If "location, location, location" are the three most important rules in real estate, then "convenience, convenience, convenience" may be the mantra in healthcare today.
Patients are paying more out-of-pocket for healthcare services than ever. They increasingly expect consumer value and better service for their dollars. Fewer patients, particularly those younger than age 60, are loyal to one practice. Instead, many patients would readily seek care elsewhere if it meant a same-day appointment or a shorter wait time. This expectation of care-on-demand is driving the growth of telehealth.
Live-video encounters that allow patients to stay at home and use a web camera to communicate are becoming popular. Still, while the market is rapidly growing, there are many issues that affect telehealth adoption in practices.
Here are the top five:
1. Rising patient demand
The telehealth technology that most patients are familiar with has been available for more than a decade, but with limited acceptance. Until recently, patient skepticism and a lack of widespread high-speed internet access has hampered growth. Today, as many as 74 percent of American consumers in a recent survey agreed they would use telehealth for certain types of appointments. Nearly three-quarters of Americans (73 percent) have broadband internet access at home and 77 percent own a smartphone. Consumer adoption of such technology and a firmly established consumer mindset are expected to grow the telehealth market from $572 million in 2014 to $2.8 billion by 2022.
2. Improving, but complicated, technology
While consumer telehealth technology has reached a tipping point, the same is not quite true for providers. Cloud-based telehealth platforms that require only a web browser and camera for providers to begin delivering care are available, but integration with their EHRs and practice management systems are not always feasible. As a result, providers must often toggle between monitor windows during a telehealth encounter to view the patient while charting. Fully integrated homegrown telehealth platforms are an option, but they demand both time and investments that not all practices can afford.
3. Growing payer acceptance
Affordability and financial compensation remain a major market issue surrounding telehealth. Reimbursement is still widely variable among commercial payers, and Medicare generally limits payment to telehealth delivered in rural regions, or within managed Medicare. Although commercial payers such as Anthem, Aetna, Cigna and UnitedHealth have partnerships with national telehealth providers such as American Well and Doctor on Demand, such agreements with individual practices are rare. Asking patients to pay cash for telehealth is a possibility, but those with insurance may reject the option even if the telehealth appointment is discounted more than an in-person appointment.
4. Solving the workflow puzzle
Perhaps the greatest telehealth issue facing practices is workflow efficiency. Many practices recognize that their patients want the convenience of telehealth, but they have neither the time nor the staff to effectively conduct online visits. Asking patients to schedule a telehealth appointment lacks the on-demand convenience patients desire. And, asking a provider to switch between an in person and a virtual visit is also inefficient and complex. It's not practical for most practices to pay a provider to sit at a computer and wait for telehealth patients to engage. Although few practices can currently justify that staffing expense, eventually there may be sufficient demand to have a full-time online provider who conducts online appointments and answers patients' questions between visits.
5. Approaching opportunity
Patients prefer care delivered by local provider organizations, rather than unknown clinicians. They are currently forced to weigh convenient access to an unknown provider with inconvenient access to a health system with a strong brand reputation. Therefore, healthcare organizations should have the upper hand when they start to offer telehealth. However, first practices need to determine if now is the right time to begin offering those services. The key is to start by defining the practice's telehealth goals and strategy.
For example, perhaps conducting on-demand online appointments for new low-complexity acute conditions is not feasible for a practice. Instead, scheduled telehealth visits could be offered for check-ins with high-complexity, high-risk patients. Such services would be easier for providers to coordinate and convenient for patients. This may be of particular value to practices involved in risk-based contracts. Conversely, practices that decide to conduct on-demand telehealth appointments might want to concentrate on younger, typically healthy patient populations in order to generate sufficient patient volume and revenue. Coincidentally, young single people and younger families were among the most frequent patients retail health clinic. Those same types of patients might also be attracted to the convenience and familiarity of telehealth services from their local practices.
Here to stay
The telehealth market is growing quickly. Regardless of a practice's telehealth strategy, earning physician acceptance is essential. A successful telehealth program usually needs a strong physician champion who is willing to motivate others, guide strategy, and oversee implementation.
Practices must answer numerous questions to determine the right time to begin testing the telehealth waters. Yet one factor is certain: If it's not now, it will be soon.
Nancy Gagliano, M.D., is chief medical officer for Culbert Healthcare Solutions