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Report: Telehealth Market Estimated to Reach $19.5B by 2025

April 2, 2018
by Heather Landi
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The global telehealth market is forecasted to reach $19.5 billion by 2025, according to a report from market intelligence company Transparency Market Research.

The global telehealth market was valued at $6 billion in 2016 and is projected to expand at a compound annual growth rate (CAGR) of 13 percent from 2017 to 2025, according to the report. An increase in the geriatric population, a rise in the prevalence of chronic diseases such as diabetes, cardiovascular diseases, and others, and a surge in demand for self-care devices and solutions is predicted to drive the market through 2025, the report states. What’s more, technological advancement in medical imaging and mobile solutions for healthcare will also drive the market.

However, the report also notes that cyber threats and the rise in data security breaches will likely limit the market’s growth.

In the U.S., the telehealth market is predicted to grow 14.8 percent during this time period to reach $2.8 billion. North America and Europe are projected to dominate the global telehealth market during this time period, driven by government initiatives to increase adoption of telehealth solutions, technological advancements, and efforts of key players to expand their market presence in North America, the report notes.

The market in Asia Pacific is anticipated to grow by 15 percent through 2025. And, the report states that an aging population, a large patient pool suffering from chronic diseases, a surge in demand to cut down healthcare costs, and improving health care infrastructure in countries such as India, China, and Australia are estimated to propel the telehealth market through 2025.

The report also examines the global telehealth market by application and projects that radiology will account for a high share of the market, projected to expand at a CAGR of 13 percent from 2017 to 2025. “Telehealth technology and services enable knowledge and resource sharing between rural and urban areas in minimum time duration. Moreover, consistent evolution in information and communication technologies, effective image transfer, consultation and reporting, and scarcity of radiologists across the globe are the factors expected to drive the segment through 2015,” the report states.

Cardiology is another key application of telehealth and is anticipated to account for 19 percent market share by 2025. Increase in prevalence of cardiovascular diseases such as heart diseases and stroke are the factors likely to drive the segment during this time, the report states.

In terms of end-users, the report segments the global telehealth market into payers, providers, patients, and others. The providers segment accounted for major share, about half, in terms of revenue in 2016, due to an increase in adoption of telehealth products in healthcare settings and a rise in partnerships between companies and hospitals for telehealth systems. The payers segment is anticipated to grow at a higher CAGR through 2025, due to an increase in adoption of telehealth and connected medical devices by insurance companies for insurance claim management.

On a global level, the telehealth market is fragmented in terms of number of players providing hardware, software, and services, the report states. Key players contributing to the growth of the global telehealth market include Teladoc, Inc., American Well, BioTelemetry, Inc., Medtronic, Aerotel Medical Systems Ltd., InTouch Technologies, Inc., Koninklijke Philips N.V., Honeywell International, Inc., GE Healthcare, and AMD Global Telemedicine, Inc. According to the report, these key players have focused on inorganic growth strategies through various partnerships, collaboration, and expansions as a key strategy.

For instance, in March 2017, GE Healthcare acquired Monica Healthcare, a monitoring technology company dedicated toward improving the birthing experience and enhancing obstetric care through wearable wireless fetal monitoring devices, the report notes. Moreover, in January 2018, Royal Philips and American Well entered into strategic partnership. Through this partnership, the two companies will work together to embed American Well's mobile telehealth services into an array of Philips solutions for both healthy consumers and patients with a medical need, spanning personal health and wellness, population health management, and clinical programs.

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Can Telehealth Slow the Traffic Between Nursing Homes, Emergency Departments?

December 6, 2018
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The RUSH Act seeks to reduce the 1.3 million transfers from skilled nursing facilities to emergency rooms each year

There are 1.3 million transfers from skilled nursing facilities (SNFs) to emergency rooms each year, and CMS estimates that two-thirds of those are avoidable. The result is as much as $40 billion in unnecessary spending. Could telehealth be part of the solution?

That question led Timothy Peck, M.D., formerly chief resident in the Emergency Department at Beth Israel Deaconess/Harvard, to co-found a startup company, Call9, and become an advocate for legislation, the RUSH (Reducing Unnecessary Senior Hospitalizations) Act of 2018, to support reimbursement for connecting emergency physicians and SNFs.

Peck has spent considerable time studying the issue. “I didn’t know much about nursing homes when I started,” he said.  “I went and lived in one for three months. I wound up sleeping on a cot in a conference room.”

Peck was trying to understand nursing home finances and operations and why the patients are being transferred. They usually have things like urinary tract infections or pneumonia, which could be treated in the outpatient setting, but the SNFs aren’t equipped with the right tools to be able to treat these patients. Those patients come in without their families and 43 percent have dementia, he said. “Most become delirious upon transfer. We don’t have much information about them so we order every test under the rainbow, driving up the bill unnecessarily. We put them in hallways. They get bedsores. We inevitably admit these patients for an average of $15,000 to $20,000 per admission.”

The two-thirds of transfers that are avoidable represent about $40 billion in unnecessary spending for something that harms patients,” he said. “We are spending money on hurting patients.”

Peck zeroed in on three operational issues:

• First, on average, nurse to patient ratios in nursing homes are 1 to 36. If one patient becomes acutely ill and spikes a fever, that nurse does not have time to take care of that patient when they have 35 other patients to take care of. Also, most nursing home nurses are trained to handle chronic care, not emergency or acute care. It is a mismatch of skills, not a people problem in any way, he said.  

• Second, diagnostic equipment is sparse, and EKGs and lab tests take 24 hours to 48 hours to come back. That doesn’t work well for acute care.

• Third, physicians are not present in nursing homes. “When I was living in that nursing home and walking the halls weekends and nights, I never once saw another physician. Long-term care patients are seen once a month by their primary care doctors.”

Peck described the Call9 service: They embed 24x7 a paramedic or EMT or a nurse with emergency experience in the SNF. They go to the patient’s bedside and connect to a remote emergency physician who is available 24x7 and working from home. They can see a patient in nursing home A with a paramedic by the bedside and then jump to nursing home B and see a patient there with a first responder with them. “It makes the physician a scalable resource,” Peck said. “Believe it or not, they are our least expensive resource because they get scaled.”

Call9 has full integration with the three most commonly used EHRs in the SNF world. The solution also deploys a suite of mobile diagnostics and can return lab test results in a few minutes. It offers real-time telemetry and real-time ultrasound.

After treating a few thousand Medicare Advantage patients, he said the model has shown that it can save payers more than $8 million per nursing home per year. That allowed Call9 to get involved with Medicare shared savings value-based contracts with several payers nationally. But he notes that 60 percent of patients in nursing homes are Medicare patients. “We took that data to CMS and showed it to them,” Peck said. “The Ways and Means Committee in the House of Representatives got ahold of the data and got excited and started writing the Rush Act.”  He stressed that Call9 is not the only organization creating a program like this. There are others working on similar solutions.

Peck said CMS is interested in using telehealth in this way, he said. “But they don’t have any way to change payment mechanisms in a quick manner. They would have to ask CMMI to run demos, which takes years. But Congress could pass new legislation.” He described the RUSH Act as creating a value-based shared savings arrangement with Medicare where 50 percent of the savings goes back to Medicare, and 37.5 percent goes to a company like Call9 or a physician group or medical staffing group that administers the program and 12.5 percent goes to the nursing home, aligning all stakeholders, he said. “The bill has been introduced by a bipartisan group, because it is a nonpartisan issue.” With time running out in this session, he said, the bill still has strong support among Democrats set to take over House leadership in 2019.

Besides bipartisan sponsors in Congress, the bill also has support from patient advocacy groups such as the Alzheimer’s Association, Michael J. Fox Foundation for Parkinson’s Research, American Heart Association, the National Alliance on Mental Illness, and the American Telemedicine Association. “They are saying that the patients need it; the taxpayers benefit; why are we not doing this?” Peck said.

As someone who has seen family members and friends make that repeated, disruptive round trip from nursing home to emergency room, I concur.  

 

 

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Telehealth, Interoperability Recommendations Outlined in Administration’s Health Reform Report

December 5, 2018
by Rajiv Leventhal, Managing Editor
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Various health IT recommendations related to telehealth and interoperability were made on the part of the Trump administration as part of its report on reforming the nation's healthcare delivery system.

The 119-page report, "Reforming America's Healthcare System Through Choice and Competition”—authored by Labor Secretary Alexander Acosta, Treasury Secretary Steven Mnuchin, and Health and Human Services Secretary (HHS) Alex Azar—includes more than 50 recommendations that Congress, the administration, and states can take to improve healthcare choice and competition, including several recommendations related to telehealth services and improving the exchange of health data.

The report mostly reinforces comments that the administration has made several times before, and among the administration's telehealth suggestions included: improving license portability to create additional opportunities for telehealth practice and modifying reimbursement policies that impede telehealth coverage in federal health programs, such as Medicare's originating site requirements.  The report’s authors write, “For example, Medicare fee-for-service pays for telehealth services only when patients are located at certain types of healthcare facilities (“originating sites”) in rural areas with a shortage of health professionals. Another barrier is that states may require practitioners to have first provided services in person before caring for a patient by telehealth.”

Catherine Pugh, senior director of government affairs at Health IT now, a coalition that supports the use of data and IT to improve healthcare,  said in a statement following the release of the report, “Health IT Now endorses the recommendations in this report related to expanding telehealth services because we cannot allow this critical model of care delivery to be impeded by bureaucratic rules or geographic boundaries.” The statement continued, “We support the adoption of mutual recognition compacts among physicians—like those widely adopted in the nursing profession—to create additional opportunities for telehealth practice, as the Interstate Medical Licensure Compact is not broad enough on its own to improve license portability…”

Meanwhile, in regard to the need for greater interoperability, the report noted various barriers that exist in the market today, such as: medical complexity (a given diagnosis, treatment or procedure in medical records can be recorded in many different ways); lack of business drivers (the fee-for-service model provides little incentive to connect with other clinicians  or  service  providers  and  leads  to  significant  disconnects  across  the  care continuum); lack of accessible APIs (typically, EHR developers have either not published their APIs,  charged  prohibitively  high  fees,  or  set  onerous  contractual  conditions  to  use  their APIs); and lack of network exchange (most systems simply do not or cannot communicate with one another).

As such, the report mentioned the 21st Century Cures Act and recommended that “the administration should expeditiously implement [its] provisions to prevent information blocking, make it easier for patients anywhere to get  their  core  health  information,  support  “open  application  programming interfaces”  to  allow  patients  to  get  data  on  their  smart  phones,  and  encourage support of population-level data queries to allow payers electronic access to clinical data.”

The report further recommended that agencies such as CMS (the Centers for Medicare & Medicaid Services) and ONC (the Office of the National Coordinator for Health IT) should continue to work on ways to reduce the documentation burden that currently plagues clinicians.

What’s more, the report suggested that CMS should continue its efforts to make data available to patients through efforts such as “MyHealthEData” and Blue Button 2.0, and that “ONC should continue making standards more comprehensive and robust.”

Related Insights For: Telehealth

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Study: Physicians’ Use of Telemedicine Still the Exception, not the Rule

December 4, 2018
by Rajiv Leventhal, Managing Editor
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In 2016, 15 percent of physicians worked in practices that used telemedicine for patient interactions, such as diagnosing or treating patients, following up with patients, or managing patients with chronic conditions, according to an AMA (American Medical Association) study on telemedicine.

The research, published in the December issue of Health Affairs, which covers telemedicine trends in an array of different ways, gauges the emergence of telemedicine and its integration into healthcare delivery.

Regarding the overall use of telemedicine, the findings showed that 15 percent of physicians worked in practices that used telemedicine for patient interactions, such as diagnosing or treating patients, following up with patients, or managing patients with chronic conditions. Meanwhile, 11 percent of physicians worked in practices that used telemedicine for interactions with healthcare professionals, such as having a specialty consultation, or getting a second opinion.

When it comes to telemedicine use by specialty, radiologists (40 percent), psychiatrists (29 percent), and cardiologists (24 percent) had the highest use of telemedicine for patient interactions. In other specialties, the use of telemedicine for patient interactions ranged from 6 percent to 23 percent, according to the research.

Emergency medicine physicians (39 percent), pathologists (30 percent), and radiologists (26 percent) had the highest use of telemedicine for interactions with healthcare professionals. In other specialties, the use of telemedicine for interactions with healthcare professionals ranged from 3 percent to 15 percent.

What’s more, videoconferencing was the telemedicine modality with the most widespread use, as it was used in the practices of 13 percent of physicians. Use of videoconferencing was most common among emergency medicine physicians, psychiatrists and pathologists. Remote patient monitoring (RPM) was used in the practices of 7 percent of physicians.

Breaking it down further by practice size, physicians in smaller medical practices and physician-owned medical practices had a lower rate of telemedicine use than physicians in larger medical practices and ones that were not physician-owned. The findings suggest the financial burden of implementing telemedicine may be a continuing barrier, especially for that segment of practices, researchers said.

The researchers concluded, “Our work suggests that despite regulatory and legislative changes designed to encourage the use of telemedicine, the financial burden of implementing it may be a continuing barrier, especially for small practices. Even after we controlled for specialty differences, we found that physicians in larger practices and ones that were not physician owned were more likely to report that their practices used telemedicine for interactions with both patients and healthcare professionals.”

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