Providers are trying to navigate the troubled waters of healthcare with what Care Innovations COO Marcus Grindstaff memorably described as, “a foot in each canoe”. In one canoe rides the lion’s share of their patient population for whom care is paid for in the legacy ‘fee-for-service’ model. In the other new, and unpredictable, ‘value-based’ canoe, providers can see large monetary gains or losses based on the quality and effectiveness of their care (ACOs, bundled payments, etc.). It’s a precarious way to make it down a turbulent river, but it describes the experience for many health system executives as they operate with two fundamentally different business models across their patient base.
It’s clear that the system is heading toward value-based care, yet the path to get there is less clear. One path is through Remote Care, which is provided outside the four walls of the hospital or clinic. This type of care ensures patients get care at the right time and in the right place, while also being an incredibly powerful tool for prevention and maintenance. Despite its value, Remote Care still faces some barriers. That’s why I recently spent two days in Washington, DC with colleagues from the Alliance for Connected Care. We spoke with folks on the Hill and in the White House about exciting things happening in telehealth and remote monitoring, and tried to make the case for further advances in rules and regulations to increase adoption and reimbursement for distributed care.
One thing that was clear was the importance of defining and understanding the differences between two important types of Remote Care, telehealth and remote patient monitoring. Telehealth is a visit in a moment in time. Remote patient monitoring is monitoring a person’s health over time, and in real-time. These are both important tools for a clinician managing the health of individuals in a population, but a dichotomy of regulation and reimbursement for nuanced versions of distributed care is slowing adoption. This is frustrating for patients and other stakeholders, especially when evidence shows both that Remote Care through telehealth and remote patient monitoring is working, and the technology is mature enough to make adoption easy for patients, providers, and payors.
There have been positive changes in the last few months, and there is recognition in Washington that distributed care is not only a path toward better, more efficient care, but also a critical step in the transition toward value-based care. This week, the House Energy and Commerce Committee passed the Access to Telehealth Services for Opioid Use Disorders Act (H.R. 5603). This is an important first step, and we are pleased that the Senate is poised to consider similar legislation. Ultimately, we would like to see the provisions broadened to serve more patients at a variety of sites of care.
Yet, Medicare’s slow adoption and reimbursement of telehealth and remote monitoring is impacting implementation across the entire system because providers are less inclined to change their practices when they are treating patients with a variety of coverage. The transition from fee-for-service to value-based care requires the entire system to operate differently – from how, when, and where providers treat patients, to how payors reimburse for that care, to how patients engage with their health between visits. Technology can help facilitate this transition, and build collaboration among stakeholders, especially when rules and regulations support its use. Recently, the House Ways and Means Committee Health Subcommittee held a hearing on “Identifying Innovative Practices and Technology in Health Care” to learn more about new methods of care and technology, including remote care monitoring, that are changing the landscape and have the potential to modernize our health care system.
At Intel, we’re excited about what lies ahead for Remote Care. Our time on the Hill shows the policy momentum is heading in the direction that will allow providers, payors, and patients to take advantage of the technology that is available today to make care more effective and efficient. We’re confident that Remote Care will be established as a standard of care. The sooner we can make that a reality, the sooner the system can end its balancing act in the transition from fee-for-service to value-based care.
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