Telehealth and Care Continuity

Posted by Michael Greiwe, MD | November 8, 2018 |
Michael Greiwe, MD

Much has been written on healthcare’s silos. There are silos of care between service lines and specialties and even ambulatory sites within a hospital system. As far back as a decade ago, we recognized that “all care is not local” and our increasingly multi-state dispersed treatment centers, coupled with a mobile population, and were disrupting the continuity of care that traditionally was the hallmark of the family practice physician. Today, millennials don’t even select a primary care provider, instead choosing the convenience of episodic and potentially cash-based treatment from walk-in or urgent care centers.

We already understand the importance of consistency in care delivery, but a recent review of the current research published in BMJ shows that continuity of care is, in fact, a matter of life and death.

While we’re making an effort to put the family practice doctor back at the center of the wheel hub, physician shortages are going to nullify some of these efforts. But there is a technology right at our fingertips to improve the continuity of care with patients. As the aging of the Baby Boomers is about to hit full-force, using telehealth to manage chronic long-term conditions will help improve care continuity in the United States.

The Importance of Silo-Smashing

“Despite the inherent rigidity of silos, the forces of transformation continue to gain strength, driven by patients, by economics, and by a society that expects high quality and safety in care at a manageable cost. Systems of care are gradually transitioning to structures in which “silos” are being replaced by “teams,” and the provider-centric focus of the past is giving way to a patient-centric focus for the future.”
“Breaking Down Clinical Silos: Enhancing Care Coordination”
Frontiers of Health Services Management
Foundation of the American College of Healthcare Executives

Clinical integration has been as much of a buzzword phrase as the idea of care continuity. Despite becoming almost clichéd, the concepts themselves are crucial to improved care quality and lowered costs. Yet how can these sprawling systems of care achieve the goals of care continuity when even how we’re paid is fragmented based on payer, physician specialty, and the service itself.

Problems with care continuity may end with payment, but they start with the patient. 90% of our $3.3 trillion in annual healthcare costs are for people with chronic care conditions. This makes it a necessity to have one primary care coordinator to integrate the sometimes-disjointed and certainly complicated long-term treatment modalities.

Care coordination is a patient-centric framework that addresses gaps in the treatment of chronic conditions. Studies show having coordinated care cuts costs and improves healthcare outcomes and patient satisfaction scores.

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Unfortunately, there is no standard for what coordinated care looks like or how it can be achieved. There are currently several types of coordinated care models, including:

  • Disease management programs, which have been around for a decade to manage chronic conditions. But these programs often fall short of true care integration, instead offering appointment setting and patient education. While important, these are often just additional services added on to an uncoordinated care model.
  • Case management is often more about receiving prior authorization from a payer and not true care coordination.

While the entire concept of accountable care organizations is to bring together a dispersed healthcare paradigm around a patient population, the concept is still evolving and have had mixed results.

Community Catalyst suggests criteria for true care coordination to include:

  • Placing the patient and their family at the center of care.
  • Coordinating care across multiple clinical and non-medical services.
  • Facilitating appropriate clinical support to coordinate care.

We would suggest that there is a tool available currently to meet this criterion and to help fill patient care gaps while providing true continuity of care. The technology is telemedicine and here is how it can help patients with today’s disjointed care experience.

A Telehealth Framework for Patient Continuity

“As our global population grows older with a higher incidence of chronic conditions, we have an imperative to truly improve quality of care both within and beyond the walls of the hospital while reducing costs. Continuity of care plays a key role in patient management by ensuring that patients experience a smooth transition from the hospital back to the home, and new models of care that utilize telehealth technologies will be important to support this process and reduce rehospitalizations.”
“Using Telehealth to Improve Continuity of Care”
Brooke Schmidt
Patient Safety & Quality Healthcare

The goal of telemedicine is simply to bring treatment to the patient wherever they may be. This goes to the heart of the “patient first” goal of care continuity. Telehealth can bring together a dispersed healthcare team and their patients in the following ways:

  • Strengthens the doctor/patient relationship
    Video-enabled treatment can follow a patient home after their inpatient stay while allowing clinicians to provide additional clinical counsel to patients and their caregivers. This can strengthen the doctor/patient relationship; studies show this can engage patients in their own treatment and increase patient satisfaction with their quality of care.
  • Reduce inpatient costs
    Most hospitals are now providing treatment by using telemedicine applications. Studies have shown that telemedicine can reduce inpatient admissions on long-term chronic diseases. This is on-demand treatment that can link mid-levels, clinicians, patients, and their families. Telehealth is available both as an on-call or scheduled service. This can cut down on emergency room trips – which also reduces costs.
  • Improves communication
    But it’s the simple idea of improving the speed and accuracy of communication between specialty providers that hold such power within the telehealth framework. One study utilized a nurse as a clinical care coordinator for a group of patients. Remote monitoring was utilized to help patients make better behavioral choices to more positively affect clinical outcomes on chronic disorders. Care between doctors was streamlined by using simply video conferencing to coordinate treatment.

As the majority of the American population moves toward retirement, healthcare costs will continue to skyrocket. Care will continue to be disjointed, which will ensure that patient care quality and even mortality will continue to suffer. Telehealth can shift the paradigm and fill treatment gaps to improve the patient experience. Providers such as OrthoLive, have developed specific applications that leverage this important technology to cut costs, and improve outcomes. Contact OrthoLive to get to know telemedicine, its benefits, and how it could help your practice.