Total Health

Nov 19, 2020 - Nov 20, 2020, Digital Conference, Networking & Exhibition

Challenge what’s possible. Transform patient experience. Change lives

How sustainable is remote health at scale?

Remote health has proved its worth to the entire healthcare sector but sustaining and scaling it requires work from every stakeholder



With the crisis in healthcare resulting from COVID-19 also come opportunities.
 
One of these opportunities is the mass adoption of remote healthcare and a new appreciation of its many advantages for healthcare providers and patients alike.
 
But the pressing question is: Can this innovative model of care weather the post-pandemic future? After all, remote healthcare isn’t new and unsuccessful attempts have been made to scale it in the past.
 
The overriding feeling is that remote healthcare is here to stay, having proved its worth to providers, payers, pharma, digital health firms, and patients. So, what is so different this time?
 
Firstly, consumers are behind the wheel
Technology is driving a trend towards the ‘consumerization’ of healthcare, with patients holding an increasing degree of market power. Post-pandemic, remote healthcare is no longer going to be an optional offering by providers as patients will demand it, says David Sides, Chief Operating Officer at Teladoc Health: “People will be accustomed to the convenience remote care offered during the pandemic and will want to expand it because it allows access when they need it and can be cost-effective.” 
 
Importantly, providers are ready to listen to the desires of their consumers as many are on the same page as patients in recognizing the convenience and value offered by remote healthcare. “Three years of change has occurred in three months due to COVID,” says Sam Marwaha, Senior Partner and Managing Director at The Boston Group. “Reluctance to engage with patients remotely has been challenged and we now want to have eyes and ears on the patient at home.”
 
Secondly, the industry is being more innovative with technology
The combination of different technologies is creating new possibilities and driving more value from the adoption of remote healthcare, says Jennifer Esposito-Hockenjos, Manager of Process and Portfolio Management at The Janssen Pharmaceutical Companies of Johnson & Johnson.
 
“It's not just that telehealth is becoming available, but also capabilities like artificial intelligence (AI). This convergence of multiple different technologies is super important. It is what's different today and what makes this a really interesting opportunity – to bring all those different technologies together at the same time.”
 
And it seems we are only scratching the surface of what will be possible. The technology for integrating new visual ways to engage using VR and AR is just one example. “We're opening up the boundaries of how we use advancing technologies to integrate them into existing and new systems,” says Suraj Kapa, Director of Augmented and Virtual Reality Innovation at the Mayo Clinic.
 
Scaling remote healthcare for the long-term
Consumer demands and smarter combinations and applications of emerging technologies will undoubtedly help scale remote healthcare, but they won’t be enough. Technology or user enthusiasm are not enough, and the healthcare sector needs to drive a series of other transformations.
 
1. Providers and payers need to renegotiate
Perverse incentives in most healthcare systems are a significant barrier to scaling, says Peter Thomas, Director of Digital Innovation and Consultant Ophthalmologist at Moorfields Eye Hospital, London, “In the UK, for example, we've seen that virtual consultations haven’t been as well reimbursed as in-person consultations. Under the old payment-by-results model, hospitals may have taken a hit if they moved everyone to virtual consultations.” 
 
Solutions might include the use of block contracts that pay for service delivery regardless of how this is achieved. “If they can provide that service in a more efficient way remotely, then it makes sense at all levels to do that,” he says.
 
Reimbursement discrepancies also need to be addressed in the US. “In the US, a key obstacle to scalability is long-term changes in regulations enabling reimbursement variances,” says Rachel Hall, US Consulting Health Digital Leader at EY. 
 
It is believed by some that the Medicaid ‘best price’ requirement has resulted in the slow adoption of value-based reimbursement, leading to significant pricing variances at the per-patient level. However, as the FDA does not regulate contract terms for value-based agreements, Hall says, “Providers and payers will need to create common ground on reimbursement levels.”
 
According to Hall, “Considerations include reimbursement levels being near, or at, in-person care levels, and the exploration of new episodic payment models, and capitation payment models.” 
 
(Episodic payment, or episode-of-care payment, is a bundled payment which covers all the care a
patient receives for the treatment of a particular condition. It contrasts the traditional
fee-for-service reimbursement where providers are paid individually for their services. Capitation payments, on the other hand, are where providers are paid a fixed amount of money in advance per patient.)
 
 
2. Providers and payers need to redefine how they interact with patients
Patients expect a user experience similar to that which is delivered by the more customer-centric tech industry. “There needs to be a concerted shift in industry towards experience transformations and the patient experience includes their environment, family, and healthcare access,” Hall adds.
 
“Technology-enabled patients want the healthcare experience to be like other industries,” says Hall. “This includes the use of messaging, the detection of patterns to inform next best action, more efficient diagnosis, and the use of machine learning and AI to streamline their experience.” 
For remote healthcare to work, patients need to be partners not passive recipients, in their care. So to scale remote healthcare, the industry must make a cultural shift to override the “learned helplessness” that Jamie Heywood, Co-Founder of AOBiome and PatientsLikeMe, and Founder of the ALS Therapy Development Institute, believes is inherent within healthcare language and interactions with patients. 
 
In this respect, providers and payers must place their trust in patients. “The more we trust people and empower them with the tools to make their own effective decisions on their terms, the better we are, and the more we prescribe, instruct and control, the worse we are,” he says. 
 
This doesn’t mean patients won’t need help preparing for the responsibility that comes with remote care, however. Education is one way to help patients prepare, but empowerment is a better way, believes Marwaha. 
 
3. Providers may need support 
While providers have adopted remote healthcare delivery en masse, that does not mean that they are now experts. “We all have a role to play in helping providers navigate the new normal,” says Sides. “They will need help determining what to do physically in their office versus what to do virtually. A dermatologist may have a day in the office doing excisions and then treating patients virtually on the other days because they don't actually have to see them in person to still provide high quality of care.”
 
Some providers may remain hesitant and in need of evidence for the efficacy of remote healthcare. Thomas says that Moorfields Eye Hospital has gone from no video consultations to about 3,000 in March. “In terms of scaling, it was really a matter of supporting those earlier doctors, measuring what the output is, and using that to create case studies that can convince other people to adopt it,” he says.
 
4. Regulators must be on board
Esposito-Hockenjos points out that before COVID-19, US regulations were slowing down the progress of telehealth. “It’s very important to allow some of the relaxation in regulations that have occurred as part of COVID-19 to continue post-pandemic so that people are able to embrace remote care without the friction and frustration that was there before,” she says.
 
Kapa agrees: “Even before COVID, the Mayo clinic was already working on increasing telehealth capabilities and video visits implemented through our patient app. The biggest problem was regulatory rather than implementation.” If the government reverses the rules around interstate licensing of virtual visits it would be a massive blow to their wider adoption. “That could roll back the explosion of telehealth capabilities and the ability to use it,” he warns.
 
In September 2020, commissioners from the Medicare Payment Advisory (MedPAC) raised various concerns regarding the continued relaxation of telehealth policies post-COVID. These concerns were primarily centered around payment models and the role of telehealth in exacerbating the digital divide for traditionally underserved populations. However, it is expected that some policies will be kept, and MedPAC is set to advise Congress on some of the policies they believe should be allowed to continue post-COVID, including Medicare telehealth payment policies.
 
5. Common device standards are needed to overcome fragmentation
To get the most from technology the devices patients and HCPs use must become part of an integrated whole rather than siloed components that prevent the sharing of data. “We have all these devices and nothing is really pulling them together for the benefit of the patient and their care team,” says Marhawa.
 
This fragmented infrastructure has made interoperability a huge challenge in both the US and Europe, says Kapa. “We need to go beyond FDA approval or CE markings for digital tools and towards a minimum interoperability standard.” 
 
6. Questions around equity of care need to be answered
In the headlong rush towards a broad adoption of remote healthcare, the industry needs to consider bringing all groups along, regardless of age or socio-economic status. “Because of COVID, we've taken technology to the next level exponentially faster, but I would argue for who?,” says
Jim Weinstein, SVP for Microsoft Health. “We can't dissociate economics from the delivery of healthcare. To be successful today means improving it for everyone, not just for some.”
 
One concern is for the “technophobic” older population from accessing help, but as Kenny O’Neill, Participatory Health Strategy Leader at EY, says, this is an outdated stereotype and older people are increasingly comfortable with using technology to access care, especially telehealth. Indeed, Kapa shares, “I've had virtual visits with people up to 96 years old and they have been fine working this way.”
 
The message is clear, however: It is important to ensure the extra layer of technology offered by remote care doesn't provide another layer of inequality and that it actually does what the ambition is, which is to provide more equality and better access.
 
7. The concept of real-world evidence (RWE) needs re-examining
Pharma is still coming to terms with the potential generation of RWE that technology enables and the uses to which it might be put. Marwaha believes that remote care takes us beyond RWE. “As we get to the patient's home, it's not just about virtualizing the visit,” he says. “We now have an ongoing knowledge of how people are living their real lives, and so it's almost like going beyond RWE, which has come to mean lab results or electronic medical records.
 
We now have ‘in real life’ evidence, which includes those subtle daily changes and indicators that we should enable everyone to engage with productively.” For example, by measuring people in their normal environment, we have much better data to build AI and machine learning models for predictive analytics.
 
8. It is time to transition from sick care to health care
The great opportunity of remote health powered by smart technology is that it enables us to prevent and pre-empt ill health but this will only be done with a new care model. “By operating within the ‘sick care’ paradigm, remote provision is only targeted once patients are sick, whereas remote provision could be targeted at everyone using predictive tools,” says O’Neill. 
 
By adopting this wellness-oriented approach, scalability is much more feasible and will create further opportunities including advancing preventative care and enhancing daily life. And there is really no excuse not to make this transition towards a holistic health model. 
 
 

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Total Health

Nov 19, 2020 - Nov 20, 2020, Digital Conference, Networking & Exhibition

Challenge what’s possible. Transform patient experience. Change lives