As a model of care, telemedicine is coming into its own. It's a rapidly maturing mode of care delivery made more popular in part by an aging population -- the so-called "Silver Tsunami" of baby boomers who are increasingly open to care options that are delivered remotely.
Increasingly, the Centers for Medicare and Medicaid Services is reimbursing for virtual care to Medicare beneficiaries.
The convenience of such a model is hard to ignore for aging populations. Receiving diagnosis and treatment virtually is attractive to those for whom transportation and mobility may be a problem.
It also helps offset the physician and nursing shortage as both the number of seniors and chronic conditions climb.
There's just one problem: If not handled well, telemedicine can feel impersonal to some, adding virtual distance between patient and provider.
Because of that, it's important to maintain an element of humanity in the telehealth model. Consumers increasingly dictate the type and quality of care they receive, and consumers typically want convenience, transparency, and importantly, a personal touch.
"You're not letting the technology drive," said Jon Pearce, CEO of virtual care company Zipnosis. "You're using it to revamp our perception about what healthcare is. It's the most human thing we do every day. There's a need for nerds like me to get infatuated with the technology, so it's our job to say, 'At the end of the day, if the technology doesn't help the human journey, it's useless.'"
A PERSONAL TOUCH
In Pearce's view, one of the fundamental problems in healthcare, from a patient perspective, is getting providers to acknowledge the value of their time.
To adequately address this, telemedicine models should focus on providing real-time interactions between patients and providers. Among consumers generally and seniors specifically, there's a strong desire to know that someone is there talking to them. It's not just about the raw data and the symptoms.
"We need to provide a broader pallet," Pearce said. "We implement a virtual starting point, which goes into a handoff for when the patient needs or prefers to be seen in person.
"Sometimes in our busy society we have conflicting views of what convenience is," he said. "Sometimes it's like, 'I know what I want, give me what I want.' That's a broad range of things we're trying to master. That's a broad shift in telemedicine."
Zipnosis' approach to the problem is to let consumers start their virtual visit in an asynchronous fashion. Patients connect with a physician via phone or video, but then can then transition into a face-to-face encounter, further enhancing the philosophy of providing people with the broadest array of options. Starting on their phone, at home, patients benefit from a seamless interaction.
About 15 providers around the country currently license with the platform, including Baylor, Scott & White Health. Patients in MInnesota can log onto the system directly through the state's oncare.org website and view a list of conditions for which they can be treated, answering a set of questions as a starting point and then deciding whether they want a video, chat or in-person consultation. Sort of like a virtual care choose-your-own-adventure story.
The clinician gets a text alerting them that someone is in their queue, and within a couple of short minutes they can snag the relevant information, make a diagnosis and prescribe medication as needed. A short time later, the patient receives treatment plan options on their phone or computer.
The approach has proven popular with consumers because it fits snugly into the slipstream of their lives. But physicians have reacted positively as well.
"The physician experience is really what sells this," said Pearce. "They have more time ... and it rips out all the administrative burden so they can do clinical things and nothing else."
TECHNOLOGY AS A HUMANITY ENABLER
There are two bits of smart technology, available to anyone, that lube the gears of this process. One is triage. Behind the scenes, a tech team determines whether it's appropriate to treat a given patient online. If it's not, this may mean the consumer has a more serious ailment that requires being connected to someone quickly. This triage capability can be an outsourced technology.
The documentation piece can be outsourced as well, and hew strictly to the clinical guidelines of face-to-face encounters, only realized in a digital package.
Some telehealth providers, Zipnosis included, are even testing the waters of behavioral health with tests such as depression screening, which fits neatly into a clinical automation model. Medication management and screening capabilities are growing and beginning to mature.
Still, challenges remain, including reimbursement, which today is still largely built around the antiquated telephone model that forces payers to say "This is a visit," or "This is a phone call." If they determine that a virtual visit isn't a phone call and doesn't meet the expectations for convenience, then reimbursement can be a tricky proposition, although the picture is starting to improve in that regard.
CMS is allowing telehealth to be added as a benefit to Medicare Advantage plans starting in 2020. The number of codes for telehealth services for traditional Medicare have also been expanded.
A second challenge, said Pearce, is "partners' ability to have a cogent strategy for introducing this to the patient population as well as the physician population. It requires good alignment around the business objectives.
"It's really interesting transitioning from the analog world into digital and virtual care," he said. "The industry needs to pay attention to the human experience above all. The most powerful motivator for me and for the team are the letters we get from patients saying, 'You have changed my life.'"
In making decisions about when to use telehealth, providers would do well to avoid incidents such as the very public one experienced earlier this month by a Kaiser Permanente hospital in Fremont, California.
A family was furious after their 78-year old husband and father, who was back in the hospital for lung disease, was told that he was dying by video conference rather than receiving the news in person. The doctor, speaking through video live streaming that was setup by the man's bedside, told his patient there was nothing else to be done to help him except to give him morphine. The patient died two days later.
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