By Chau Hoang, Director of Development, Denniston Data Inc.
According to Centers for Disease Control and Prevention (CDC), “Telehealth is the use of two-way telecommunications technology to provide clinical health care through a variety of remote methods.” (Lisa M. Koonin, et al., 2020). Simply speaking, it is a collection of means to enhance healthcare patient delivery covering different domain applications: two-way audio-video communications/Live Video, Store-and-Forward, Remote Patient Monitoring, and Mobile Health or mHealth (Center for Connected Health Policy, 2021). Telehealth has been around for quite a long time and has ramped up by about 5-10 years in the space of 6-9 months because of Covid-19. Everyone is talking about telehealth. Consumers and medical providers have more a favorable perception toward it. Regulations have been relaxed to expand its service and payment coverage in the telemedicine space during public health emergencies.
Digital health startups continue to receive substantial investments from private funding. Venture investors pumped $14.7B in digital health companies in the first half of 2021, surpassing all of 2020’s funding of $14.6B (Bill Evans, 2021). Apparently, telehealth is impacting healthcare industry positively in so many ways. Let’s take a quick look at the opportunities and challenges of telemedicine from different perspectives.
Access to health: Telemedicine allows patients to have better access to care, especially patients in remote areas who have no means of seeing a doctor. Telemedicine evolved more rapidly because of Covid-19 and is growing quickly in all areas such as primary care, behavioral care, dermatology, lactation, nutrition, etc. Think about seeing your doctor without leaving the house, when you need to be home the most, via any mobile device you are comfortable with. How cool is that? But how do employers and patients discern a provider’s experience level when not seeing a local doctor? Doctor finder services are available online, but ratings tend to be based on opinions. Provider Ranking System (PRS)was created to answer unique patient and employer needs, including those mentioned. PRS is objective and transparent, two crucial ingredients for evaluating a provider.
Cost efficiency: According to the Centers of Medicare and Medicaid Services (CMS), the National Health Expenditure was projected to reach 18% of the US gross domestic product (GDP) on healthcare in 2020.
Private health spending in the US is about 9% of the GDP (Statista, 2021). In the U.S., over 20% of overall medical care is unnecessary or harmful according to multiple studies in PubMed. There is much poor quality, ineffective care. Healthcare costs will be reduced significantly with telemedicine, for both consumers and providers, but only if care is directed by the right doctors. Doctors, with higher quality of care, do not incur the excess costs associated with inappropriate care or excessive utilization of services. PRS identifies providers based on their experience by procedure. Sending patients to the most highly qualified providers for their specific need, results in costs going down, while outcomes improve.
Improved quality of care: Many studies prove that telemedicine improves outcomes and quality of daily care delivery in many sectors, especially in mental health and urgent care. In addition to reduced transportation expense, overhead costs, medical providers are combining technologies with health coaches to help educate and monitor consumers on a variety of aspects such as fall risk, nutrition, etc., to reduce hospital readmission rate and improve quality of care.
Better outcomes. By adopting technologies such as wearable devices, real-time remote monitoring platforms, educational tools, providers can remotely manage chronic stable and non-life-threatening conditions while offering preventive care to deliver better outcomes to their patients and promoting population health. There are about 72,000 medical apps available on iOS and Android. Why don’t providers leverage these great tools to deliver better care to patients?
Alternative source of revenue streams. Providers can see more patients while getting reimbursed for almost the same amount, saving substantial overhead costs, and reducing infection transmission rate down to zero percent. Does it seem too good to be true?
Under the public health emergency declaration, CMS has expanded its Medicare telehealth services to pay for telehealth across the country. While several current procedure terminology codes (CPT codes) are made permanent for telehealth coverage, some are set on a temporary basis and some other restrictions on telehealth such as coverage, licensure, credentialing, geographical limit, etc. may be reinstated once the public health emergency ends. Many states, including Washington D.C., have adopted or partially adopted telehealth parity law. According to the Center for Connected Health Policy (2021), there are two types of telehealth parity requirements: one is ‘service parity’ that requires “the same services be covered via telehealth as would be covered if delivered in-person”, and the other is ‘payment parity’ that requires “the same payment rate or amount to be reimbursed via telehealth as would be if it had been delivered in-person”. It is important to know how your state medicine policy compare to other states, which is the state having the best telemedicine policy and which is state imposing barriers for telemedicine access. According to the American Telemedicine Association, it “has released its 2019 State of the States Report: Coverage and Reimbursement, a wide-ranging analysis of telehealth laws and policies across all 50 states and the District of Columbia. This comprehensive, state-by-state analysis includes a review of how patient settings, different technologies, and provider types are treated across the country, as well as detailed information on the unique policies dictating reimbursement and coverage of telehealth services in the U.S” (2019). Well, how about license immunity? This is the result of a significant effort to reduce barriers to healthcare practitioners to provide immunity from tort liability claims (except for willful misconduct) under the Public Readiness and Emergency Preparedness Act (PREP Act) (Harris, 2020). Is it a complete shield for medical providers across all states and jurisdictions? The common answer I have heard so far from many insurance program administrators is no. Healthcare practitioners can still be sued for negligence during Covid. So you want to be up-to-date on rules and regulations of your state.
Digital Healthcare Insurance
As we talk about digital health solutions, here comes the digital healthcare insurance. Does it sound a little bit strange to you? Traditional health insurance products such as general liability insurance, medical malpractice insurance, and cyber security liability insurance, etc. have been built to fit the in-person care delivery approach for years. Are they still applicable in the world of digital health? Maybe not completely. The adoption of technologies and wearable devices in telemedicine introduce some emergent risks such as technology, cyber security, copyright infringement, and patient data privacy control risks. So how does traditional health insurance industry cover these emergent risks? As for telemedicine practitioners, it is essential that you re-evaluate your digital care delivery process and discuss with your insurance company for the best coverage.
In addition, virtual-first health plans have just come into existence; however, these plans start gaining attention among employers, payers, and brokers due to its affordability and convenience care options. It’s one of the digital “front door” solutions that allows patients to quickly and easily access a virtual primary care doctor that then directs them to in-person care as needed (Tashnek, 2020). Insurance companies such as Kaiser Permanente, Oscar Health, and UnitedHealthcare have already started virtual-first health plans early this year (Murphy, 2021).
Like the traditional health insurers, digital health insurers are under high pressure to adopt evidence-based physician ranking methodologies. According to Texas Medical Association (2021), current cost-ranking physician profiles are not “scientifically sound and are poor indicators of the quality of care provided to patients.”  PRS brings transparency into physician profiling by providing evidence-based data of practice experience of over one million US doctors with ranking comparisons by services performed in specific medical procedures, along with list price and allowable cost, trends, and rate of repetition.
Telehealth is on the rise
Telehealth is carving out its niche and will become an integral part in the healthcare delivery arena, complementing existing avenues including urgent care centers, emergency rooms, office visits, medical referrals, etc. Healthcare consumers are becoming more sophisticated. They want to make decision about care in an informed and thoughtful way while staying within their budget. Insurance companies have introduced online pricing tools and cost estimator tools in response to tremendous pressure to cut costs and price transparency laws. How is it reflected in telehealth? How can we enable transparency in telehealth to drive more values to its users? This is where Provider Ranking SystemTM (PRS) comes into play. We offer a pathway to transparency and high-quality and cost-efficient care in telehealth. First, users are no longer limited their choice of medical providers to those locally. Instead, they can choose the top performing providers for their specific condition, from anywhere across the country, with the integration of PRS into current telehealth solutions. Second, cost of care transparency offered by PRS allows (1) employers to better manage medical costs while improving care for their employees, (2) employees to collect real information on list prices, allowable amount by Medicare, and practice experience data of providers to get high quality and cost-efficient care, and (3) providers to get the recognition they deserve. Third, (3) an evidence-based database of providers’ practice experience by procedures on PRS is vital to the in-house vetting processes and physician ranking methodologies of health insurers, both traditional and tech-focused, and telehealth service providers.
Many research and peer reviewed studies show that high-performing doctors produce better outcomes and cost less. Integrating evidence-based data of doctors’ practice experience like PRS into virtual health delivery platforms or health insurer’s provider network management system makes it easy for patients and professionals to find and access the best provider for their needs when and where they need the most, and at a more affordable cost.
How can I be a resource to you? My name is Chau Hoang, Director of Development at Denniston Data Inc. You can email me at firstname.lastname@example.org or reach me at (361)-462-2646 or connect with me on LinkedIn at https://www.linkedin.com/in/chautranminhhoang/. I’m happy to help.
Disclaimer: The information contained in this article is provided for informational purposes only, and should not be construed as legal advice on any subject matter.