The future of telemedicine remains uncertain. But that has not stopped the predictions. Some say the future of healthcare is purely virtual while others believe the traditional in-person model of care cannot be replaced.
What is certain is that the future of telemedicine will be determined by the insurance industry. Health insurance companies are now de facto technology companies, each with their own digital platforms to correlate clinical services with financial compensation. Telemedicine will have a role in this platform.
But that role will be less clinical and more financial. Healthcare insurers are in a cost cutting frenzy and looking to optimize patient utilization – insurance-speak for how much healthcare people use, the types of healthcare they use, and the timing of that care.
Too much utilization leads to excess cost for insurers. Too little utilization leads to gaps in care that result in poor outcomes. Optimal utilization balances care rendered with its cost. This is where telemedicine will sustain its footing long term.
It provides low cost communication that is both convenient and increasingly accessible. It allows patients to discuss things that they could not during the in-and-out bustle of a clinical visit. It can be conducted by mid-level healthcare providers who work at lower hourly rates than doctors. In short, it is the ideal vehicle for healthcare insurers to optimize utilization by addressing care gaps cost-effectively.
Care gaps have been shown to worsen clinical outcomes and lead to higher costs of care. But most of these gaps are nothing more than depression screenings, referrals, or medication reconciliations – reviewing the medications a patient takes. They are simple conversations that cover the basics of clinical care, but can be the difference between a compliant patient or a frequent flier to the emergency department.
More importantly, telemedicine offers the opportunity to engage with patients outside of the traditional clinical encounter, to discuss aspects of their care that are overlooked or not properly discussed during a traditional visit. Often what is discussed matters less than the discussion itself. A patient may forget the medication interactions discussed during a telemedicine meeting, but she will always remember that a conversation took place.
In this sense, telemedicine is a tool for engagement – addressing care gaps by increasing engagements and eventually, optimizing utilization by reducing cost of care. Telemedicine cannot replace traditional in-person care, but it can enhance it.
Accordingly, the balance between telemedicine and traditional care will be defined by care gap utilizations, which itself is a balance between the care rendered and its cost. For clinical care in which it is more cost effective to reach out to patients digitally, telemedicine will be utilized. For clinical care that requires direct, face-to-face interaction, the traditional patient encounter will remain in place.
But this balance is by no means static. Rather, it varies based on the technological capabilities afforded through telemedicine and the perception of those capabilities. Take remote patient monitoring for example. Only a few years earlier it was inconceivable that patients could regularly take their blood pressure and synchronize the values into a medical record system. Now the technology to do this is essentially a commodity. Patients who previously came to the doctor’s office to monitor their blood pressure can remain at home while sending blood pressure readings digitally.
Indeed many care gaps that once required an extra visit to the doctor may soon be addressed digitally. It depends on using technology in a way that patients both understand and accept as part of their care. As technology evolves, and patient integration evolves commensurately, the balance between telemedicine and traditional medicine will shift.
At the fulcrum of this balance, carefully overseeing the shift, is the other balance, that of utilization, balancing the modality of care with its costs.
