The next generation of healthcare visits — New opportunities with Telehealth 2.0


Over the past few centuries, healthcare has moved from the age of modern medicine with the house call to the centralized mean of production at clinics and hospitals. Patients wait in line to see medical specialists and the process becomes inefficient. But telehealth is changing that.

"Now we have the opportunity to be truly innovative; to combine efficacy, efficiency and convenience in telehealth," said Jeff Kosowsky, MD, PhD, SVP, Corporate Development at American Well in a webinar titled "Telehealth 2.0: From Z-Pak to Impact."

Telehealth is a new area; only a small percentage of people have tried it but 64 percent of people said they are willing to see a physician via video. Among providers, 57 percent say they are open to seeing patients via video.

"What this has become, from telehealth 1.0, it has become the first line of defense for urgent care. No need to rush to the emergency room and pay a large copay; no need to try to squeeze in the urgent care before it closes or catch your doctor," said Dr. Kosowsky. "If you have a question that can be answered from the convenience of your home, you can do it via telehealth."

Telehealth can be on the go, online, onsite or over the phone, and emphasizes consumer choice. Patients can choose a practice, physician and where the medicine is picked up or delivered. Patients can use PCs, tablets or phones as well as various kiosks to reach providers.

"We prescribe online about the same percentage of what happens in traditional urgent care offices, but the resolution is often a quicker," said Dr. Kosowsky.

The technology also allows provider-to-provider connection that can inject a specialist into a primary care visit, virtual rounds or specialty expertise in remote locations. Z-Pak works with Apple Health to leverage biometrics; patients choose which data to share with the telehealth encounter and spread the information to their providers.

"It allows for expanded specialties and specialists, so just like a multispecialty physical practice where one might go for a prenatal visit, one might go for labs or one might go for pediatrics, we have a multispecialty virtual telehealth visit where the patient can choose between multiple specialties and then choose a provider there," said Dr. Kosowsky. "Telehealth 2.0 also enables chronic disease management by focusing on use cases."

An expert panel also contributed to the webinar. The panel included John F. Jesser, vice president of provider engagement strategy for Anthem; Deanna Larson, senior vice president of quality and eCare at Avera Health in Sioux Falls, S.D.; Peter Antall, MD, chief medical officer of American Well and medical director of Online Care Group.

"We needed to support our patients with specialists such as cardiologists and pulmonologists as well as support their emergency services. When we went into this, we really were trying to find a resource or care delivery model that would support providers and rural geography; really equalize the level of care that was being actualized in communities the size of 5,000 to 10,000," said Ms. Larson.

As an early adopter, Avera Health was able to connect with patients and provide transportation to the regional centers if necessary or provide support to the local locations if providers at their community hospitals and clinics could provide the appropriate care.

"We have been successful enough that we have been able to make a separate business out of these types of services and today we are in 10 states across the U.S. providing our services in a vendor relationship subscription model that really helps other rural geographies experience the same kind of care delivery," she said.

However, technology and the regulatory environment are roadblocks. Live video streaming has the best quality access for patients where providers can see their patients and talk face-to-face. In the beginning, people needed a computer with a video camera, but now most people have smart phones with a camera built in.

Additionally, each state has rules about how medicine can be practiced online and over telehealth. However, Mr. Antall and his team was able to educate state medical societies about the potential of telehealth and American Well technology is now live in 47 states around the countries.

"When it comes to barriers, the main and largest barriers are by and large falling away," said Mr. Antall. "Reimbursement is still a little bit of a work in progress. John has been a real advocate for telehealth reimbursement and I would argue that Anthem led the country here in this regard. A lot of reimbursement policy trickles down from Medicare, but Medicare has been really stuck on telehealth based on the laws that exist and require an act of Congress to modernize. Anthem and some other companies that followed suit led the way to commercial insurers and we are moving into a place where this is by and large a reimbursable event if you tick the right boxes."

There are a lot of physicians frustrated with the current state of practicing medicine and signing up for telehealth. Providers are already busy in many cases and used to doing things in one way. Patients spend hours in waiting rooms but providers walk from room to room and there is a patient waiting for them; the system has been built around provider convenience and now is changing toward patient-centric care.

"Providers are going to be subject to value-based contracts and they are going to need to change. It will no longer be a matter of doing things the way you always did them. Providers are going to need to be more cost effective and find ways to increase their touch points with their most ill patients and be more proactive and productive to keep them out of the ED and inpatient wards," said Mr. Antall.

Anthem is working with bread-and-butter primary care practices to enable them with telehealth tools and live health online. As of January, it includes live health psychology where social workers and therapists offer therapy from the convenience of their home.

"What we are doing is working with practices to enable them to do more than after-hours care. Oftentimes the providers in patient-centered medical homes or these ACOs these groups are either at risk or in a gainshare and they are interested in not having their patients wind up in the ER just because their provider finally had to go to bed and couldn't be around the clock," said Mr. Jesser. "They want to convert a telephone call after hours into a telehealth visit that's reimbursable, which is good for the practice, knowing if they do go to bed, there are physicians online available so their patients will see a board-certified doctor who isn't interested in seeing the patient and they're able to see the patient record in the morning."

The practice can use it for care management, schedule care managers with chronic care patients, use diabetic educators through live video and other activities with this tool. Busy practices can start scheduling telehelath visits for patients in addition to the clinic rooms if they have some capacity, allowing the physician's partners or extender to see patients.

"We think in the future patients are going to look for practices that have these capabilities," Mr. Jesser said.

But telehealth isn't in its final iteration; it will continue developing in the future based on patient needs.

"I really see over the next five to 10 years that telehealth will be not just a mainstream way of receiving urgent care in the home but a mainstream point of care, a normal way medicine is delivered just like the telephone and other modalities are used today. Really what we are going to see, as we build out these programs and patients come to realize this is available to them, as providers in rural settings or in step down units or elder care facilities realize they can access specialists and support electronically, we are going to increases in efficiency and improvement in access to the allied health provider who can support patients wherever they are or providers who need a hand," said Mr. Antall.

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