Telehealth utilizes communication technologies, (computers, smart phones, tablets) to provide health care, substance abuse counseling and behavioral health services remotely. This has been a hot topic as of late, and for good reason, it has a lot of potential. Much of that potential has been squandered up until now because of well-intentioned but poorly designed and executed public policy. For more on that you can review my thoughts on the failed Meaningful Use experiment. This time around, though, I prefer to focus on the exciting direction telehealth is headed and why that’s so important to the addiction treatment community.
At present, only 15% of general practitioners make use of telehealth, and it has an estimated market value of only $2.5 billion.
However, it is projected that the use of telehealth will at least double in 2018. It is also anticipated that 76% of US hospitals and health systems will implement it, in some form or another, this year. That will greatly increase exposure to telehealth and comfort in its use to the entire medical community, causing the market to expand rapidly.
The Biggest Stumbling Block for Telehealth
The biggest stumbling block for telehealth, to date, has been the lack of reimbursement for telehealth provided services, but, that’s now all in the process of change. As of this publication, 13 states have telehealth reimbursement legislation on their books and I expect several more to come on board soon. Moreover, Congress proposed legislation on June 17, 2017, to approve greater reimbursement of telehealth, demonstrating further political support behind the movement. Moreover, several large insurers such as Aetna, Anthem, and Blue Cross and Blue Shield in several states, are now experimenting with reimbursement for certain types of telehealth services. Why? Because it saves time and money. It just makes sense. The only hesitation we have seen in this area is driven by the fact that states and insurers are still tinkering with systems and processes to protect against fraud. However, once they get their arms wrapped around this issue, greater use of telehealth is primed to take off like a rocket. 74% of US consumer say they are ready to accept and regularly use telehealth, while 84% of medical providers believe it is important or very important to the future of their organizations.
The first key area in which I see telehealth affecting the addiction treatment community is in communications. Many treatment facilities and their employees have been playing Russian Roulette with HIPAA’s regulations without even realizing it. Protected Health Information (PHI) is a pretty expansive term under HIPAA. Many unassuming or decidedly innocent emails, texts, data transfers or even pictures, prove to be anything but innocent, because of how that information is transferred. The message typically gets sent from a cell phone or tablet (iPad) to an ISP or phone service provider, which then transfers it to the recipient’s ISP or phone service provider, and is eventually received by the recipient.
Without encryption, this process fails HIPAA’s strict security requirements on several levels. The thing is, HIPAA isn’t concerned with whether you intended to violate its regulations. It consists of black and white, hard and fast rules. Thankfully, no federal agency has made a big deal about this yet, but “yet” seems to be the operative word. All we need is some gunslinging US Attorney seeking to build a reputation, to take down a daisy chain of well-run addiction treatment facilities because of unintentional poor security practices. This type of telehealth need has been largely ignored, but now that prices are very affordable, it would be foolhardy not to purchase this inexpensive kind of business insurance.
More over, the transition from Fee-for-Service to Success-Based medical fee reimbursement will also have a huge impact on telehealth. For the past 100 years, or so, a patient went into a hospital or doctor’s office, got treated, and was charged a set amount, whether or not they got better. If the problem still persisted, they’d return at a later date and be charged again. Well, as of 2018, Medicaid and Medicare will begin basing part of their reimbursement on outcomes – did the patient actually get better? If not, the medical care provider (or, in our case, addiction treatment facility) will have to provide additional treatment free of charge. The insurance companies are watching this with eager anticipation, looking for ways they can limit their reimbursement responsibilities. This transition will occur over a several year period, but we can all expect pushback to begin almost immediately. This issue is particularly poignant for the addiction treatment community because relapse rates are relatively high, as compared to other chronic diseases. The only lever we have to better serve this need is technology. We can use it to lower current costs while also increasing post-acute care options with online services and apps to reduce relapse rates. Use of technology will also demonstrate adoption of best practices, for combating insurance company pushback. That’s a key reason behind Kipu’s development of RecoveryBound™ which we anticipate rolling out in the middle of 2018. We are already offering PingMD encrypted and secure, one-on-one therapist sessions, and are adding group meetings, exercises, reminders, surveys, warning alerts and built in accountability features, to aid addiction treatment centers in meeting their aftercare requirements.
Telehealth also has the potential to perform numerous functions not currently in practice. For example, mobile tracking of a person’s health can help identify when it’s time to see a doctor and make that visit more meaningful, like sensors on a car telling you it’s time for a tune-up. Doctors will have an aggregation of months of data instead of just a snapshot on your day of visit. Imagine the possibilities with respect to addiction treatment. Feedback Informed Treatment (FIT) will also be critical. The 2016 US Surgeons General’s Report on Addiction referred to studies demonstrating that people are more comfortable being honest answering questions on a computer than they are face-to-face with a doctor or therapist.
There are numerous reasons for this. It limits embarrassment, breaks down the interaction into a simple read and answer format instead of conversation, and many people simply don’t want to disappoint their doctor or therapist even when it might negatively impact their physical or mental health. Despite all of the evidence on the importance of FIT, the mental health community has nonetheless been reluctant to adopt it because doctors and therapists have traditionally trusted their instincts more than data spit out by a computer. However, all of that too is about to change.
The Joint Commission is making FIT mandatory as part of Success-Based medical care. For that reason, Kipu now offers a FIT program as part of its KipuEMR package and we plan on rolling out additional options. We are also doing our own research and development in this area, based on our experience with over 480,000 episodes of care. Telehealth takes on two different types of forms. The first involves utilizing technology to supplement services provided by medical professionals. The second is using technology to analyze medical options and practices, in the form of artificial intelligence, to improve the overall service of medical care. That’s where FIT comes in and Kipu’s unique and extensive breadth of knowledge will help us be a singularly helpful resource to the addiction treatment community.
Universal adoption of telehealth has taken more time than most professionals anticipated or hoped. That is understandably frustrating. However, as a result of the current need to control exorbitant medical costs and mandatory regulatory requirements, telehealth will soon be ubiquitous, helping to generate savings and improve outcomes at the very same time.