Guest post by Cliff Bleustein, M.D., M.B.A., chief medical officer, Dell Services.
For decades, reimbursement for the time spent coordinating care and keeping people healthy has been mostly non-existent. But the tide is turning, as government and private payers see that coordinated care and the time spent keeping people healthy can lower the amount of money they spend treating illness.
Primary care physicians are even seeing higher reimbursements in some areas. For example, beginning in 2011, CareFirst BlueCross BlueShield, the largest insurer in the Washington, D.C., area, substantially raised reimbursement rates for general internists and family practitioners who adopted the medical home model, which emphasizes care coordination. They also rewarded them with significant bonuses if they met quality standards and reduced costs. They also provided the physicians with round-the-clock nursing assistance to help with their sickest and riskiest patients.
CareFirst CEO Chet Burrell said in news reports that the program is saving “hundreds of millions of dollars in accumulated, avoided costs.”
Government payers are also reaping benefits from coordinated care, including Medicaid, Medicare and the Veteran’s Administration.
That’s good news for everyone. Coordinated care requires an upfront-investment in people and technology that is often beyond the resources of a primary care practice, but it is far less expensive than the business-as-usual, uncoordinated care that has seen costs rise at double the rate of inflation for most of the past two decades. If public and private health plans make that upfront investment, paying for the time and the needed resources, they can reap the financial benefits while patients reap the benefit of better health.
No matter what the discussion is or who you are talking with, this often seems to be the big question. It’s not enough to say “what;” what matters is, “What’s Next?”
Healthcare: This area is the largest, fastest growing and perhaps the fastest changing element of our economy and lives. As a result, just about every conversation we have about healthcare involves a “What’s next?” discussion.
At Fathom, we have the privilege of spending a lot of time exploring what’s next in healthcare marketing and communications. Based on our conversations, observations and research, here is a list of the top 10 tech trends every hospital and healthcare professional should know about.
Predictive analytics. Real time isn’t fast enough. Predictive analytics—or the systematic use of data to predict patient behavior—will usher a big shift in the quality of care. By analyzing hospital data, social media conversations and search patterns, hospitals can predict patient behavior and needs. Hospitals can predict and be ready for flu outbreaks. By analyzing historical admissions data, weather patterns and census data, hospitals can predict emergency room volume and staff for it. Healthcare systems can even look ahead 10 or 20 years and predict the need for cancer care or assisted-living facilities with population data.
Wearables. Wearable devices can monitor blood pressure, heart rate, insulin levels and more. Forget the simple devices we use today: The next generation of wearables will elevate health monitoring to the next level. All this information can also be shared in real time with a healthcare provider, making it part of a larger trend: Partnership between patients and providers.
Mobile devices are completely ingrained in the fabric of our daily lives – from personal use to business – throughout the world.
The healthcare industry, usually resistant to the whims of technology trends, has been a fast and significant adopter of mobile devices. Apple’s introduction of the iPad appears to have been a watershed that brought healthcare IT into the 21st century. Besides improved efficiency in communication and administrative functions, clinicians found the devices much more practical to incorporate to patient interactions – from consultation to education. Now mobile devices have become almost indispensable in the daily care of patients. Physicians use smart phones and tablets wherever they review patient records, receive updates or alerts by secure text messaging and coordinate care among other clinicians. Care professionals are connected to health information like never before.
Telehealth has “connected” patients and physicians for decades in an attempt to deliver proactive healthcare, but mobile devices and cloud-based technologies are making remote healthcare more practical. Still, we are just scratching the surface as to what a “connected healthcare system” can look like. Despite strides, we still need to tie it all together: patients, physicians, devices, data, analytics, decision support, monitoring services and education – to achieve the best outcomes for our patients.
A connected patient is more compliant with a better chance to attain better outcomes. A connected provider has access to better information to make better decisions. The common goal is to keep the patient out of the hospital, lower costs, reduce the strain on an already strained healthcare system and provide better outcomes. How we implement the goal of a connected healthcare system is the challenge.
In assessing how to best utilize mobile technology with patients and providers, my belief is that one solution doesn’t fit all. We must align the right technology with the right patients. Smart phones and tablets with complex apps and expensive data plans may be common in demographic groups that may skew younger, or those with higher technical literacy and dexterity and more disposable income. Simpler technology using month-to-month or prepaid service plans may better suit seniors and those with limited and fixed incomes. Meaningful change will come faster by focusing on the 15 percent of the population that consumes 80 percent of healthcare costs. This segment traditionally includes the elderly and indigent, Medicare/Medicaid population. This group doesn’t overwhelmingly consume the “latest and greatest” devices with the hottest apps and seamless connectivity – 4G, Bluetooth, WiFi and syncing to the cloud is not reality. We must be realistic when we propose solutions to address something as important as the delivery of patient care, providing the right technology to meet the needs of the people using it. Acquiring the right data, at the right time, and right cost, to achieve the right (better) outcome for the patient.
Healthcare reform, the newly insured and a growing interest in population health management are accelerating the market’s interest in telehealth technologies and services. Healthcare providers are developing integrated strategies for adopting these technologies with the goal of extending capabilities and patient interactions beyond traditional care settings. As more payers and employers begin to pay for telehealth services, the value of these tools is coming into focus. Market analyst IHS predicts the US telehealth market will grow from $240 million in revenue in 2013 to $1.9 billion in 2018, an annual growth rate of more than 50 percent, according to Forbes. Keys to the anticipated surge are the current physician shortage, an expanded patient base under the Patient Protection and Affordable Care Act and an effort to put consumers at the center of their own care.
Overcoming the obstacles
Historically, the healthcare industry has proceeded carefully in the world of digital advancements. High investment costs and uncertain return on investment have created a tenuous economic model. Healthcare providers also face three other key obstacles: uncertain reimbursement, varied state licensing laws and the potential for breaches in privacy and security.
Navigating reimbursement challenges
Reimbursement for telehealth services varies widely. Medicare pays for some services, especially in remote rural areas, but the program has several restrictions. It generally covers only services delivered “real time,” through videoconferencing, as opposed to “anytime,” through store-and-forward technologies.
Medicaid is the most common route states are taking to implement their telehealth programs. The National Conference of State Legislatures (NCSL) notes that to date, 43 states and the District of Columbia provide some form of Medicaid reimbursement for telehealth services.
Private payers need to comply with state regulations. Currently, 19 states and the District of Columbia require private insurance plans in the state to cover telehealth services, according to the NCSL. Arizona will join this list in January 2015. Nontraditional payers for telehealth services range from charitable organizations, long-term care and community health providers to self-insured groups and agencies serving special populations.
Policies continue to evolve. Several bills are before Congress to establish a federal standard for telehealth, while Medicare’s 2014 physician fee schedule will expand coverage incrementally for telehealth services.
Tapan Mehta, global healthcare lead, Cisco, brings more than 15 years of healthcare information technology, marketing and business development leadership as Cisco’s global healthcare lead. Mehta is responsible for managing the development and marketing efforts for healthcare solutions including clinical workflow improvement, telemedicine, patient safety, regulatory requirements and EHR integration.
Here he discusses the demand for telehealth, the changing role of hospital health IT, wearable technology and patient monitoring and what Cisco is doing to serve its healthcare clients.
Tell me about Cisco and how it serves healthcare.
At Cisco, we see the healthcare industry as ripe for technology disruption. After doing things the same way for years, we think technology can be the catalyst that brings positive changes to how care is delivered. Drawing from our experience as the worldwide networking leader, Cisco is well positioned to help improve the future of healthcare through networked technologies that transform how people connect, access and share information, and collaborate. New healthcare technologies, like those offered by Cisco, benefit everyone – from patients to providers, payers to life sciences organizations.
What is your role, specifically, and what is the most challenging aspect of it?
I have a global marketing role where my team is tasked to develop healthcare specific solutions, go-to-market strategy and field enablement, as well as serve as the “voice of the customer” by bringing the outside-in view to Cisco and its various business groups. Healthcare is at a very critical inflection point in the industry whereby there are several key underlying currents in areas such as mHealth, telehealth, data analytics, wearables, etc. While there are several interesting opportunities to pursue, what makes it difficult is to prioritize them as each segment has substantial market opportunity and growth prospects.
What inspires you and does this translate to your leadership style?
Healthcare is very personal. It touches everyone in the society in some shape or form. I have been in the healthcare space for the past 15 years and I am extremely fortunate that I am in an industry that is going to go through a transformational change over the next decade. Historically, healthcare has fundamentally lagged behind most industries when it comes to technology adoption, but I perceive that changing over the next several years. Healthcare “consumerism,” combined with government mandates around the globe, is going to force the industry to adopt technology if it truly wants to improve quality of patient care and workflows throughout the continuum of care. I am really excited to be part of this healthcare eco-system, whereby I can make a difference in how our customers do their business and more importantly how quality of patient care can be vastly improved.
Guest post by Garrett Taylor CEO of Uplift Comprehensive Services.
My organization, Uplift Comprehensive Services (residential services) is fully involved in “mhealth.” We use mobile high-definition video conferencing, which allows our doctors and clinicians to care for patients in geographically remote areas of North Carolina, and gives them full access to electronic health records and an easy way to collaborate each other. Along the way, we’ve improved patient service, enhanced productivity, and cut travel and office costs.
By combining video conferencing technology with a bring your own device (BYOD) mobile strategy, Uplift saves at least $500 for each scheduled physician visit. The thousands of dollars we save each year can be used instead to find grant opportunities for better patient care.
It’s not as hard as you might think to use video conferencing in a mhealth strategy. What follows is an explanation of Uplift’s mobile video conferencing approach.
Uplift Comprehensive Services has been in business for 12 years, covering 15 counties across North Carolina. We offer community-based assistance for children, adolescents and adults, with services substance abuse prevention to mental health treatment. Our treatment options include multi-systemic therapy, outpatient therapy, and medication management, among others. Continue Reading
