Across the country, governments, employers, and health insurers are driving healthcare delivery organizations toward new payment models that make them accountable for the quality, cost, coordination, and outcomes of care. As a result, value in the eye of providers is no longer defined as better quality, safety, or outcomes regardless of cost but rather better outcomes and better health of the people and populations they serve at a lower cost per capita.
This new shared accountability model is causing a once-in-a-century shift from medicine practiced by solo performers paid for piecework to medicine practiced by multi-disciplinary teams paid for Triple Aim results: the optimal balance of good health within a defined population, positive patient experience of care by the people in this population, and a lower cost per capita of providing that care for that population.
These new payment models are driving providers to innovate and use technology in creative new ways to deliver Triple Aim results. Under the fee for service reimbursement model, higher cost innovations were preferentially rewarded over lower cost, disruptive innovations as long as providers could prove to 3rd party payers that innovations were "medically necessary." But now that providers are assuming more risk and accountability for the health, outcomes and costs of care for the populations they serve, the mother of invention – necessity – is redirecting providers to shift their focus toward lower cost innovations rather than higher cost ones as has been customary in the fee for service model.
One area that's ripe for disruptive innovation is telehealth. Whereas, under the fee for service model, telemedicine was seen as an efficient vehicle to connect doctors to more patients to expand their practices, in the shared accountability model, providers now see telehealth as a more efficient vehicle to connect patients with the multi-disciplinary teams they need to improve their experience of care, their health, and reduce their need for costly care and hospitalization.
But the problem for all but the largest and well-capitalized hospital systems is that the costs associated with a telehealth solution can be prohibitive, especially with reimbursements and payments falling and operational budgets shrinking. As a result, Microsoft has been working with several innovative provider organizations on low-cost telehealth programs that utilize technologies such as Microsoft Lync, our unified communications platform, in simple and innovative ways.
We’ve discussed one example
in this blog before: Dallas Neurosurgical & Spine
utilizing Microsoft Lync Online
to deliver remote patient consultations via the cloud. The provider is having such great success in serving its patients located in rural areas that they are looking to expand the program to as far away as Saudi Arabia and Peru.
St. Luke’s Health System
, a non-profit healthcare provider in Boise, Idaho, is another example of a provider using Lync to deliver remote care and health services. The provider operates seven hospitals and five cancer treatment clinics spread across the state, and worked with us to develop a low-cost, mobile solution, dubbed the “Telehealth Cart,” which uses Microsoft Lync 2010 as the core communications platform.
Like many providers operating in remote areas of the country, St. Luke’s had significant logistical challenges in mobilizing its geographically dispersed multi-disciplinary teams to deliver care to its patient population dispersed across the state. For example, at its cancer facility in Fruitland, Idaho, patients had to travel 30 to 40 miles on average to receive even a quick genetic or nutrition consultation. Furthermore, because specialists at St. Luke’s rotate between many clinics locations and visit each just a few times per month, patients were limited in the days and times they could schedule appointments. For cancer patients dealing with severe intestinal discomfort, for example, a meeting with a nutritionist could often be an urgent, critical need.
So, the forward-thinking provider decided that they needed a telehealth program to provide patients with a better experience and quicker access to care.
In looking for a solution, St. Luke’s sought to achieve four primary goals:
- Provide a “low-touch” configuration that allows clinical staff to operate the solution easily and independently of IT assistance
- Meet regulatory and organizational security and compliance requirements
- Provide a high-quality experience for patients and providers through superior system performance and audio and video clarity
- Identify the lowest-cost solution
However, St. Luke’s had to consider several challenges, including the fact that telehealth has a number of difficulties in being accepted as a treatment platform for insurance billing, and high revenue treatments using telehealth are still under review by state legislators. Furthermore, St. Luke’s had to work within a limited budget for the program, and after assessing several existing products, none were viable given their high starting prices upward of $10,000 per endpoint.
Given these barriers, St. Luke’s elected to create their own solution leveraging a battery-powered mobile cart, a Windows 7 desktop configured as a kiosk, an off-the-shelf Microsoft HD LifeCam Cinema WebCam, and Microsoft Lync 2010 – and all for less than $4,500.
“The experience we achieved through Microsoft Lync exceeded our expectations in terms of the quality of audio and video clarity, system responsiveness, and connection resiliency,” noted Kevin Mark, a member of the Infrastructure and Operations leadership team at St. Luke's overseeing the solution design. The resulting Telehealth Cart, which is easily wheeled into treatment rooms, allows remote clinicians to connect with patients, share information and provide consultative care via real-time video – something that was only possible before through in-person visits.
St. Luke’s put the system in action at its Fruitland facility, where approximately 42 patients, during their visits to the facility, have participated in genetic or nutrition counseling with remote clinicians – and initial results are promising. For genetic counseling alone, the telehealth program has reduced appointment wait times by nearly 7 days, and early feedback has been extremely positive. In a survey of patients who participated in St. Luke’s program, 94 percent reported overall satisfaction with the Tele-Cart and noted they would recommend telehealth to a friend. Patients were pleased with the improved convenience, access, and cost savings provided by the telehealth system while receiving high quality care.
Clinicians were similarly pleased with the experience. As Rhone Levin, Dietician, Clinical Nutrition Services at the Mountain States Tumor Institute stated, “[Microsoft Lync] allows me to provide excellent quality interventions from a distance for acute oncology nutrition issues. I am able to provide medical nutrition therapy coverage to several rural cancer centers each day of the week. The quality of the interaction is seamless to the patient.”
In addition, because of Lync’s lower cost point, quick deployment and rapid time-to-value, it is clear to St. Luke’s that the solution makes sense as part of their long term strategy going forward, and they plan to expand the Telehealth Cart model to other remote clinics. The next phase of the project entails the use of USB- and wireless-enabled medical peripheral devices, such as digital stethoscopes and video otoscopes, on the Lync platform to enhance the services physicians provide to patients across the region. Initial feedback from physicians has been positive thus far and the team remains optimistic that they will be able to enhance St. Luke’s telehealth capabilities using these peripheral devices.
Despite a number of challenges and a limited budget, St. Luke’s successfully launched an innovative telehealth program, and can truly serve as a lesson in telehealth to health systems and organizations throughout the country.
Have you created and are you using a low cost telehealth solution to enable your patients to connect with the multi-disciplinary teams they need to improve their experience of care, their health, and reduce their need for costly care and hospitalizations? If so, I'd like to hear about it.