One of the primary goals of the Affordable Care Act is to achieve the greatest value from the health care resources invested into the system while making lasting improvements in patient outcomes, wellness, and overall health. Telecare can potentially make a valuable difference in achieving this goal, yet widespread adoption is greatly hindered by both policy and practice barriers.
While telecare is not new, dramatic improvements in the available communication technologies have made it more accessible than ever before. As such, we can no longer just talk about traditional “telemedicine” to describe the breadth of applications across the entire health care and public health spectrum. As health innovations advance, it will be essential for policymakers, private insurance payers and consumers to fully recognize telecare’s capacity to not only increase access to care, but also to make real improvements in both the quality and the efficiency of care.
However, a number of misconceptions regarding this field need to be corrected to achieve this goal. First and foremost, telecare should no longer be treated as a unique service requiring its own separate rules. Rather, telecare technologies are a means to enhance the delivery of health care and supportive services and should be held to the same quality and practice standards as in-person care.
Second, telecare is much more than just a live videoconference. Today, this field is rich with a range of electronic communication technologies such as remotely monitored biometric data and the storing and forwarding of digitized data, pictures and video for non-real-time consultation. One of the fastest growing areas of this field is mobile health, which makes full use of smartphones, tablets and personal health monitoring devices for the timely collection and transmission of personal health data for diagnostic, monitoring and educational purposes.
Telecare and the Triple Aim
A growing body of evidence from programs across the country reinforces how telecare applications successfully achieve the ACA’s “Triple Aim” health care reform goals: improved care quality and health outcomes, coupled with reduced per-capita costs. In fact, the Department of Veterans Affairs has become the nation’s leader in telecare use to achieve these results. Video conferencing and telecommunications have been used with great success to allow veterans with varying chronic physical and mental conditions to remain at home for consultations and monitoring without having to travel to a VA medical center. Here are some examples of how other health systems are successfully using telecare.
- University of Arkansas Medical Sciences’ ANGELS program uses telecare to provide quality and timely care to high-risk pregnant women with a 24/7 call center and live video consultations. The program widely distributes guidelines, educational materials and case management guidance. It also educates and supports physicians, nurses and other providers. The program helped reduce the 60-day infant mortality rate and complications, leading to cost savings for the Medicaid program while increasing client satisfaction.
- University of the Pacific School of Dentistry created the Virtual Dental Home, which uses dental hygienists and assistants to collect dental information from patients in community settings. The information is electronically sent to the supervising dentist, who creates a dental treatment plan for a hygienist or assistant to implement. More than 2,000 patients have been seen in more than 45 remote sites throughout California, providing a low-cost system of preventive and early-intervention dental care to vulnerable populations.
- In 2010, Lee Memorial Health System in Florida implemented a remote patient monitoring program for discharged patients in need of home health services. The health system avoided 950 readmissions in the first two years, resulting in an estimated savings of more than $5.3 million.
- The Expanding Access to Diabetic Retinopathy Screening initiative in California used store-and-forward digital retinal imaging to address patient barriers to diabetic eye care in 13 safety-net clinics. The project demonstrated that telecare could be deployed for large-scale retinopathy screening and showed a net benefit to the state from reduced costs associated with vision loss.
- After implementing a new telemental health program with advanced practice nurses (APNs) at two of its most rural locations, the Bowen Center in Indiana realized significant reductions in average wait times after the initial service request, decreased average days until follow-up sessions and experienced a 20% to 30% increase in the amount of billable services for APNs’ clinical time compare with traditional care.
The Challenges Ahead for Telecare
Despite the obvious benefits of these technologies, a number of obstacles continue to prevent telecare expansion. Recent analysis of the telecare laws, regulations and administrative policies across all fifty states and Washington, D.C., revealed a patchwork of outdated and misguided policies, with no two states alike. We join with the American Telemedicine Association’s call to eliminate federal and state artificial barriers to telecare, and to promote new payment and service models that allow for the full use of telecare’s contributions.
Just as important to improving the public policy environment is the need to fundamentally change health care in practice, so as to take full advantage of telecare technologies. A valuable lesson from the field is that it is a mistake to believe that you can simply overlay telecare practices onto a traditional health care operation. The full benefit of these technologies requires a total commitment from all involved to reorganize the operational infrastructure to fully integrate telecare into their organization. Private payers also will need to rethink reimbursement models to reward efficiency and quality resulting from the use of telecare technologies.
Over the next decade, the transformation of our current health care system from a fee-driven model to one that is based on improving health and achieving the maximum value for resources invested will be challenging. That journey will be much more successful if policymakers, payers and practitioners are motivated to allow the true potential of the telecare revolution to flourish.