It was a simple follow up office visit to ensure my son’s prescription acne medication was working and there were no side effects. The dermatologist was running late and a quick visit turned into an afternoon affair. The feeling of wasted time was compounded when the doctor informed us that the appointment had been scheduled too soon after the medication had been prescribed to make an evaluation. “Could we do this by webcam?”, I thought to myself.
Within a week of the wasted afternoon, the Commonwealth Fund released a review of telehealth or remote patient monitoring and I received emails from Anthem Blue Cross and Blue Shield of California announcing their telehealth plans.
Telehealth or remote doctor-patient communication either by phone or webcam is nothing new. With the impending launch of the Affordable Care Act allowing millions of more people access to a doctor, insurance companies and hospitals are exploring new ways to filter folks through the healhcare system. Consequently, consulting with patients with non-medical emergencies over the phone or internet is gaining steam.
Telehealth had wrong price point
To be honest, I have been approach by different telehealth companies wanting me to sell their service to families and small employer groups. When I looked at the monthly fees of $20 to $40 per month for phone consultations, I didn’t see the value proposition for the client. It struck me that this would be a far better benefit for the insurance companies to include in their plans. On a large scale, the Commonwealth Fund review does illustrate the cost savings of implementing a telehealth program.
Commonwealth Fund Review
Scaling Telehealth Programs: Lessons from Early Adopters [download id=”43″]reviews three large scale telehealth or remote patient monitoring programs undertaken by the Veterans Administration, Partners Healthcare and Centura Health at Home. The big hope for telehealth was to better manage chronic medical conditions in an effort to keep patients healthier and reduce visits to a clinician as often for consultations.
Over a four year period, 2004-07, the VA was able decrease the utilization of on-site services of patients anywhere from 20.4% for diabetes patients to 30.% for those with hypertension with the use of telehealth chronic disease managment monitoring. The VA now has over 70,000 patients receiving telehealth-supported care managment in 2012.
In 2006, Partners Healthcare in Boston started the telehealth Connected Cardiac Care Program (CCCP) pilot study.
To date, more than 1,200 patients have been enrolled in CCCP. The program has consistently experienced an approximate 50 percent reduction in heart failure–related readmission rates for enrolled patients. Non–heart failure readmissions have declined by 44 percent. CCH’s in-house analysis estimates that the program has generated total cost savings of more than $10 million since 2006 for the more than 1,200 enrolled patients.
Centura Health at Home of Colorado merged an existing clinical call center with remote monitoring telehealth system.
A one-year pilot of the integrated program in 2010–2011 demonstrated successful outcomes in terms of reducing 30-day hospital readmissions and home nursing visits, while improving quality of life and patient self-management and education.
Over the course of the year-long pilot, 30-day readmission rates across the three targeted conditions were reduced by 62 percent. Emergency department use decreased from 283 visits in the prior year to 21 visits after one year, and the frequency of home visits was reduced to an average of three visits over a 60-day period from an average of two or three visits per week prior to the implementation of the intervention.
Affordable Family Telehealth?
This all looks promising, cost saving and wonderful for those with chronic diseases. But what about families that have sick little kids that get sick or that icky rash on your arm. Anthem Blue Cross released the following press release:
will make virtual doctor visits a reality, January 24, 2013
Our parent company plans to begin rolling out in stages a new online care service that will let members connect with a doctor using a computer webcam or video-enabled tablets and smartphones. Some people call this a “virtual doctor visit.” Others refer to it as a “remote consult.”
No matter what you call it, this innovative solution promises to enhance access and affordability and change the way doctors interact with their patients.
For our members, it will offer a convenient and secure way to reach board certified, credentialed primary care doctors on demand, 24/7. For someone seeking non-emergency medical attention, it will be a flexible and sensible alternative to waiting in a crowded emergency room or urgent care center. And it’s likely to cost less than many face-to-face visits.
We will be among the first insurers to incorporate such an online care solution as a covered benefit in our health plans. Rollout is targeted to occur in stages, with an initial phase starting sometime over the next several months. The exact timing in each market depends largely on state regulatory approvals. So please stay tuned for more news to come in the future about LiveHealth Online.
LiveHealth isn’t live just yet, but it is significant that Anthem is creating pathways to accommodate more member requests for health services while trying to keep them out of the expensive emergency rooms, urgent care, doctor offices, or clinics. They are also focusing on the urgent care aspect as opposed to the routine follow-up appointments, which would seem to be an equal cost saver. As if not to be outdone, I received this email from Blue Shield of California regarding their partnership with Teledoc.
I am not sure if Blue Shield is rolling this out to all plans or just the one I happen to be associated with. When I called to set up an account, I was told there would be a $12 fee to populate the medical information. If that is a one time fee and there are no monthly fees associated with the service, then it might be a good deal for families especially if they have numerous little ones.
But there are other settings were telehealth, if structured properly could be advantageous: Assisted living centers, day care centers, group homes and the “man cave” where middle-aged men reside and never venture out to see a doc. While no one is suggesting a webcam consultation for the treatment of acne, I pray that it will come sooner rather than later.