Reimbursement Concerns Slow Telehealth Advances, According to New Survey

| URAC Staff
doctor using a calculator for medical costs with VR icon diagram

While there’s growing excitement about telehealth applications among healthcare providers, lack of reimbursement is the “most significant” barrier to wider adoption, according to a comprehensive new survey released by the Center for Connected Medicine (CCM) and The Health Management Academy (HMA).

The survey report, Top of Mind for Top Health Systems 2019, includes the input of 44 executives representing 38 health systems. Nearly three-quarters (70 percent) cited reimbursement concerns as their main trepidation when looking at weaving telehealth into their service and business model.  Most health systems have not yet calculated a return on investment (ROI) for telehealth, according to the report.

Payer-providers, such as the University of Pittsburgh Medical Center (UPMC) and Kaiser Permanente, are best structured to demonstrate value in telehealth, according to URAC’s Industry Insight Report, Accelerating Telehealth Adoption: Telemedicine’s Role in the Volume to Value Journey. These organizations are demonstrating the value of telehealth in not only cost savings, but improved health outcomes, quality of care and patient satisfaction.

“Until we truly shift the national payment model to value-based and outcomes-based, we are much better positioned because we have both sides of the house,” says UPMC Telemedicine Executive Director Natasa Sokolovich.

There appears to be optimism in the broader community when it comes to a shift in the reimbursement model. While executives see the majority of funding for telehealth care delivery services coming from internal funding and patient co-pays in 2019, they believe the majority of funding will shift to government and commercial reimbursement by 2022.

Uncertainty surrounding the reimbursement issue aside, telehealth remains a factor in future planning for many healthcare executives, with 45 percent of respondents saying they expect a significant increase in percent of total care delivery provided through telehealth. Driving factors that have prompted health systems to continue developing and implementing additional telehealth services include increasing access, leveraging specialty services, and meeting consumer demand. Telehealth can be viewed as a cost saving initiative.

The survey report points to the new level of value that artificial intelligence (AI) and machine learning could bring to telehealth, although most of the healthcare executives interviewed are not leveraging these advanced tools. Data obtained through telehealth, specifically through remote patient monitoring platforms, “may help health systems implement more robust predictive modeling and preventative care,” the report states.

This type of real-world data from millions of patients can be combined into cohorts that provide longitudinal information to inform medical decisions on a personal basis, says Martin Kohn, M.D., former chief medical scientist at Sentrian and at IBM Research. An independent consultant today, Dr. Kohn created predictive analytic systems at Sentrian and he used big data to help design the Watson supercomputer to better support the work of practicing physicians.

Dr. Kohn, a keynote speaker at the Telemed Leadership Forum 2019, says he sees an “inevitable momentum” in how today’s telehealth and associated technologies are transforming healthcare to a personalized system that improves clinical outcomes while simultaneously reducing costs.


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