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Partnerships Between Behavioral Health & Telemedicine Drive Real Value and Impact Outcomes

Posted on April 24, 2015 I Written By

The following is a guest blog post by Dr. Bill Bithoney, Managing Director and Chief Physician Executive with The BDO Center for Healthcare Excellence & Innovation.
Bill Bithoney
The behavioral health and medical care delivery systems have long been separate, but the tides are changing. We’re starting to see more of a push to integrate the two, and it’s a trend expected to continue. Increased efforts to grow behavioral health service capacity through better integration with clinical care have health systems turning toward telemedicine. The benefits of this partnership are almost considered a “no brainer” when you take a look at the numbers and the opportunity for growth:

  • $6 billion: Where the telemedicine market will grow by 2020, according to the American Medical Association.
  • 7 million: The number of individuals with co-occurring substance abuse disorders and mental health issues, according to SAMHSA’s most recent National Survey on Drug Use and Health.
  • 38 percent: The number of adults with diagnosable mental health problems who actually receive needed treatment, according to the Department of Health and Human Services.

Still, providers and payors often find themselves asking, “How can I ensure this partnership will drive real value for the organization and impact outcomes?”

Telemedicine provides caregivers the ability to be in multiple locations at once – and provides patients access to care at times and places more convenient to them. As noted above, only 38 percent of adults with diagnosable mental health problems actually receive treatment. This means that more than 60 percent of individuals who know they need help aren’t able to receive it due to commonly cited challenges of not knowing where to go, inconvenience and lack of transportation. Further, psychiatrists, particularly those certified in addiction treatment, are in high demand nationwide. Indiana, which is experimenting with behavioral health telemedicine, has 462 in a state that should have 600.

And telemedicine has been proven effective in behavioral health treatment in numerous studies. Smartphones and apps are actually preferred by patients over prescriptions for medication. Through practices such as screening, brief intervention and referral to treatment (SBIRT)—included in Medicare telehealth services since 2013­­—problematic use issues, abuse and dependence on alcohol and illicit drugs can be proactively identified, reduced and prevented before ballooning into something greater. Moreover, the reduction in facility costs and increased access to patients makes telehealth, and telepsychiatry specifically, a cost-effective alternative to in-person treatments, while delivering much needed care.

Virtual visits and virtual early intervention through SBIRT impact not only the consumer’s health by extending the potential reach of substance abuse and mental health providers, but also the finances of the individual’s employer and insurer since the risks of costly and unanticipated urgent care and emergency department visits are greatly reduced. Additionally, insurers view this aggregation of data as a way to proactively monitor patients’ health, which can help prevent the risk of costly hospital admissions and readmissions.

The era of a partnership between behavioral health and telemedicine is upon us. Developing new avenues to deliver care that support behavior change, while engaging individuals in their own health, can not only be a more cost-effective strategy than simply providing more (or different) health care services, but can also be a smarter strategy to ensure better quality of care.

Dr. Bill Bithoney is a Managing Director and Chief Physician Executive with The BDO Center for Healthcare Excellence & Innovation. He can be reached at bbithoney@bdo.com

 

Getting Paid for Telemedicine

Posted on March 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


In case you’re like me and missed the slow rolling out of reimbursement for telemedicine, it looks like it’s slowly becoming a reality. 22 state mandated reimbursement of telemedicine is a really big deal. Makes you wonder if a federal law will be far away.

The biggest complaint I’ve heard over and over from doctors about telemedicine is that they don’t get paid to do it. Sure, every once in a while some will say that they’re not sure how well they can treat a patient over video (which is true in a number of cases), but the majority of the physicians I talk to would have no issue using telemedicine if they could just get paid for doing the work.

In fact, I think it’s some pretty genius marketing of Chiron Health (who created the tweet above) for mentioning in their Twitter profile that they’re a telemedicine provider and they want doctors to get paid for it. That’s a message the resonates with many doctors.

In fact, I think Chiron Health’s website hits the key areas where I’ve seen telemedicine taking off: Follow-Up, Chronic Patients and Behavioral Health. This image from their website describes well where I see Telemedicine working well:
Telemedicine Options

I’ll admit that I didn’t know anything about Chiron Health until today (Looks like they’re hiring which is a good sign for a company). However, I’m impressed by the way they’re approaching the telemedicine market. I’d love to learn more about the ways they help doctors get paid for telemedicine. Although, I’m certain that list is about to grow in a really amazing way. I have no doubt that telemedicine will be an important part of the future of healthcare.

Telehealth, or ‘How to Ditch the Waiting Room’

Posted on February 13, 2015 I Written By

The following is a guest blog post by Ryan Nelson, Director of Business Development for Medical Web Experts.

Navigating the doctor’s office for a non-emergency can feel like getting lost in a quagmire of lengthy routines. For those who choose to forego the experience for as long as possible, haphazardly browsing WebMD in the middle of the night is no better. This could all change soon.

Telemedicine is on the rise as health insurers and employers have become more willing to pay for online video consultations in recent years. Convenience (imagine not having to leave the comfort of your home for every service!) and positive health outcomes – not to mention significant cost savings for both employers and patients – are propelling online video consultations to the forefront of healthcare strategies.

Convenience
People don’t like driving far, and they don’t like spending 45 minutes in a waiting room only to be discharged in under 15. The average wait time for a doctor’s appointment is 20 days in the US. This is more than enough time to deter patients from booking appointments for conditions that could be minor. Doctors usually don’t get reimbursed for time spent taking phone calls, so they often nix the medium altogether. Virtual doctor visits can fulfill patients’ need for instantaneous advice, closing a potentially dangerous communication gap while opening a new business opportunity for healthcare professionals.

A recent Harris Poll survey commissioned by Amwell found that around 40% of consumers would opt for video appointments for both antibiotics and birth control prescriptions, while at least 70% would rather have an online video visit to obtain a prescription than travel to their doctor’s office. Telehealth also offers a good solution for patients with mobility issues or chronic conditions, and it gives patients and doctors in rural or remote communities more options for receiving and dispensing care.

Health Outcomes
Biomed Central’s systematic review of telehealth service studies revealed that health outcomes for telehealth and in-person appointments are usually similar. About one-third of studies showed improved outcomes and only two indicated that telehealth was less effective. One way that online video appointments can improve health outcomes for the general population is to filter out minor health concerns and free up ER staff to deal with more serious ailments in-house. Additionally, video consultations can make it easier for physicians to track the recovery of discharged patients and to monitor patient adherence in a time-sensitive manner.

Cost Savings
The Amwell survey revealed that 64% of patients are willing to attend virtual appointments, challenging the dated assumption that in-person interactions tend to be perceived as a better experience. Contributing to this popularity is the fact that virtual appointments cost much less than an ER visit and are cheaper than an urgent care center or most face-to-face consults, generally figuring in around $40 to $50.

Biomed Central also found that out of 36 studies, nearly two-thirds showed cost savings for employers and patients. Meanwhile, Towers Watson predicted that the number of employers offering telemedicine will increase by 68% in 2015, which would result in $6B in employer savings.

Consumer Concerns
Consumers are concerned about how doctors can thoroughly examine patients through video, according to Amwell. However, the proliferation of self-monitoring mobile devices that can be used in conjunction with video consultations suggests that doctors may be able to get much of the information they need online. Besides, it can be argued that during most medical appointments a doctor doesn’t have much time to perform a comprehensive examination or truly get to know a patient.

Amwell subjects also questioned how a patient can be certain that he or she is speaking to a real doctor; however, this can easily be addressed by medical web platforms that thoroughly screen physicians and can thus provide adequate proof of their qualifications.

Digital Relationships
Research has shown that online video communication improves patient satisfaction and increases efficiency and access to healthcare for all demographics, at all times. While the medium appeals to people across all age groups, it especially appeals to younger, tech-savvy patients. This demographic tends to prefer instantaneous communication for non-emergencies and is generally comfortable communicating despite physical distance.

Consumers already use technology to communicate with their friends and families. Finally, doctors – another one of every person’s most intimate relationships – can join the ranks.

References:
Amwell
Biomed
Towers Watson

By Supporting Digital Health, EMRs To Create Collective Savings of $78B Over Next Five Years

Posted on December 1, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Here’s the news EMR proponents have been insisting would emerge someday, justifying their long-suffering faith in the value of such systems.  A new study from Juniper Research has concluded that EMRs will save $78 billion cumulatively across the globe over the next five years, largely by connecting digital health technologies together.

While I’m tempted to get cynical about this — my poor heart has been broken by so many unsupportable or conflicting claims regarding EMR savings over the years — I think the study definitely bears examination. If digital health technologies like smart watches, fitness trackers, sensor-laden clothing, smart mobile health apps, remote monitoring and telemedicine share a common backbone that serves clinicians, the study’s conclusions look reasonable on first glance.

According to Juniper, the growth of ACOs is pushing providers to think on a population health level and that, in turn, is propelling them to adopt digital health tech.  And it’s not just top healthcare leaders that are getting excited about digital health. Juniper found that over the last 18 months, healthcare workers have become significantly more engaged in digital healthcare.

But how will providers come to grips with the floods of data generated by these emerging technologies? Why, EMRs will do the job. “Advanced EHRs will provide the ‘glue’ to bring together the devices, stakeholders and medical records in the future connected healthcare environment,” according to Juniper report author Anthony Cox.

But it’s important to note that at present, EMRs aren’t likely to have the capacity sort out the growing flood of connected health data on their own. Instead, it appears that healthcare providers will have to rely on data intermediary platforms like Apple’s HealthKit, Samsung’s SAMI (Samsung Architecture for Multimodal Interactions) and Microsoft Health. In reality, it’s platforms like these, not EMRs, that are truly serving as the glue for far-flung digital health data.

I guess what I’m trying to say is that on reflection, my cynical take on the study is somewhat justified. While they’ll play a very important role, I believe that it’s disingenuous to suggest that EMRs themselves will create huge healthcare savings.

Sure, EMRs are ultimately where the buck stops, and unless digital health data can be consumed by doctors at an EMR console, they’re unlikely to use it. But even though using EMRs as the backbone for digital health collection and population health management sounds peachy, the truth is that EMR vendors are nowhere near ready to offer robust support for these efforts.

Yes, I believe that the combination of EMRs and digital health data will prove to be very powerful over time. And I also believe that platforms like HealthKit will help us get there. I even believe that the huge savings projected by Juniper is possible. I just think getting there will be a lot more awkward than the study makes it sound.

Insights from Dr. Eric Topol at #SHSMD14

Posted on October 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


Patient care will eventually win, but sacred cows still have a lot of fight in them.


I’m still chewing on this one. I definitely love the idea of remote visits. Not sure it’s the smartest patient room.


This trend is definitely happening. Although, if you sound out Iwwiwwiwi, it sounds a lot like whining. I’m not sure that’s a good thing. Either way, I think the market is going to push towards on demand medicine.


I’d love to hear more about this topic. I think the first step is identifying the real cost problem. Seems like these top drugs could provide a really good start.

Which Comes First in Accountable Care: Data or Patients?

Posted on September 30, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The headlines are stark and accusatory. “ACOs’ health IT capabilities remain rudimentary.” “ACOs held back by poor interoperability.” But a recent 19-page survey released by the eHealth Initiative tells two stories about Accountable Care Organizations–and I find the story about interoperability less compelling than another one that focuses on patient empowerment.
Read more..

Rise of the Digital Patient Infographic

Posted on September 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The social people behind CDW Healthcare are doing a good job putting out some great content on social media. A great example of this is this Digital Patient Infographic that they recently posted:
mHealth_DigitalPatient_Infographic_0914_1000

I recently took part in a webinar with Dodge Communications (I’ll add a link to the webinar once it’s available) yesterday and I made the comment that telemedicine is more efficient for the patient, but I wasn’t sure telemedicine was more efficient for the doctor. There might be a disconnect of benefits there that needs to be reconciled.

As I look at the infographic above, I’m reminded of something similar. The stats in the infographic and just some basic common sense says how much patients would love to do an eVisit. If this is the case, why is it that healthcare hasn’t filled this customer demand? I think the answer is the disconnect of benefits.

What are your thoughts?

Also, since CDW created the infographic above, It’s worth mentioning that CDW also listed this blog on their list of Top 50 Health IT blogs for 2014. I’m not sure I agree that it’s the top 50 health IT blogs since EMR and HIPAA and a number of other Healthcare Scene blogs aren’t on the list, but there are a lot of great bloggers on the list just the same.

HealthTap Offerings Track the Evolution of Health Care

Posted on August 15, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

09-TAKE-ACTION-Customized-Checklists-HealthTap
Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.

4 Things Your Patient Portal Should Include

Posted on May 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Karen Gallagher Grant has a great blog post up on the MRA Health Information Services blog that talks about the ideal patient portal. She breaks it down into 4 things that a patient portal should provide:

  1. Information that is meaningful
  2. Easy access for patient review for data integrity
  3. Dashboard information about prescriptions that combine pharmacy information and clinical information
  4. Appointment scheduling

And 5 things she’d ideally like to see in a patient portal:

  1. Details about my next appointment
  2. Wellness tips
  3. Access to home health through telemedicine solutions
  4. Customized decision support via nationwide clinical data repositories
  5. Patient exchange of information

I found these lists really interesting, but I asked myself “Is this what we really want in a patient portal?

I think the number thing people want in a patient portal is access to a provider. Sure, it’s great to be able to access your paper records, your prescription history, your appointment list, and even some health information. Although the health information is never going to be as good as what Dr. Google can provide.

I was surprised that almost nothing (except the Telemedicine solution) talks about the patient portal being used to connect with the doctor. This is the most compelling reason for a patient to use the portal. They want to connect with someone. Notice the emphasis on the one, that means with an actual person. Yes, in many cases this can be the front desk, the biller, or the nurse, but patient portals see the most value when the portal is a way for a patient to connect to a person. Then, the rest of the resources become more valuable and used as well.

The problem is that most of the patient portals out there don’t do a good job connecting people. Although, maybe I’m just biased because of the Physia Connect messaging product we’ve developed and the docBeat messaging company I advise. However, seeing these two products helps me realize how beneficial it can be to make healthcare communication simple. Once we do that, it opens up whole new windows of opportunities.

Will Telemedicine Really Lower Costs?

Posted on May 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was talking with the mobile health lead at one of the large telcom providers recently and we had a good discussion about telemedicine and its possible impact for good or bad on healthcare. She asked a really good question, “Will telemedicine lower the cost of healthcare or just add new touch points?

The translation to that question is whether telemedicine will replace other healthcare costs or if it will just create new healthcare costs that never existed before. I should say that her feeling was that telemedicine would end up lowering costs, but the question is well worth asking. In fact, even if the answer is that telemedicine will lower healthcare costs, there are many on the payer side of the equation that aren’t as confident.

The reality is that a telemedicine visit likely could raise costs. The idea of having to uproot yourself, go to the doctors office, wait in the waiting room, wait in the exam room, etc is a really big deterrent that stops many of us from going to the doctors. The idea that I could click on a link and see a doctor from the comfort of my own home with no wait times (or at least I’m waiting at home where I can get other things done) will definitely cause us to see the doctor more often.

This means that the real question isn’t whether telemedicine will increase the number of visits to the doctor (and more visits equals more costs). Let’s assume that we do see the doctor more often in a telemedicine enabled world. This then begs the question of whether these extra visits will reduce the long term costs of healthcare.

Using our assumptions above, it suggests that we’ll visit the doctor earlier under telemedicine than we would today. Could these early visits catch a disease earlier? Could these early visits avoid a hospitalization or other expensive healthcare cost? Could early treatment of an issue prevent someone from having a visit (or dozens of visits) later? Looking at it from a different angle, can telemedicine make a doctor more efficient?

This impact won’t likely happen immediately, but is the long term hope of what telemedicine can become and how it could lower healthcare costs. I personally lean towards telemedicine being able to realize these goals. Although, we won’t know until we figure out the way to reimburse a doctor for a telemedicine visit. Not to mention overcoming the physician licensing issues with telemedicine. Each of those will happen though and then we’ll really know if telemedicine lowers the costs of healthcare or not.