I continue to believe that telemedicine will be one of the key elements enabling hospitals to provide services to more consumers at a lower cost. Telemedicine was initially limited to simple, easily diagnosed conditions but is now expanding into areas like chronic care (see: Treatment of Patients with Chronic Diseases: Important for the Future of Telemedicine. Early adopters of telemedicine such as Kaiser Health (see: Kaiser CEO: Telehealth Outpaced In-Person Visits Last Year) and the Cleveland Clinic are now testing new types of care delivery with the technology and a recent article was devoted to this topic (see: How Cleveland Clinic uses telehealth to introduce new dimensions of care). Below is an excerpt from it:
Telehealth may have begun as being most relevant for urgent care, but it has greatly expanded its potential and can be effective across many departments of a hospital. Cleveland Clinic has introduced telehealth across 40 different departments, including neurology, endocrinology, heart and vascular, women’s health and genetics. Any department can be an optimal fit for virtual care, as long as the excitement for telehealth is built into the DNA of providers....Cleveland Clinic has introduced telehealth across many different types of visits, from post-operative care and shared medical appointments, to discharge follow-up and coaching. They see future opportunity for areas like home care and medication reconciliation. The health system thinks beyond the routine visit for a cough or cold, and has experimented with patients in all types of situations. Cleveland Clinic recently began a chronic care and remote patient monitoring pilot, providing video visits to hypertension patients. The pilot involves care coaching and management, combined with remote patient monitoring to assess and track the patients. The pilot relies on data from consumer devices, the platform’s integration with Apple HealthKit, and devices to monitor blood pressure.
In this note, I want to briefly discuss the use of telemedicine in health coaching which is defined in the following way:
Health coaching is differentiated from [w]ellness coaching in that health coaching is the use of evidence-based skillful conversation, clinical interventions and strategies to actively and safely engage client/patients in health behavior change. Health coaches are certified or credentialed to safely guide clients and patients who may have chronic conditions or those at moderate to high risk for chronic conditions (see: Health coaching).
Health coaching with telemedicine seems to me to provide a solution for the care of patients with chronic diseases. However, one of the criticisms of telemedicine by hospital executives has been that reimbursement is complex and sometimes inadequate (see: Telemedicine Reimbursement). However, health coaching with telemedicine may necessitate a reevaluation of this criticism. Hospitals are currently penalized if their inpatient readmission rate is too high (see: Medicare’s Readmission Penalties Hit New High). It may thus make sense financially for hospitals to focus part of their telemedicine health coaching effort on patients post-discharge who have a high likelihood of readmission such as those with congestive heart failure (see: Hospital Strategies Associated with 30-Day Readmission Rates for Patients with Heart Failure). In so doing, a reduced reimbursement rate for these patents can be ameliorated by the lower readmission rate that is achieved.