Telehealth Is Remaking More Than Therapy

I think telehealth services will be a major disruptor of the health and human service system—online therapy, remote consultations, virtual follow-up groups, and more (see Employer Health Plans Pushing Telehealth Adoption One Step Closer To ‘Ubiquity’ and The Bigger The Challenge, The Bigger The Opportunity). But I got a better understanding of just how disruptive telehealth could be when I moderated a panel discussion last month at the Innovative Technology in Community Health Care Conference in Boston. One of the panelists was Stephanie Jordan Brown, Director of the MassHealth Office of Behavioral Health. Among the many new initiatives that are on deck in Massachusetts, Ms. Jordan Brown described one that I found intriguing—their plan to integrate mobile crisis response with the first responder system using telehealth (see MassHealth Office of Behavioral Health & Technology).

I recently spoke again with Ms. Brown, who expanded on the plans in Massachusetts:

Stephanie Jordan Brown

We get approached regularly with the question “do you cover telehealth”? Increasingly we are looking at telehealth as integral to how we transform the delivery system. As we move the MassHealth program into Accountable Care Organizations, the question is no longer do we pay for telehealth in FFS, but how do we want the delivery system to leverage that technology in the context of value-based payment? When we think about the nexus of emergency room, behavioral health provider, hospital involved in crisis care today – the multiple hand-offs and hold-ups – we need to reimagine how those consultations take place to get members to the right care as quickly and efficiently as possible. Coming out of demonstration projects in Mobile Integrated Health, our Department of Public Health is now working on regulations that would enable our EMS providers to do 911 response with field-based triage through real-time consultation with medical and behavioral health providers, making it possible to triage directly to a community-based behavioral health urgent care center when appropriate. That entire model relies on telehealth. And even though we haven’t operationalized this yet, it’s key to the service models we are designing now.

A similar program is currently being piloted in Los Angeles County—community paramedicine. The program uses paramedics and emergency medical technicians (EMTs), with a combination of community-based services and telehealth to deliver a more integrated service to consumers. The concept is straightforward—instead of reacting to health care crisis situations, these paramedics are deployed to treat consumers before they are sick enough to need emergency care (see New Breed Of Paramedics Treats Patients Before Emergencies Occur).

MassHealth and Los Angeles aren’t the only programs using the new capabilities of technology to rethink emergency services. In Manatee County, Florida, the county outfitted two emergency vehicles with telehealth technology, allowing a three-person crew in each vehicle to provide primary and mental health care to consumers frequently using emergency services, along with medication, health and wellness advice, and substance abuse treatment (see What is Community Paramedicine?). The professionals staffing these vehicles include two community paramedics and a supervisor.

And in Glacier County, Montana, the county launched Integrated Mobile Health (IMH) services to serve consumers in the out-of-hospital settings by providing patient-centered, team-based care using telehealth and mobile resources. The professionals staffing this community approach include community paramedics, registered nurses (RN), and EMTs along with other trained health care. These are just a few of many examples of reinvention of urgent care services using technology—see Minnesota North Memorial Health System Sends Paramedics On House Calls To Reduce Repeat Emergency Visits; Austin-Travis County EMS: Community Health Paramedic Program; and Pennsylvania’s Highmark, UPMC In Rare Partnership.

So what does all this mean for strategy in the health and human service field? We don’t know exactly what the impact of telehealth (and computerized therapy, avatars, passive remote monitoring, and more) will be. At this point, we’re talking about substitution effect and productivity enhancement. But it may change the fundamental functionality and distribution system of health care just like Apple and Amazon have disrupted consumer purchasing and business processes. (To expand your thinking about the possibilities, check out – How Apple (Unintentionally) Revolutionized Corporate IT and How Amazon Has Changed The Way We Shop.)

And there is legislative and regulatory momentum for fundamental rules changes. The Veterans Administration is proposing fundamental rules changes in licensure requirements—Authority Of Health Care Providers To Practice Telehealth. For more analysis of the rule, see VA’s Proposed Rule Would Override State Telehealth Regs.

In addition, new Congressional bills—the Increasing Telehealth Access to Medicare Act and the Creating High-Quality Results & Outcomes Necessary To Improve Chronic (CHRONIC) Care Act of 2017—are wending their way through the legislative process. For more on these bills, check out Telehealth expansion takes a step forward with Senate’s passage of CHRONIC Care Act and Telehealth Bills Get Senate Approval, Good News From CBO.

Where to take all of this? I like the advice of futurist Jacob Morgan, “Start to think about your company like a lab and less like a factory.” Innovation in the face of disruption is the key. For more, check out these resources from the OPEN MINDS Industry Library:

  1. The Disruption Of Strategy
  2. Community Paramedicine Evaluation Tool
  3. The Evidence for Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program
  4. Community Paramedic Toolkit
  5. The Feasibility and Role of Community Paramedicine in Nebraska
  6. The Telehealth Market – Now, Soon & Future
  7. The Telehealth Market – The Future Has Arrived
  8. Primary Care Goes Virtual & On-Demand
  9. The Latest Telehealth Example: Pay-For-Value
  10. The Uphill Climb To Virtual Care

And to learn how to get your own telehealth program up and running, join OPEN MINDS Senior Associate Matthew Chamberlain on November 7 at The 2017 OPEN MINDS Technology & Informatics Institute for his session, “Telehealth Best Practices: How To Build A Successful, Sustainable Program.”