Telehealth: The Cost-effective, Convenient Future of Healthcare

Monday, November 16, 2015

David J. Fong, PharmD

After returning from the NACDS Total Store Expo and spending time with retail pharmacy executives on their vision of “Healthcare in the Future,” I am increasingly more convinced that telehealth and remote healthcare will become more common and cost-effective as technology continues to improve and healthcare records become more digitalized.

We all have heard and read that the current healthcare ecosystem is severely impacting the U.S. economy. Healthcare spend continues to grow – the forecast is that it will increase to 30% of GDP from the current 20% by 2050. Readmissions of Medicare patients cost over $26 billion annually, nearly all of which could be saved if patients were receiving proper care during and after their first visit. The Affordable Care Act (ACA) is driving greater access, affordability, and coordinated care, while consumer centricity driving health and wellness initiatives to address growing deductibles. There is a need to better manage chronic conditions – today, 1 of out every 2 people have at least one chronic condition, while 25% of the population have multiple chronic diseases. Finally, providing services to millions of patients in remote locations who lack access to hospitals, clinics, pharmacies, and other healthcare professionals account for almost 20% of the healthcare spend who live in rural areas.

Telehealth as an enabling technology platform potentially can target 5 key markets:

  1. The underserved
  2. Elderly and caregivers
  3. Persons with chronic disease
  4. Employees and dependents
  5. Fitness-oriented individuals

The value to the healthcare spend is that this platform can help:

  • Reduce hospital readmissions
  • Create better patient engagement and virtual house calls
  • Provide patients with convenient and timely access to doctors and other healthcare professionals
  • Enable the elderly and physically challenged to obtain regular healthcare series without leaving the home
  • Address the physician shortage and growing demand for healthcare
  • Improve medication adherence
  • Meet consumer demand
  • Improve delivery and access to care in rural communities

Why hasn’t there been mass deployment of telemedicine in the U.S.? After all, there are pockets of success: Europe has been using telemedicine for a while. It’s also provided to workers on oil rigs, astronauts in space, and Native American communities in Alaska.

Slow adoption of telemedicine comes from a lack of reimbursement by payers; licensing issues, especially regarding multistate systems and practitioners; barriers with regulatory agencies such as the FDA, FCC, etc.; systems and technology barriers on use of telemedicine and telehealth that limit certain providers; unavailability of services and technologies access in many geographic areas; pending regulations to address patient safety and privacy concerns; lack of knowledge and acceptance by consumers; workflow implications to healthcare professionals; and developing a business model that returns a favorable capital and operational expense investment.

So what has changed that will promote greater adoption of telehealth?

Government is now taking more of a direct advocacy role in telehealth technology and encouraging healthcare supply chain adoption. Early indicators include greater funding; encouraging federal, state and private payer reimbursement (42 states allow reimbursement through Medicaid or private payer services); removing the barrier of multi-state licensing required for doctors in one state to treat patients elsewhere; and introducing disincentives that penalize hospitals for too many patients being readmitted within 30 days of discharge.

Sounds great since the desired outcomes of telemedicine are obvious:

  • It’s good for patients, who can enjoy better health, share in their healthcare decisions, and manage their expenses cost effectively
  • It’s good for the industry, leading to overall cost-effective healthcare
  • it’s good for physicians and other healthcare professionals, enabling them to focus on delivery of optimal medical care
  • It’s good for healthcare practices, since it will align practitioners and foster collaboration and working toward the single goal of delivery of optimal patient care
  • It’s good for payers and employers, since it will help mitigate the growing healthcare spend and growing concerns that healthcare costs continue to outpace operating profits

What will it take to increase adoption?

Telehealth involves new technology, which inherently means implementing interoperable health information technology standards for clinical data exchanges. It requires new relationships and collaboration amongst providers of care and creates new practices, from virtual coordination, to managing and using data for clinically actionable information. It also requires the development of technology-enabled chronic disease state management models outside of large healthcare organizations; capital investment and ongoing expenditures; and enhanced processes to address patient safety, confidentiality, and liability.

As telehealth continues to grow and integrates into the healthcare supply chain, pharmacy needs to have a “seat at the table” and define its role.

Pharmacy is strategically positioned to play a very significant role in telehealth, leveraging access, affordability, and the value of its pharmacists and its services. Beyond just dispensing prescription drugs, pharmacies can offer convenience of location and access to patients, a holistic approach and delivered offerings to address prevention, screenings, medication therapy management, and diet/lifestyle. It’s important that pharmacy contributes to the continued development AND implementation of the telehealth “blueprint” and “roadmap.” Further recognition and acknowledgement of the expanded and coordinated care role of the pharmacy and pharmacists includes achieving provider status in many states, and hopefully soon, at the federal level.

More to come as the telehealth story continues to develop …

David J. Fong, PharmD, is president of Dave Fong Rx Consulting, Inc. As a former senior retail pharmacy executive for Fortune 100 and Fortune 500 companies, he is recognized as one of the U.S. and Canada’s business and professional healthcare leaders, leveraging his knowledge and experience working with pharmaceutical manufacturers, distributors, retailers, payers, and healthcare technology companies to bring value to the industry and the consumer.

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