The concept behind telemedicine is very simple: connect patients to physicians who can provide care from a distance. Perhaps the term telemedicine drums up images of a physician connecting with a rural patient through a video chat. But the way in which telemedicine is delivered is becoming ever the more expansive, and can include phone calls, emails, instant messaging and potentially even apps on mobile devices.
Telemedicine may also help provide coordinated care solutions to newly-formed accountable care organizations and hospitals nationwide.
"Everybody agrees that you have to figure out ways to use technology, use innovative solutions to solve problems with the archaic, established ways healthcare has been accessed and delivered," says Wolf Shlagman, the CEO and founder of telemedicine company Consult A Doctor, which provides services to employers, payors and consumers, as well as a platform that offers providers telemedicine technology. The company primarily works with separate organizations that are part of an ACO, but Mr. Shlagman says it could work directly with ACOs in the future.
Here, he discusses three ways telemedicine can help accountable care organizations and hospitals improve efficiency and save money, while keeping patients at the center of care.
1. Telemedicine provides patients an avenue to receive unlimited access to a medical professional. The intent of any ACO is to improve quality of care for each patient within its set population. With telemedicine tools, patients can theoretically engage a physician or care coordinator anytime, anywhere. They are not limited by distance, cost or time spent driving to and from appointments.
"When you look at ACOs, they are given the task to manage patient populations, and in many cases, do it with whatever technological means necessary to save money, improve quality and outcomes ," Mr. Shlagman says.
Additionally, telemedicine may help ease concerns of emergency room utilization. A recent CDC report showed that 80 percent of adults between the ages of 18 to 64 who visited an emergency room during the first half of 2011 did so because they lacked access to other providers. Telemedicine has the potential to provide more access for some of those adults through mobile technology. If those adults are among the patients in an ACO population, physicians and hospitals will want to keep those patients out of emergency rooms in an effort to reduce costs.
Further, as hospitals continue to align and acquire physician practices, they are seeking ways to balance the use of technology to offer on-demand care in the most appropriate cost setting while also utilizing the physicians time wisely, Mr. Shlagman says. Telemedicine provides "the most efficient solution for patient/physician interactions and consultations by phone or email 24 hours a day, seven days a week."
He offers an analogy of the banking industry to describe how telemedicine can potentially transform healthcare. Fifteen years ago, no one was using mobile technology to pay for bills; online banking was a pilot program or an entrepreneur's idea. Now, the industry has changed so dramatically that many people with mobile access rarely, if ever, step inside a brick and mortar bank.
Telemedicine has the power to have a similar affect on healthcare delivery, Mr. Shlagman suggests, because it replaces unnecessary hospital and ER visits. Patients with a phone or an internet connection can express health concerns to physicians or nurses before coming into a hospital or clinic. Perhaps the patient takes a picture of a wound on his or her smart phone and then sends it to a medical expert. In turn, the physician or nurse evaluates whether emergency care is needed.
2. Telemedicine offers ACOs a means of monitoring patient populations and reducing readmissions. Telemedicine is a part of an "evolution of a more connected, patient-centered healthcare ecosystem," Mr. Shlagman says. Advances in telemedicine can help care teams monitor the various vitals of a patient in an ACO or automatically check in with a patient through an email or voice mail. Patient monitoring and communication following a discharge can play a vital role in reducing the likelihood of an unnecessary readmission.
"Telemedicine is a perfect marriage of using proven technology to be able to lower the cost of care delivery and, in many cases, improve access and quality," Mr. Shlagman says. "You're also reducing potential liability and penalties because of unnecessary readmissions."
By keeping in touch with patients following a discharge, ACOs can reduce readmissions and potentially save money.
3. Telemedicine advances the legislative intent of CMS ACOs to provide evidence-based medicine and engage patients. Telemedicine — referred to as telehealth in the CMS rule — is a central element to the government's accountable care plan. It allows a patient access to physicians or medical experts around the clock without the strain of having to take a trip to the hospital or a clinic. In some ways, it may be more convenient for physicians who do not need to be on location to provide medical information or counseling to the patient.
"ACO legislation is trying to make healthcare more efficient by taking out some of the high costs associated with it," Mr. Shlagman says. "I think telemedicine really fits nicely in that legislation."
As written in CMS' final rule for the Medicare Shared Savings Program, accountable care organizations must "define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies."
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