Globally, in developed economies, the challenges of increasing health care costs, access to quality health care, aging citizens and the supply of clinicians are universal. CSC says telemedicine can address these challenges as part of reforming health care delivery and financing throughout the world.
In Telemedicine: An Essential Technology for Reformed Healthcare, CSC sees telemedicine as an enabler for health reforms’ goals the world over. In the U.S., telemedicine is explicitly mentioned in the Affordable Care Act. In April 2011, the Federal Register included language about health financing reform that said, “The ACO shall 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….”
Telemedicine falls into three categories: tele-visits, which is the use of information and communications technologies (ICT) to conduct provider visits with patients; tele-consults, the use of ICT by at least two health providers to discuss a patient (whether present or not); and, tele-monitoring, using ICT for the patient to track and communicate clinical information (e.g., weight, blood pressure, glucose, etc.) to providers.
CSC recommends that providers deploy a telemedicine solution for an immediate problem, such as managing a chronic condition, to demonstrate a short-term ROI. Furthermore, CSC recognizes that there are barriers to deploying telehealth broadly, so providers should work with regulators and influencers to address these. For example, the recent CMS ruling published in May 2011 that streamlines credentialing for physicians using telemedicine will go some way to gaining market traction. Beyond reimbursement and credentialling (typically formidable obstacles to deploying telemedicine), other major barriers including legacy care models, access to patient clinical data, and technology (such as the availability of broadband and IT interoperability).
CSC also suggests that providers’ telemedicine strategies should involve many diverse stakeholders in the community: health plans, patients and clinicians alike.
Health Populi’s Hot Points: Novel health financing models will help to usher in the broad adoption of telehealth in the U.S. Bundled payments, pay-for-performance, medical homes, and accountable care can be designed to align providers’ interests with patients much more effectively than fee-for-service plans that incentivize face-to-face encounters versus more appropriate, infrastructure-independent approach to health care.
Telemedicine as a health reform enabler, though, isn’t only about providers: it must be patient-centric and -accessible. In particular, tele-monitoring has the promise of enabling the most personal form of health reform: health engagement. With the ubiquity of mobile phones and consumer-facing medical technology increasingly available in pharmacies and electronics stores, people on-the-go and at-home can track any number of health metrics. With a simple Bluetooth signal, app-in-the-cloud, or USB-connection to a personal computer, self-tracking seamlessly communicates observations of daily living to clinicians, more and more of whom will be equipped with electronic health records. Health Nirvana happens when the loop closes between patient and provider, and when the picture painted by data — both “medically derived” through blood tests and doctors’ visits and the data of daily life — comes into focus.
Telemedicine is an enabler of both kinds of health reform: political and personal.