The major challenges facing the U.S. healthcare system are, among others, increased access to affordable, efficient and quality care; and reducing its spiraling costs. One in five Americans lacks adequate access to primary care due to a shortage of primary care physicians in their communities. Healthcare spending accounts for nearly 20 percent of the U.S. economy. With 30 million people projected to be added to the healthcare system as a result of reform, tens of millions of baby boomers approaching retirement age and an aging physician population, the U.S. healthcare system, and the nation’s fiscal balance, are at risk.
To succeed in delivering high-quality care and reducing costs, an increasing number of physicians and hospitals are banding together on their own, or with payers, to form accountable care organizations (ACOs), which transition from fee-for-service models to bundled payments and risk/reward models. As a result, physicians and other providers are “accountable” for the health outcomes of their patients and incentivized to adhere to quality, low-cost care approaches.
While the goal is simple, it’s far from a modest feat.
ACOs face steep challenges that cannot be solved by increasing the number of providers to the supply side of the equation. The Association of American Medical Colleges projects that by 2015, the U.S. will face a shortage of 63,000 doctors, and this number could double by 2025.
A key goal of ACOs is to improve chronic disease care, which accounts for more than 75 percent of U.S. healthcare expenditures. Yet preventing and managing chronic disease is complex, requiring enhanced physician/patient communication, improved clinical coordination and continuity of care. Many chronic disease patients require treatment from multiple healthcare providers, often leading to fragmentation in the delivery of care.
Engaging patients and empowering primary care providers to manage patients more effectively – particularly those who are at risk – are pivotal to driving down costs and saving the system as a whole. ACOs and the healthcare system require an efficient, cost-effective and innovative solution to envelop patients with high-quality care and appropriate allied health services, wherever and whenever healthcare is needed. Healthcare providers that make up ACOs need to seamlessly share clinical information, and their own skills, in order to maximize their ability to contain patient care in the ACO, a key principle for its success.
One of the most promising solutions on the market today to meet these challenges and transform the U.S. healthcare industry is telehealth. Telehealth allows providers, from their office or home, to follow up with their patients, who are at home or their workplace, using live video, secure text chat and phone. Telehealth is transforming healthcare delivery by removing traditional barriers, such as distance, mobility and time constraints. By bringing healthcare directly to patients, it reverses the longstanding paradigm of placing the burden on patients to seek care where it’s available. For chronic patients, this supports preventive care efforts and reduces costs by shifting care to lower cost settings, reducing ER utilization, hospitalizations and even the overhead associated with routine follow-ups.
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Telehealth also enhances care coordination by allowing primary care providers to consult with clinical specialists in real time, without sending the patient for a referral and an additional visit. By connecting hospitals, providers and patients, telehealth helps patients remain with their local providers as long as possible, while ensuring that they receive the best care possible.
During the past decade, telehealth’s growth moved from linear to exponential. The global telemedicine market grew from $9.8 billion in 2010 to $11.6 billion in 2011, and will almost triple to $27.3 billion by 2016. According to the American Telemedicine Association, 16 U.S. states, covering more than 120 million Americans, have passed laws that require reimbursement for telehealth. Major health plans and healthcare systems – including Wellpoint, United Healthcare, the U.S. Department of Veterans Affairs and a large number of BlueCross Blue Shield plans throughout the country – have made telehealth a foundational part of their long-term strategies.
The Massachusetts Cost Containment Bill, recently signed by Governor Deval Patrick, intends to save the Commonwealth up to $200 billion in healthcare costs over the next 15 years by encouraging the creation of ACOs. Governor Patrick said, “Massachusetts has been a model to the nation for access to healthcare. Today, we become the first to crack the code on cost.”
Telehealth technology is poised to play an integral role in cracking that code. The new Massachusetts law includes multiple applications of telehealth as a way to contain healthcare costs while improving access to care. The state that set the national standard for improving and ensuring healthcare access is now tackling cost-containment issues, and telehealth has been identified as a top priority for both.
Yet inertia still remains. Physicians and hospital administrators continue to debate how to seamlessly implement telehealth delivery systems in a manner that improves patient care and care coordination, while maximizing market growth and ROI. Some are taking a wait-and-see approach, while others consistently experiment and explore the promise that telehealth presents.
Boldly engaging modern technology – telehealth specifically – to rewrite the map of healthcare availability around the country is now an imperative, not a luxury. The question today is not whether we should embrace telehealth technology, but rather how to do so safely and systematically.
We simply cannot afford the inaction that was lurking under the continuous debate. We need to put technology to work in realizing the vision-turned-mandate of healthcare for every American.
About the author
Roy Schoenberg, M.D., M.P.H., is CEO, American Well Systems. For more on American Well, click here.