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Next year could be a watershed year for telehealth. Currently, use of telehealth in the U.S. health and human service delivery system could be described as “sporadic” and “uneven.” Earlier this year, we looked at the adoption rates and they are very low – The Telehealth Numbers Are In – And They Aren’t Too Impressive. These data are reflected in the SERMO survey that found that only 15% of U.S. physicians thought their state was doing a good job with telehealth, and 44% called telehealth implementation outright poor (see U.S. lags on adoption of telehealth, according to over 3000 international physicians).

But it may be employer health plans that move the needle on telehealth. Employer-sponsored health plans currently cover over half of the non-elderly population (150 million consumers) and is 19.9% of total spending (see Trends In Employer-Sponsored Insurance Offer And Coverage Rates, 1999-2014 and National Health Expenditures 2015 Highlights). And, it appears that in 2018 those employer health plans are making significant changes in telehealth coverage. According to the recently released Large Employers’ 2018 Health Care Strategy and Plan Design Survey, almost all employers (96%) will make telehealth services available in states where it is allowed next year ( see Large U.S. Employers Project Health Care Benefit Costs to Surpass $14,000 per Employee in 2018, National Business Group on Health Survey Finds). And, more than half (56%) plan to offer telehealth for behavioral health services, more than double the percentage this year. Telehealth utilization is on the rise, with nearly 20% of employers experiencing employee utilization rates of 8% or higher.

And large health systems are responding. In a separate survey, the Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey, reported that 76% of U.S. hospitals and health systems either have in place or expect to implement a consumer telehealth program by 2018. And, that 69% of organizations that currently have consumer telehealth programs are planning to expand their offerings (see Telehealth Adoption To Double By 2018).

I think the widespread adoption of telehealth – along with value-based reimbursement – will be one of the ultimate disruptions of “business as usual” in health and human services. Value-based reimbursement (VBR) changes the fundamental business model of provider organizations by shifting away from rewards for “volume” (see The Business Model Transition To Value-Based Care and The Value-Based Reimbursement Steeplechase).

But while VBR may change the provider organization business model, telehealth represents the ultimate “outsourcing” of core services. In the past, outsourcing (defined as contracting work out or abroad) was about subcontracting – another entity providing services in your facility, such as maintenance or dietary services. But, technology (the internet, the cloud, and more) eliminates the need for co-occurring physical presence of service provider and customer. This, in turns, expands the universe of potential service providers beyond traditional borders whether county, state, or national. Suddenly, physical presence isn’t required for competition or for the delivery of services.

This looming presence is what Amazon was to bookstores a decade earlier – the competition that is virtual but not in the community. Amazon didn’t kill entire categories of retail solely because of lower prices (though that was a factor). It changed the way people thought about shopping. Because of Amazon, I go to physical locations much less frequently. I expect my other on-line retailers to be prompt in getting me my purchases. I expect to be able to easily access pricing information. I expect the retailer to “remember” my preferences and purchase information.

Slowly and surely, I think telehealth will change the way consumers think about getting health services. Consumers will likely use the physical on-site services less frequently in favor of more on-line services. They will expect convenient “on-demand” services, price transparency, and easy payment processes (even for complicated copayments and deductibles). This isn’t a world of “virtual” health care, it is a world of tech-enabled health care where the service delivery system is a seamless hybrid of physical and virtual services. It reminds me of the 2011 presentation at The 2011 OPEN MINDS Institute for Behavioral Health Informatics, by Nancy Green of Verizon, “Expanding Our Thinking About Virtual Care: How mhealth & Telehealth Can Shape The Behavioral Health & Social Services Landscape” – and her concept of “any time, any place continuous and personalized care.” (see Any Professional, Any Program, Any Device, Anywhere). It’s a tall order but some organization is, eventually, going to do it.


Autor(en)/Author(s): Monica E. Oss

Quelle/Source: Open Minds, 01.09.2017

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