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Monday, December 2, 2013

Paying for Telehealth

This question came up in one of my classes last week:

What do you believe is/are the most likely and important applications of telemedicine/telehealth in the future?

I liked my answer so much, I thought I'd share it.  It's the sort of upside-down thinking that appeals to me.

I see a lot of attention for telehealth being focused on big ticket items, or on issues where distance is a real challenge. While I think these are areas that have a lot of value, I wonder about the smaller things.

I would have loved to be able to care for my daugher's ear infections using telemedicine, using something like this.

I really want to be able to remote home monitoring with an iHealth BP cuff, a Withings scale, or a smart-phone enabled glucose monitor for my wife and be able to communicate that information readily to my healthcare provider so that he can incorporate it into his EHR record.

I'd love to be able to remotely request prescription refills and schedule appointments. I'd love to be able to fill out forms online instead of spending an extra 10 minutes for that at the doctors office. I'd love to be able to pick referrals like I pick flights, with information about both time and cost readily available and comparable.

Yes, I think e-visits would be extremely valuable. A 30 minute consultation with a dietician over webex is something I'd do, whereas it requires a two hour time committment to get the dietician in my physician's practice. And a lot of the stuff I'd spend time as "pre-work" before we actually talked I could do via the internet.

I put a $ value on my personal time, for something I'm disinclined to like, it's more, and for stuff I like to do, less. I'd be willing to spend a bit more money to be able to have access to those services. The other value for these services is to employers. If insurance companies were willing to reimburse primary care providers for these fairly straight-forward telehealth implementations on an annual basis per patient, employers could likely see savings resulting from less use of personal time for healthcare related visits.

For some quick back of the napkin calculations, business receive from $50,000 to $1,000,000 of revenue per employee per year. That's a value of $25 to $500 an hour. Let's say a physician in general practice sees 700 patients a year whose insurers will pay him an annual "bonus" for providing simple telehealth services (half of the low end panel size from this article). Let's say that average revenue per employee is on the low side, but not at the bottom, call it $50 / hour. If telehealth can save two hours of a consumer's time, then the value to the employer is $100. Give up half that to the payers ($50/patient), and give a large chunk of that to the providers ($45). That results in a payment of $31,500 a year to providers. Employers save $100 of revenue a year that would be otherwise lost, pay out $50 of that to payers, and providers get a chunk of money that can go into the telehealth technology, and they'll save time and money too.


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