Telehealth

As American health care shifts from the fee-for-service, disconnected health care to value-based, holistic care, an alignment between providers and total cost of care should encourage the use of telemedicine—especially in cases where it has been shown to reduce costs and improve individual care and population.
The CMO of Teladoc, one of the country’s largest telemedicine providers, certainly knows how to sing the praises of the industry, and handle devil’s advocate kind of questions as well. Most of Teledoc’s customers are commercial insurers and employers. Medicare? Not so much. Medicaid makes “perfect sense.”
One area where more research is needed is on programs that mix telemental health with traditional treatment, because in many instances a combination of the two will work better than a steady diet of either. The use of telemental health as an alternative or a backup needn’t be saved for emergencies.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
What we have here is irrational telehealth exuberance. Investors are plowing millions into startups. And even though millennials could be eager adopters, these are still early days for the industry. It may take years—and some regulatory changes—for profits to materialize.
Telemedicine consultations can improve the quality of care in local hospitals, possibly reducing the necessity of transfers to hospitals with higher levels of care, according to a study in Mayo Clinic Proceedings. Helicopter transfers to higher-level neonatal intensive care units would have cost anywhere from $12,000 to $25,000.
Workers still haven’t bought in. A lot hinges on this question: Do you feel comfortable getting a diagnosis or being treated for a condition by someone on a screen? Large employers especially are willing to bet that the answer is yes.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
The Hippocratic oath says, “First, do no harm.” The early 21st century push to make health care more convenient seems to add, “and make it snappy.” Retail clinics are perhaps the most prominent and market-proven aspect of the move to convenience. But there are many variations on the theme.

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