One Swallow does not a Summer Make

A young man, a great spendthrift, had run through all his patrimony and had but one good cloak left. One day he happened to see a swallow, which had appeared before its season, skimming along a pool and twittering gaily. He supposed that summer had come, and went and sold his cloak. Not many days later, winter set in again with renewed frost and cold. When he found the unfortunate Swallow lifeless on the ground, he said, “Unhappy bird! what have you done? By thus appearing before the springtime you have not only killed yourself, but you have wrought my destruction also.”

There’s a big difference between offering one or two telehealth services and effectively leveraging telehealth to achieve a healthcare organization’s strategic objectives, such as improving outcomes, reducing costs, or growing revenue. 

In my assessment, most health systems will be launching 50-60 different telehealth services over the next 5-6 years, with smaller practices or rural community clinics looking at launching between 6-15 telehealth services. Yet many organizations act as if they already “do” telehealth, when in reality what they have is a few services with a few physicians or just a subscription with one of the national telemedicine providers. 

The Big World of Telehealth

Telehealth is delivering care at a distance and by that definition covers the complete spectrum of care delivery — across all clinical specialities, across the various stages of care (from preventive to acute to chronic), to the many different locations (e.g., home, work, SNFs, ERs, rural clinics, etc.). There are dozens if not hundreds of different “use cases” for telehealth that require different business models, different technology, different workflows and also differ in their clinical efficacy. 

• A TeleStroke service requires different equipment, different billing and reimbursement and very different workflows than a TelePsychiatry visit with a patient at a rural clinic. 
• A Televisit to a patient’s home requires a different software than a Televisit with a patient presenting at a remote clinic. 
• TeleExams for specialties such as cardiology or pulmonology require different tools than TeleExams for primary care. 
• Remote Patient Monitoring for the purpose of preventing readmissions is a different service, than managing the high utilization of COPD patients through Remote Patient Monitoring. 

To illustrate the vastness of telehealth opportunities, the graphic below depicts the various dimensions of telehealth: the telehealth mode, the provider, the recipient, the care stage, the specialties and the location. When you calculate the permutations across those dimensions, there are 202,178 use cases for telehealth!

The difference across the different flavors of telehealth is not limited to the technology, workflows, or specialties. Since reimbursement in a fee-for-service world is either non-existent or not consistent across all payors, different telehealth services are based on different business models to make them sustainable. Aside from the typical fee-for-service mode, additional business models include care bundles; down-stream savings (e.g., referrals or preventing readmissions); affecting health outcomes and reducing utilization in capitated environments; direct-to-consumer (DTC) cash pay; etc.

Telehealth as the Core Strategy for the Delivery of Care

Rather than thinking about telehealth as a one-off thing to ask the IT department to buy and implement, effectively leveraging telehealth requires adopting a new mindset that must start at the very top, with leadership. With the growing demand (and technical possibility) for convenient and high-quality access to services such as shopping, banking or even hailing a taxi, the modern healthcare consumer is actively looking for the same experience in healthcare and the likes of Amazon Care and Walmart Health are poised to satisfy that need.

Telehealth can serve as a great tool in achieving your organizations strategic objectives:

• lowering the cost of care by keeping people away from the ER and preventing readmissions 
• growing market share by offering convenient access across a wider geographic area. 
• improve staff satisfaction by offering experience in the inevitable technology of the future
• improve patient satisfaction through convenience and fostering independence 
• improve your standing in the community by bringing more diverse services
• etc.

While one swallow is an indicator that things are about to change, it takes many more swallows, conscious coordination (for a well-coordinated gulp of swallows), and focused work (such as building nests) to be able to truly declare that summer is, indeed, here.

The first step is to define your telehealth strategy and develop a Telehealth Program Business Plan.

What do you have at your organization - a single swallow or a healthy gulp of birds?

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Christian Milaster is the Founder and CEO of Ingenium Digital Health where he and his expert advisors partner with healthcare leaders to optimize the delivery of care. Contact Christian by phone or text at 657-464-3648, via email, or video chat.