The Chicken and the Egg: Accountable Care Before Telemedicine

Telemedicine has never been more viable than it is today, thanks in part to the incredibly connected, data-driven way of the modern world.

Yet despite the promise and vast potential for telemedicine, it remains largely in the pre-adoption stages across the country, waiting for the first domino to fall that will allow it to revolutionize healthcare.

This is because modern medicine is billed according to access: fee for service is essentially fee for access. Telemedicine, by design, is supposed to increase access; without an emphasis on quality of care, and the actual outcomes for patients, telemedicine could actually compound the current problem of affordability, rather than saving lives as intended.

First Things First

The egg that needs to hatch before telemedicine can enter into the world and take up its place, isn’t a matter of generating enough demand, proving the technology, or training providers on how to interact with patients and information digitally. The problem is how to appropriately measure the value of care when, rather than patients coming to receive it, care comes to them remotely.

Fortunately, telemedicine helps put the onus on patients to adhere to recommendations, follow medication schedules, and share their personal health data. The explosion of apps and devices available to consumer wishing to monitor all manner of health metrics means even passive patients have the capacity to glean actionable information on themselves.

Accountable care is a two-way street: patients and their care providers both have a stake in positive outcomes, and the sophistication of the tools measuring outcomes means patients won’t be able to hide poor adherence from their doctors.

Paying for outcomes—actually benefitting from care, rather than simply being proximate to it—is fundamental to telemedicine. Absent accountable care, telehealth patients simply have more opportunities to go broke trying to get better, without the bother of leaving their homes to incur service-based fees. Putting the focus on outcomes would enable medical professionals utilizing telehealth to make the most of technology to simplify maintenance, empower patients to be more proactive, and fully realize the function of all the new health apps and devices so in vogue at the moment.

Prepped and Ready

Technology may actually be the smallest hurdle in the path of telemedicine. Modern medical students are learning that hands-on training involves not just patient interaction, but interfacing with digital devices, records, and communication tools.

Younger students, as digital natives, are naturally conditioned to instantly transition from a digital to face-to-face interaction, as has been documented in pilot studies at the University of Ohio and University of Cincinnati’s Nursing Schools. There, students online and on campus alike are integrating everything from hands-free headsets, iPads, seamlessly into their curriculum. Besides previewing the sort of digital task-management demanded in the field, this sets students up to handle the demands of on-going learning and technical skill-development throughout their careers.

The ubiquity of digital devices and records in modern hospitals ultimately means greater transparency: everyone, patients included, will have access to the same notes, recommendations, and medical history. The ease and power of digital documentation makes accountability almost a no-brainer; as the system become more interactive, a clear chain of cause and effect in medicine will be transparent.

Linking fees only to the positive effects—rather than to the treatment “causes” as is done currently—would eliminate waste, and put the emphasis back on results, rather than covering all bases: a net win for patients and providers.

Saving Lives and Money

Telemedicine is the natural extension of this cross-training on utilizing digital tools and information protocols. Just as a nurse and physician deficit nationwide is colliding with a rising population of elderly patients managing chronic conditions, medical students are learning ways to engage with more patients, more efficiently, through the tools of telemedicine. Their best chance of reaching more of this vulnerable population is to utilize these skills.

As the primary demographic demanding care, elderly and long-term care patients stand to benefit enormously from the ease and convenience of remote monitoring, virtual consultations, and distance care—but only if they are billed according to the quality of such care, rather than the frequency of service.

The net benefits of telehealth cannot yet be realized because they are still fundamentally at odds with current service-based models. Medical services are billed without respect to outcomes, and telehealth makes services more mobile. In the current system, that makes telemedicine little more than an efficient method for increasing billable services. To be meaningful, telemedicine needs and accountable care platform that ties fees to outcomes.