The demand for efficient and effective health care has never been more urgent. In response to more than 30 years of skyrocketing costs of caring for an increasing elderly and ill population, the Affordable Care Act is changing healthcare as we know it.
By adding 32 million newly insured Americans to the system, the ACA will test an already-strained health care delivery system. It will also exacerbate a critical shortage of physicians and other care providers, upend the economics of hospitals and health systems (moving from a fee-for-service to a fee-for-quality environment) and challenge consumers to take a more-active role in their own health. How our system adapts to these changes will establish the new normal.
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We have already begun to see responses to these challenges: a renewed focus on prevention over treatment; shifting of services from hospital care to less-costly and more-efficient locations, such as outpatient facilities and the home; and a quest for new staffing efficiencies. As the shape of health care continues to shift, telehealth will play a leading role in addressing these challenges.
Telehealth programs have been piloted for well over a decade, and have been steadily adopted more widely across the country during the past several years. In its truest and most effective form, telehealth is a fully-integrated clinical program that changes the way care is delivered, and from a centralized facility (telehealth center) can provide care across the entire continuum, from hospital to home. And it’s yielding impressive results.
Improvements in Patient Care and Outcomes
Telehealth is allowing clinicians to take a more proactive (preventive) approach to care delivery. With real-time information and better around-the-clock patient monitoring, physicians are able to spot trends and deterioration in patient conditions, so they can intervene earlier to prevent adverse events.
In a recent study published in CHEST Journal, a team of researchers led by Dr. Craig M. Lilly, a professor of medicine, anesthesiology and surgery at the University of Massachusetts Medical School, examined the impact of an electronic intensive care unit, or eICU, program across 19 health systems. The study of 120,000 patients found that those who received their ICU care as part of an eICU program were 26 percent more likely to survive the ICU and 16 percent more likely to survive hospitalization and be discharged.
While 11 percent of all ICUs in the United States have an eICU program, these results point to a significant untapped opportunity for additional telehealth programs in the ICU. Telehealth can also improve the care provider-to-patient ratio, dramatically reducing costs. From a productivity standpoint, one intensive care doctor, with the support of critical care nurses, can manage more than 150 ICU beds across any geography. This capability is unprecedented in health care and represents a key adaptation to “do more with less.”
Banner Health a Phoenix, Arizona- based health system operating 25 acute-care hospitals and health care facilities in seven states, has deployed telehealth services in its medical and surgical units and has seen quality improvements and cost containment. Compared to standard care, the telehealth-based care delivery model in the medical/surgical units led to:
Fewer patients requiring transfer to the ICU
Reduced length of stay (a key proxy for cost) by 17 percent
Reduced overall cost of care per case by 16 percent
Reduced falls (a major reason for extended and costly hospital stays) by 36 percent
As patients move into the home, telehealth plays an important role in serving remote, rural and underserved communities. The Indian Health Service cares for more than 2 million Native Americans and Alaska Natives who are often located far from urban health care resources. Long an innovative user of telehealth and other remote technologies, the IHS reports that telehealth programs have helped reduce the life expectancy gap between the Native American and Alaska Native people it serves and whites (from eight years to five years) and improved measures of diabetes control.
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