As the shift in Medicare reimbursements moves from pay for services to pay for outcomes, it necessitates a more proactive and less reactive approach to delivering healthcare to patients. A major component of this emerging approach and its manifestation in accountable care organizations (ACOs) and patient-centered medical homes (PCMH) is recognition that the point of care is not exclusively clinical.
“We’re seeing with the emergence of ACOs, a number of folks talking about how we can we do this more efficiently,” says Kevin Quinn, Senior Vice President at AMC Health. “How can we help patients connect the dots but also do it in a way that’s economical for us and enables us to dramatically improve clinical efficiencies so we can afford to touch more patients who may potentially need additional guidance, support, and assistance as they navigate their way through healthcare spectrum?”
The answer to these questions could very well be telemedicine (or more generally telehealth). “It struck me that telehealth, remote patient monitoring, was an effective way to address a lot of those gaps that are created and help people understand what’s going on with the patient where they spend the bulk of their time, in the home setting,” observes Quinn.
According to Quinn, the evolution of medicine and healthcare delivery appears ripe for the adoption of solutions and services that extend the range of healthcare organizations and providers. “We’ve received a lot of help, frankly, with the CMS penalties for Medicare related to 30-day readmissions,” he explains. “We were in the right place at the right time.”
Quinn and AMC Health have worked with integrated delivery networks (IDNs) such as Geisinger Health System in Northeastern and Central Pennsylvania. And while this and other geographical regions having adopted telehealth are large and generally rural, this doesn’t necessarily mean that telehealth is limited in its ability to improve healthcare for other areas.
“Many people have different definitions of telehealth,” argues Quinn. “Patients who could be in Manhattan, New York City, for example, they could literally be a block and a half away from their doctor but they can still benefit from the same service.”
From the provider’s perspective, the challenge of adopting telehealth solutions and services comes down to solving two key problems: provider resistance and patient engagement.
Similar to EHR adoption, telehealth adoption requires the appropriate culture within the clinic, one that enables and sustains the use of this health IT. “The physician community at large doesn’t have a complete completion for how this all works. They need to feel comfortable that the information can be provided in a meaningful way — that it’s not going to be just a lot of noise,” adds Quinn.
According to Quinn, eliminating provider resistance to telehealth adoption begins with identifying and choosing the right providers, the “internal champions,” who will become models for their colleagues and other clinical teams to look to for proof that it works. “Through the success achieved by those few, it helps drive the motivation to participate in the whole team,” he believes.
The second challenge is making sure that patients are comfortable in the use of telehealth technologies and services. “We’ve historically found that if you’re just bombarding patients with collateral pieces or general information or even just routinely calling them at predetermined, you’re not often getting the same kind of meaningful dialogue and engagement,” explains Quinn.
The key here is to work with patients to develop an understanding of what devices such as biometrics, glucometers, and the like bring to the interaction between providers and patients.
For telehealth to play that “significant role” that Quinn and AMC Health envision, providers and patients together must first appreciate that this technology and its application are a means to improved outcomes by way of lessening the distance, both physical and informational, between the two.