Providers are trying to navigate the troubled waters of healthcare with “a foot in each canoe”1. 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/effectiveness of their care (ACOs, bundled payments, etc.). It’s a precarious way to make it down the river, but it describes the experience for many health system executives when they are operating with two fundamentally different business models among their patient base.
It’s clear that value-based care is the direction the system is heading, yet the path to get there is less clear. One path is through Remote Care – care that is provided outside the four walls of the hospital or clinic. This type of care ensures patients are not only getting care at the right time and in the right place, but also can be an incredibly powerful tool for prevention and maintenance. Despite its value, Remote Care still faces some barriers, so I spent two days in Washington, DC with colleagues from the Alliance for Connected Care talking with folks on the Hill and in the White House. We discussed the 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.
In our meetings on the Hill, it was important to make sure we were aligned on the definition of and understood the difference between different types of Remote Care, namely 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. For a clinician to manage the health of individuals in a population these are both important tools, but having such dichotomy of regulation and reimbursement for nuanced versions of distributed care is creating slower adoption. This is frustrating for audiences across the ecosystem, especially when evidence shows Remote Care through telehealth and remote patient monitoring is working, and the technology is in a place that makes 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. Last week, the House Energy and Commerce Subcommittee approved the Access to Telehealth Services for Opioid Use Disorders Act (H.R. 5603), which could be broadened when it goes to a full committee vote, including waiving rural and originating site restrictions.
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 practice 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 about “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 the call to action to establish Remote Care as a standard of care will be realized, and 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.
1Marcus Grindstaff, COO, Care Innovations