By Eric Wicklund, mHealth Intelligence | April 15, 2019
The business of telehealth can be tricky, to which far too many mHealth startups and hospital-based programs would attest. As the nation’s healthcare ecosystem shifts into a value-based model, the challenge for providers and payers is to find the right definition for value.
As the American Telemedicine Association’s 2019 conference and exhibition kicked into gear Sunday in New Orleans, words like “value” and “cost” and “sustainability” were on many lips. From the opening plenary to education sessions on topics ranging from direct-to-consumer telehealth to telepsychiatry, much of the talk centered on how to make connected health work like a business.
“We know telemedicine works,” Andrew Watson, MD, MLitt, FACS, UPMC’s Vice President of Clinical Information Technology Transformation and the ATA’s outgoing president, told a crowded auditorium during Sunday’s opening plenary. But it isn’t catching on quite like it should.
“We have to look at the macroeconomics of this,” he said.
To Elizabeth Teisberg, PhD, executive director of the Value Institute for Health and Care at the University of Texas-Austin’s Dell Medical School and the McCombs School of Business, the problem may lie in the currency used.
“Price is what you pay, (and) value is what you get,” she said, quoting Warren Buffett. “And the core problem is we’re not getting enough health.”
By all rights, Teisberg said, the US should have the finest, most efficient health system – but it doesn’t. Costs are way up and outcomes are way down. Providers are locked into what she called a “dysfunctional competition,” battling over market share and bargaining power.
The nation’s health system, Teisberg said, should be placing more value on health. Value is created when someone’s health improves, rather than when costs are reduced or workflows are improved (though those are pretty important, too).
“If you’re not improving outcomes, value is zero,” she added. “And if you’re doing harm, value is negative.”
Teisberg’s point is that providers aren’t asking the right questions about value, and so they’re pursuing the wrong goals. Instead of asking patients to rate the health system, she said, patients should be asked how they’re doing. Were their needs met? Are they feeling better?
“Healthcare spelled as one word means treatment,” she said. “But we don’t really want more treatment. We want more health.”
That philosophy was echoed by Mike Phillips, MD, chief of Clinical and Outreach Services at Intermountain Healthcare, one of the nation’s largest health networks and a leader in telehealth and mHealth implementation. Noting that roughly 40 percent of the health system’s patients are in managed risk programs, he said providers are coming around to the idea that value lies in outcomes.
“Cost is a great way to think about health,” he noted, “because healthy people are cheap.”
There are also many ways to measure value, Phillips added.
As an example, he talked about a time that he’d listened in as Bill Beninati, MD, Intermountain’s medical director for critical care telehealth, used a virtual care platform to visit with an 80-year-old farmer who’d hurt his leg and had been driven to the hospital – a rural hospital in Utah – by his wife. Beninati talked with the farmer and his wife for a while, Phillips said, then discussed the care plan with staff at the Utah hospital.
By the end of the virtual visit, Phillips said, Beninati had listened to and helped both the farmer and his wife, then had guided hospital staff into a care plan that they could carry out, reassuring them that the patient would remain there and not be transported to another hospital.
“High-value, relationship-centered care,” Phillips pointed out. “That’s the true value of telehealth.”