Telemedicine started out as a provider supply solution for outlying rural areas that lacked multiple physicians and specialists. Now, telemedicine is evolving in waves from being a convenient perk to a part of the care continuum to eventually becoming the locus of primary care delivery and care coordination. Just last month, for example, Gov. John Hickenlooper signed a bill expanding telehealth services in the state of Colorado, removing certain population restrictions on reimbursement. Oliver Wyman’s Charlie Hoban, who tracks innovative healthcare services, explains how telemedicine is moving from a sideshow to a central part of what smart health systems do:
Wave 1: Alternative delivery of clinical and health services. The initial value proposition of telemedicine for payers and employers was as a cost-saving and convenient alternative that provided greater access to clinical care, such as urgent care kiosks with videoconferencing abilities. Recently, telemedicine has come to be viewed more as a benefits perk and as a tool to help decrease the time employees miss from work. Providers, meanwhile, are gaining increased opportunity for revenue through specialists and access to assistance from specialists. Examples of modern telemedicine programs include Teladoc, American Well, HealthSpot, and Arizona’s behavioral health telemedicine initiative.
Wave 2: Working within the care continuum. We are just at the beginning of telemedicine being integrated into the care continuum. For payers, telemedicine capabilities offer an increased ability to manage a patient’s care in a timely fashion, which can result in cost savings for some populations, especially those with diabetes and other chronic conditions. Providers that embrace telemedicine integration can enhance connections with patients. Examples of integrated telemedicine products include navigation services, remote monitoring devices, and off-site diagnostic kits and labs.
If doctors can embrace telemedicine as part of their practice, they can expand capacity by creating more flexibility in how they serve patients. – Oliver Wyman’s Charlie Hoban
Wave 3: Locus of primary care delivery and care coordination. This wave represents the future where telemedicine provides the primary access point into the care system and facilitates primary care and population health management. Payers can manage patient populations at a more affordable cost, while providers can optimize interactions with patients and better manage their total care continuum. Examples include routine access of primary care providers and care coordinators through telemedicine touchpoints.
A number of barriers have stood in the way of faster adoption. Providers have tended to view telemedicine appointments as competition to their in-person office visits. But doctors don’t have to be present for every single diagnoses or routine follow-up, and if they can embrace telemedicine as part of their practice, they can expand capacity by creating more flexibility in how they serve patients.
Technical challenges have also been hard to surmount. To become a true part of the care continuum, there needs to be a seamless link between the doctor on the phone or screen to the rest of the care system. This requires upgrades to data exchange networks—a to-do that may be checked off much sooner than anticipated due to advances in tech connectivity and the pressure of federal mandates.
A final hurdle has been concerns over how providers will be paid for telemedicine services. State and federal rules have varied widely and not kept pace with technology, leaving telemedicine billing a murky area. Yet as providers accelerate their shift to population health, billing issues will fall to the wayside as concerns over care delivery and total costs become paramount. The conversation won’t be centered on the cost of a visit, but on the most effective way to manage a patient’s health overall. And telemedicine is a clear answer to that.