new value-based payment models, telehealth may be a cost-effective solution for improving access to care and, ideally, reducing unnecessary hospital care. Several new studies contribute to the growing body of evidence that telehealth can be a cost-effective solution for certain conditions and patient populations.
One study, published in the Annals of Allergy, Asthma and Immunology, focuses on patients who scheduled an appointment for asthma-related concerns at an allergy clinic. The patients could choose to keep their original in-person appointment or change it to a telemedicine visit, which involved going to a local clinic where a registered nurse or respiratory therapist conducted the visit remotely. Of 169 children, 100 were seen in-person and 69 used the telemedicine option. Of the patients that completed all three visits (34 patients were in-person and 40 telemedicine patients), all had a small improvement in asthma control over time. After the six month follow up, the researchers concluded there was no difference in outcomes between the telemedicine visit and the in-person visit. This is encouraging news for patients with asthma who live in underserved areas where specialists are not always available.
Another study from the University of Pennsylvania found that linking family members of patients in the intensive care unit (ICU) via a videoconference could be more beneficial to clinicians than having family members physically present in the room. The video link cut down on distractions and made it easier for clinicians and family members to communicate. In the ICU, it is not always possible for family members to be present, and they are not always comfortable asking clinicians questions in this busy setting. A telehealth platform can also incorporate translators when necessary.
Kaiser Permanente published results of its telestroke program in its publication, The Permanente Journal. The program brings specialized treatment to patients in hospitals that lack an in-house stroke neurology or neurological intensive care unit. Images of the patient’s brain are shared remotely with a specialist, who can assess the patient via video to determine if the patient needs tissue plasminogen activator (tPA). tPA is a treatment for acute ischemic stroke that needs to be administered within 60 minutes of the onset of stroke symptoms and is more effective the sooner the patient receives it. The remote neurologist can sometimes assess the patient before the ambulance arrives at the ED. Among the 2,600 patients in the study, use of tPA increased from 6.3 percent among acute ischemic stroke patients to 11 percent after telestroke implementation, and overall bleeding complications were reduced slightly, from 5.1 percent to 4.9 percent. Treatment times also improved. Median time for a patient to receive diagnostic imaging went from 56 minutes to 44 minutes, and time to tPA administration was shortened from 66 minutes to 55 minutes.
Analysis: Deloitte’s recent report, Realizing the potential of telehealth, provides an overview of trends in telehealth, the regulatory landscape, and the potential barriers and enablers for telehealth in the coming years. The report highlights findings from the 2016 Deloitte Survey of US Health Care Consumers that show interest in telehealth continues to grow.
As the federal and state policy landscape evolves to reduce barriers to telehealth, providers may consider strategies for targeted populations within value-based care models. And, as health plans move toward narrower provider networks for exchange plans in order to reduce premiums, telehealth is one important strategy that could help them meet network adequacy standards more cost-effectively – and help providers deliver care to underserved areas more efficiently. Studies that show telehealth works in the commercial market may aid the federal government in setting policy.
Elisabeth A. Stelson, Brendan G. Carr, Kate E. Golden, Therese S. Richmond, M. Kit Delgado, and Daniel N. Holena, (Perceptions of family participation in intensive care unit rounds and telemedicine: A qualitative assessment), American Journal of Critical Care, September 2016; Jay M. Portnoy, Morgan Waller, Stephen De Lurgio, and Chitra Dinakar, (Telemedicine is as effective as in-person visits for patients with asthma), Annals of Allergy, Asthma and Immunology, September 2016; Kori Sauser-Zachrison, Ernest Shen, Navdeep Sangha, Zahra Ajani, William P. Neil, Michael K. Gould, Dustin Ballard, Adam L. Sharp, (Safe and effective implementation of telestroke in a US hospital community setting), The Permanente Journal: July 29, 2016
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