Editor’s note: In this article, Monica Leslie, a Senior Consultant with Schumacher Clinical Partners, and Rehan Virani, a Consulting Manager with Schumacher Clinical Partners, cover the impact of chronic conditions on our nation, outline the value telehealth can have on chronic condition management (CCM), and introduce the proprietary program—the Chronic Condition Management Benefits Estimation Tool.
In the next (June) issue of Telehealth and Medicine Today, they will report on the impact of the benefits estimation tool based on a review of more than 30 studies of CCM telehealth programs.
TMT: Why are chronic conditions and management of them discussed so much in health care?
Ms. Leslie: That’s a great question. Chronic conditions represent more than 80% of all healthcare spending and impact the health of more than half of the American population. This amounts to over $850 billion dollars annually. Many of these chronic conditions are actually reversible or preventable and typically stem from health risk behaviors, such as lack of exercise, poor nutrition, use of tobacco, and overindulgence in alcohol.
As our population ages, so will the need for effective methods of managing, improving and, to the extent possible, preventing chronic conditions. Most of that management occurs in the home of the patient, not within the four walls of the hospital.
TMT: What types of organizations should be looking to implement a Chronic Condition Management Program?
Mr. Virani: Everyone, in our opinion. By the end of 2016, 85% of Medicare hospitals fee-for-service (FFS) payments will be tied to quality or value through programs such as the Hospital Value-Based Purchasing Program and the Hospital Readmission Reduction Program. That percentage will increase to 90% by the end of 2018.
TMT: How is telehealth used to manage chronic conditions?
Ms. Leslie: Telehealth can be used to manage chronic conditions in many ways. This includes adding telehealth solutions to existing CCM programs. Examples include real-time remote patient monitoring, medication management, care plan adherence surveys, virtual follow-up visits, individual/group patient education, rehabilitation/self-management techniques, and store and forward of information such as medical imaging.
TMT: Why is it valuable to use telehealth for CCM?
Ms. Leslie: Telehealth is a value-add to traditional CCM programs for four key reasons. First, it allows providers to more seamlessly close the communication loop with patients after they return home. Second, it captures real-time data readings, which are fed to care teams instead of relying on patient-reported data.
Third, it empowers patients and allows them to be a partner in their care. Lastly, it’s a cost effective alternative to in-person visits and closes gaps in care needs for many patients.
TMT: What drivers in the market support further adoption of telehealth, specifically in the CCM space?
Mr. Virani: In 2010, passage of the Affordable Care Act (ACA) increased access to care, placing extreme demands on the nation’s health system in terms of cost and provider availability. Innovative payment models such as Next Gen ACOs (Accountable Care Organizations) and the CJR (Comprehensive Care for Joint Replacement) bundle have relaxed previously restrictive telehealth policy.
TMT: What is the biggest barrier facing organizations that decide to implement telehealth with CCM?
Ms. Leslie: Reimbursement. This is actually what set us down the path of creating the Chronic Condition Management Benefits Estimation Tool. Organizations we work with expressed great interest in this area of telehealth. However, because reimbursement isn’t aligned to pay on a fee-for-service basis in many situations, they didn’t see the financial benefit that is possible at a big picture level.
TMT: What are the expected benefits of implementing a CCM program with telehealth? Ms. Leslie: I thought you’d never ask! When planning to implement telehealth with CCM, organizations must look at the business case from the perspective of “value” created, not just “financial” benefit. Value on Investment (VOI) includes things beyond FFS revenue—reduced readmission penalties, reduced avoidable inpatient days, appropriate care setting utilization, reduction in transportation use, and clinical resources at the top of their license, to name a few.
TMT: What tips do you have for organizations seeking to better understand their value over financial benefit?
Mr. Virani: To get ahead of the curve, organizations must position themselves now. Although telehealth payment reform is likely in near future, the business case for implementing telehealth as a value-added component of an existing CCM program can be done today.
Think about your program in terms of all benefits, not just fee for service. We recommend thinking about what direct revenue can be accrued through the Medicare Chronic Care Management Program and the value achieved by avoiding losses and capitalizing on savings opportunities.
TMT: In the next issue of TMT you will present data based on experience with the Chronic Condition Management Benefits Estimation Tool. For now, please briefly describe this tool?
Mr. Virani: We’ve created a model called the Chronic Condition Management Benefits Estimation Tool. Essentially, it is a benefits estimation tool that pulls in industry data and a series of organization-specific inputs to produce a three-year projection of the value an organization can expect through implementing telehealth with their CCM program.
In the next issue of TMT the results of data analysis based on a review of 30+ studies of CCM programs with telehealth will be presented in accord with the following criteria: CCM program type, organization type, size of the organization, and technology utilized. Value on Investment will include costs associated with the reduction in avoidable readmission, costs associated with the reduction in avoidable index admissions, costs associated with the reduction in avoidable ED visits, costs associated with the reduction in ambulance services, and costs associated with the reduction in CCM resources.
Q &A Session to Determine the Impact of Telehealth on CCM.
Telehealth and Medicine Today ™ provides insightful Q & Aentitled ‘Realizing Value with Telehealth in Chronic Condition Management (CCM) Programs’ by Monica Leslie and Rehan Virani.
From remote patient monitoring to value based healthcare, covering various aspects of telehealth. Moreover, it discusses the impact of chronic conditions on the country. Check it out online for free. All you need to do is subscribe to Telehealth and Medicine Today ™.
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Monica Leslie is a Senior Consultant with Schumacher Clinical Partners, with firsthand experience designing and implementing telehealth programs while working in hospital operations.
Rehan Virani is a Consulting Manager with Schumacher Clinical Partners. He has experience helping organizations understand and evaluate the VOI as well as implement and operationalize telehealth technologies into daily operations.