Telemedicine Benefits Study09 21 10a


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White paper on the value of telemedicine as part of continuation of care.

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Telemedicine Benefits Study09 21 10a

  1. 1. the use of the Electronic Health Record4 (EHR) Telemedicine Benefits Study: and of integrated telephonic and Internet Integrating Enhanced Service Offerings access to health services. and Providing Measurable Cost Savings The Medical Home model is an approach to within the New Medical Home Model providing comprehensive primary care, facilitating partnerships between patients and their physicians, and, when appropriate, the September 21, 2010 patient’s family. It has been shown that a patient care team, centered on a primary physician, is best suited to take a whole person Patient-Centered Medical Home orientation of care to enable coordinated or integrated care. Because the care is During this time of healthcare assessment and integrated, patients have less difficulty realignment of healthcare services, the accessing care after-hours, there is improved essential factors of providing patient-centered information flow among providers and there as well as cost effective care are being are fewer duplicate tests with less medical reviewed by all employers, health plans and errors. providers. The concepts of Medical Home1 (or Patient-Centered Medical Home) and Meaningful Use2,3 are providing a new Meaningful Use and EHR vocabulary to describe our health decision- making process. The EHR enables much of this integrated health service model. The secure EHR allows By providing more healthcare options to the both patient and their physicians to access and patient with a more patient proactive focus on monitor a patient’s medical records. Patients service provision, patients will be empowered can then more easily track their own wellness to use healthcare wisely at reduced cost and, or disease management directly to encourage at the same time, develop more responsible, them to take the proper steps towards preventive health habits. Healthcare benefits prevention or proper chronic illness providers can benefit in this revisionist management. Physicians are freed from environment by adding cost effective health paper-based record-keeping and can access services to their health plans and by providing patient records from a web-based portal for integrated, cost and time saving health face-to-face or for remote consultations, more administration services. One of the key easily tracking previous consultation outcomes aspects to providing this new set of services is and prescriptions and testing and lab status. 1 When care is to be provided by a non-primary For an overview of the (Patient –Centered) care physician, this same patient EHR can be Medical Home, see Medical Home, WIKIPEDIA, securely accessed by the patient or another 2 HHS’s HIT Policy Committee Releases Draft PCP designated physician to ensure all of the Recommendations on Meaningful Use for Public pertinent patient health data is available to the Comment, Ed Jones, HIPPA LLC, 2009 specialist or alternate health provider. Certainly , 3 4 Modern Healthcare, “The search for meaning – For an overview of the Electronic Health Record and money – in “meaningful use” regulations”, (EHR), WIKIPEDIA, Webcast, January 27, 2010. 14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292 O 310-339-9042, F: 310-305-1619, Email:
  2. 2. the principle of Meaningful Use hinges on the either develop their own EHR system, select a strategic usage of a patient EHR and the vendor's EHR solution, or integrate with a integration of health services through selected health provider EHR system that is central to access to these health records. many telemedicine solutions. Health providers must decipher the numerous regulations coming out of Washington and Medical practices are being led towards and determine how best to take advantage of the rewarded for early adoption of EHR and healthcare revolution. Washington is providing integration of those records across providers to stimulus in a variety of packages to encourage build the Medical Home. Vendors in the adoption of Meaningful Use features at the healthcare market have responded to this need earliest date. Although the focus for health by developing proprietary EHR models for use reform is patient-centered, it is up to the in health services. Unfortunately, it is up to healthcare providers to decide on the best those independent health practices to convert strategy and implementation path for these their records to electronic media and then new integrated services. decide how and when to share that EHR with other healthcare providers. Medical Home and the Integrated EHR By adopting a certified EHR standard at the core of their data service model, healthcare When considering the integration of providers, health plans, and employers can information, heathcare providers, health plans, more readily embrace the Medical Home and employers, must assess all of their standards. Adopting a certified EHR will ensure ancillary service providers and the types of that one’s digital records meet national data that will need to be communicated among standards for data exchange between doctor them. The international non-profit organization, and patient and between practice and ancillary Health Level 7 (HL7)5 has grown out of this health service providers. need for clarification and definition of interoperability and is dedicated to providing a framework for the exchange, integration, Medical Care Access sharing, and retrieval of electronic health information. Just as in the early days of the Another feature of Medical Home is the information superhighway construction (the patient-centered aspect of enhanced access to Web), the health information highway is now healthcare. The demand for PCP care has only being built. increased while the number of qualified PCPs has not kept up with demand, and will only The emergence and convergence of the EHR become more severe as additional uninsured is one of the nascent applications that have are brought into the system with healthcare coalesced to become a healthcare framework reform. This has put increasing pressure on building-block. It is up to the healthcare the PCP to provide care to increasing numbers providers, health plans and employers to of patients per day, with the typical PCP visit strategically plan how they will adapt to these lasting 3-5 minutes. A common provision of emerging standards. Healthcare providers can this medical model is based on the PCP’s agreement to cover groups of patients in a 5 For overviews of the Health Level 7 (HL7) Working plan. In these cases, it is entirely up to chance Group, see Medical Home, WIKIPEDIA, whether a PCP’s schedule will be manageable and the or not, and more than likely not. PCP's are Electronic Health Record Working Group. 14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292 O 310-339-9042, F: 310-305-1619, Email: 2
  3. 3. often caught in an untenable situation where the phone or the Internet can provide another they are unable to provide the time and alternative for patients and doctors to conduct attention that patients need due to time acute care consultations. It can provide access constraints on their overbooked schedule. to board-certified physicians 24 hours a day, 7 days a week accessible either by phone, So often, the patient has come to their PCP secure messaging or webcam video. Patient because they are suffering from a common members have the ability to call, email, or illness. They just want to be able to ask a few “see” a physician to describe their common, more questions, but the doctor is already on to non-urgent condition and receive advice, a the next patient. Neither doctor nor patient is diagnosis, or even be prescribed medication. satisfied with this, but we make do. Patients When PCP patients are given the alternative of waiting to see their PCP may have to wait a waiting days to see their PCP, go to an urgent few days for an appointment. Now, what was a care facility or the emergency room, or access minor illness a few days ago has them in great a certified physician from their own home, they pain or they are home in bed and can’t work. chose the telemedicine option. Many patients cannot wait a few days to see a doctor even though their illness is not serious. They decide to go to an urgent care facility or Telemedicine and Medical Home even an emergency room to get seen today. When used within the context of Medical Actually, only 42% of doctor visits for acute Home, telemedicine services are a valuable care (treatment for newly arising health and necessary service to include in full- problems) are with the patient's PCP6. As we coverage health plans both for their employers all know, health care costs start soaring with and their employees. PCPs can be assured of this and similar options. informed, cross-coverage service for their patients during after-hours. Healthcare providers require access to a secure- Telemedicine and Telehealth networked EHR system interoperable the The American Telemedicine Association (ATA) patient's PCP EHR format. Heathcare defines telemedicine7 as the use of electronic providers must also track the progress of communications and information technologies government regulations with respect to EHR to provide clinical services when participants Certification to ensure their own EHR are at different locations. Telehealth compliance. Telemedicine consultations encompasses a broader application of require sufficient patient information to be technologies to distance education, consumer available in order to provide informed advice or outreach, and other applications wherein a diagnosis. A patient EHR must be completed electronic communications and information before using telemedicine services as one technologies are used to support healthcare would do during any initial visit to a new doctor. services. Telemedicine services accessed via Access to complete prescription records ensures that care is coordinated and integrated 6 Where Americans Get Acute Care: Increasingly It's within the patient’s current health regime. Not At Their Doctor's Office, Health Affairs, September 2010, pgs 1620-1629. Most telemedicine physicians are specially trained in cross-coverage, telemedicine care 7 Telemedicine, Telehealth, and Health Information provision so patients are assured of getting Technology, American Telemedicine Association, informed, caring advice. The Medical Home is May 2006. 14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292 O 310-339-9042, F: 310-305-1619, Email: 3
  4. 4. not only maintained by this cross-coverage wellness and disease management tracking service, but enhanced as each telemedicine assists patient members in being more consult is logged and tracked, something that proactive in maintaining their health; a key is unavailable should that patient have needed feature of the Meaningful Use initiative. Also to go to either urgent care, retail clinic, or the high on the Meaningful Use must-have list are: emergency room. In the event that a patient is increasing access to physicians when they are advised to get immediate face-to-face needed (two-thirds of acute care visits to treatment through one of these urgent or emergency rooms were on weekends and after emergency facilities, there is still a record of business hours on weekdays6), maintaining the patient’s condition logged in their EHR and integrating an electronic record (EHR) of enabling the PCP to exercise Continuity of all patient interactions, relieving PCPs of Care. burdensome routine care, increasing wellness awareness, and saving cost for patients and The ease of use and expertise of the health providers. Telemedicine, although not telemedicine physician consultation experience resolving all of these issues, provides many increases a patient’s satisfaction of care benefits to aid employers, health plans, considerably. The patient's PCP also benefits providers, and the members they serve survive from this augmented service. For those PCPs and thrive in the new heathcare environment. who do not want to be on-call after-hours, as is true of 60% of PCPs in the US6, they can rest assured that their patients are still able to Communicating Telemedicine Services and receive quality care and that they will be able Lowering Costs to maintain awareness of their patient’s From a benefit plan or employer perspective, ailments and treatment. From a quality of care the behavior change of its patient members perspective, PCPs can encourage their away from using urgent care or emergency patients to feel comfortable in using the room facilities toward using telemedicine telemedicine services for routine treatment or services provides considerable cost savings for when they are seeking advice of a general the plan provider or the employer. nature. This allows the PCP to be more freed- up and be able to spend quality time with those Typically priced lower per consultation than patients experiencing acute need or those that any other physician health service, the more have more complicated conditions, reducing patients use telemedicine services as an the scheduling pressure that is so common for alternative to urgent care centers and the many PCPs these days. If the PCP is covering emergency room, the more savings will be patients under a plan that has capitated fees, returned to the provider. Of course patients then being relieved of patient treatment for can be rewarded for this cost savings behavior routine illnesses by more cost and time- by passing on this provision savings to them by effective means is a real boon. making telemedicine choices be a less expensive health treatment choice. An ROI (return on investment) assessment clearly Additional Meaningful Use Benefits shows how utilization drives savings. The Many telemedicine services provide the means National Center for Policy Analysis reported to fulfill additional Meaningful Use criteria that over 90% of respondents said they would through the implementation of a patient health recommend telemedicine services to a friend and wellness management portal. Enhanced 14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292 O 310-339-9042, F: 310-305-1619, Email: 4
  5. 5. or family member8. Once patients become Vendors today have addressed various pieces familiar with telemedicine services, their usage of this puzzle to varying degrees. In order to rate remains high with nearly 93% of those comply with all aspects of the new regulations, who used the service report they would use it it may be prudent to consider an integrated again8. In a recent Mercer study, satisfaction approach to meeting all of the aspects ratings for interactive telemedicine were required. reported at 98% whereas face-to-face primary care physician visits were in the 70-78% The combination of a secure information range9. To drive utilization and reap additional integration platform that enables data rich savings, an outreach education program EHRs along with a telemedicine (electronically tailored to the healthcare provider or data compliant) patient-centric supplemental employer's needs makes it easy to get the care provider can take away much of the onus word out to members. Additionally, it is helpful of addressing these new regulations and to track ongoing service usage and gather reduce them to a manageable plan. satisfaction surveys to gain insightful data enabling providers, employers, and plans to understand member feedback and usage patterns and enable further incentives drive utilization and savings. Louise Falevsky The Picture of Health Executive Vice President The Grant Group Two important factors of compliance within the Medical Home and Meaningful Use world of today are the ability to gather, maintain, and Donald G. Lightfoot, MBA, CLU, CEBS integrate medical data records (EHRs) and to President and CEO provide patient-centric care including increased The Grant Group access and dissemination of proactive health information. This is a tall order for many PCPs and health plans to address. 8 Convenient Care and Telemedicine, National Center for Policy Analysis, November 2007, pg 12. 9 Telemedicine MD consultations: satisfaction rates and use patterns among working-age adults, Mercer Health and Benefits, LLC, 2008. 14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292 O 310-339-9042, F: 310-305-1619, Email: 5