Modern medicine has certainly expanded beyond the town physician who makes house calls and perhaps even accepts trades of goods or services for care. Today’s physician manages a much larger patient load and vastly more complex systems of compensation. With the kinds of technology now available to physicians, telehealth programs seemingly offer the promise of reaching more patients while still maintaining the value of interpersonal interactions championed by the town physician.
Most people probably think of telehealth in terms of video telephony, where a physician can remotely see and hear a patient to help make a diagnosis. But with the expanded usage of apps, wearables and other technologies it has been necessary to adopt a more comprehensive enterprise view. According to Oscar Health, telehealth usage was up as much as nearly 32 percent in 2017 for some health plans and nearly 20 percent of employers have telehealth utilization rates of 20 percent or higher. With this expansion has come more information than ever before, which can be overwhelming and even difficult for health plans and other entities as they strive to harness the power of this data in an efficient manner.
As the laws that regulate telehealth change and the entire healthcare industry increases its focus on value-based care, health plans are now devoting resources to the development of what is often called “enterprise telehealth strategy” or “comprehensive virtual care delivery.” Companies like Centauri are working with both health plans and providers to manage these complex data sets and support enterprise telehealth strategy development by focusing on three main care categories: urgent care, chronic illness and behavioral health.
By integrating data reported by medical and pharmacy claims, financial data, census data and geographical data, patients can better connect with community programs and resources inclusive of telehealth. Through telehealth initiatives that use social determinants of healthcare as the basis for their design, health plans can help their members increase accessibility and usability of care. Of course, the success of these new tools is contingent upon having both complete and accurate data, and the ability to use and access it in a meaningful way. For example, we often associate “insufficient access to care” and its effects on care quality and health outcomes as an issue exclusive to rural areas. But the data suggests otherwise: Between one-quarter and one-half of medical spending is not associated with improved health. Even in suburban and urban areas where there are more care settings and seemingly an urgent care clinic on every corner, the population is not accessing them.
Moreover, estimates suggest that unnecessary medical care costs the typical American family thousands of dollars per year no matter if they are rural, suburban or urban. We have the ability to help reverse that trend by helping health plans and other entities access and use their data meaningfully.
Incorporating a social assessment along with standard health risk assessments (HRAs) could help determine which members might benefit most from telehealth.
For example, Dermatology Times reported there are less than four dermatologists per 1,000 people in the United States, and average wait times to actually see one can be as long as three to six months. Even more astonishing is the more than 75 percent of US counties being classified as mental health shortage areas, where wait times to see a psychiatrist for the first time average 45 days. It may come as no surprise that 76 percent of patients prioritize access to care over the need for in-person interaction with a healthcare provider.
Understanding how to access and use medical and pharmacy claims and financial, census and geographical data to develop cost-effective and quality, population-specific initiatives depends on robust analytics. By more closely incorporating social determinants of health, telehealth services can provide a better quality and more cost-effective experience — for the patient and the provider.
Dawn Carter is Director of Product Strategy at Centauri Health Solutions.
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