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No Mandate Required

flying cadeuciiA reporter who covers healthcare asked me a thought provoking question recently: Is there a mandate for the adoption of telehealth?  The inquiry makes sense. After all, from hospitals to health plans, employers to private practices, it is expected that the global telemedicine market will expand at an annual rate of 14.3 percent through 2020. Surely the explanation has something to do with the presence of a national requirement.

And it is the case with other health technology. As many in the industry know, the federal government mandated the adoption of electronic medical records (EMRs).The US Department of Health and Human Services spent billions to implement the Health Information Technology for Economic and Clinical Health (HITECH) Act. And providers were incentivized and penalized based not only on their adoption of electronic health records, but on the efficacy of their “meaningful use” of these new tools.

Even prior to HITECH, the protection of digital personal health information required government intervention.  The Health Insurance Portability and Accountability Act established national standards for the electronic transfer of information within the health care system.

But – as it was pointed out, indirectly, by this reporter – this is not the case for telehealth.  Of course there are now several state-level mandates for payment of telehealth services, Medicaid payment policies and limited Medicare reimbursement. But telehealth adoption is multiplying at an undeniable rate in the absence of a government requirement for either providers or hospitals to do so.

Why such fertile ground for this particular component of healthcare technology?  Why this voluntary, unparalleled embrace of a new technology?

  • The time is right.

The ground has been ripe for telehealth to take hold. According to Centers for Disease Control, there are 1.2 billion doctor visits each year in the U.S., an average of 3.3 per person. Deloitte estimates that 110 million of these are for minor illnesses, the type which does not necessarily require a trip to the emergency room, urgent care clinic or even their doctor’s office. Couple this with heavy pressures on governments and businesses to lower the cost of healthcare after decades of excessive inflation. This equation begged for a shift away from the long-standing paradigm that patients should be forced to travel to these high-cost environments to seek care.

  • There is a national shortage of providers.

We have also been experiencing a growing shortage of physicians. Even prior to the implementation of the Affordable Care Act (ACA), which created 40 million newly insured consumers, the nation was experiencing a clinical drought. A shortage of some 91,000 doctors is expected by 2020. Add to this the facts that the average doctor visit in the U.S. must be scheduled 19.1 days in advance and takes 2-3 hours to complete, including travel and wait time.  It’s a simple supply and demand calculation, one that could easily be solved through innovation in technology.

  • The technology works.

Major advances have created the infrastructure upon which telehealth can flourish.We can acquire, analyze, store and transmit more data at significantly lower costs; broadband access is dependable, high speed, and nearly ubiquitous. The increasing consumer adoption of smartphones and other mobile devices provides around the clock access to video conferencing and high-resolution imaging all came together to support this once nascent modality of care delivery.

  • Policy is catching up.

Ten years ago, very few states had even considered any regulatory framework for telehealth, either in terms of what was permissible, or how telehealth services should be paid. By the dawn of 2016, thirty states had embraced the concept that telehealth should be a payable commercial service, nearly every state had a policy for extending telehealth to its Medicaid enrollees, and CMS had been continuously adding new codes for Medicare reimbursement along with an ACO designation that allowed for the greatest amount of telehealth payment to date.

  • Consumers want it.

Arguably the single greatest contributing factor to the rapid adoption of telehealth is social behavior – the consumers themselves. The modern consumer demands immediacy, choice, and control over how they procure services and products. They are increasingly in the driver’s seat, and they know it. Banking mobile apps are the norm, and electronic grocery shopping is passé. Consumer sophistication and comfort with technology has merged with a growing commitment to better health and patient engagement to produce the perfect storm. It was just a matter of time before patients embraced the concept of seeking healthcare in the same manner that they have sought consumer products, banking, and a general connection with the world at large: online.

The number of on-line medical consultations is expected to increase from less than one-tenth of one percent of the total today to 20 percent or more within the next 20 years. This would make telehealth at least a $10 billion industry in the United States alone.

It’s nothing short of an eruption. From the social to the technologic, the economic to the legislative, the power of access and cost, supply and demand.

So to that reporter who asked about telehealth adoption mandates, I would say, no mandate. No need! By the end of this decade, when this article is sent to the electronic archives, no one will even be using the terms “telehealth” or “telemedicine.”  The delivery of online, web-based care will simply be thought of as healthcare.

Kofi Jones is VP of Government Affairs for American Well, a national provider of telehealth technology and services and creator of Amwell for online doctor visits.

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John Irvine
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I would love to see a nice little chart comparing telemedicine and EMR growth rates over the last 10 years … Anybody got one handy?