By many estimates, only 5% of U.S. patients are high-need, high-cost (HNHC), yet they account for about 50% of health care spending. It has become a national priority to understand the needs of this patient cohort, identify drivers of their utilization, and implement solutions to improve their clinical outcomes while reducing their costs.
High-need, high-cost patients often have multiple chronic conditions, complex psychosocial needs, and limited ability to perform activities of daily living. Care delivery solutions, including care management, telemedicine, and home health visits, have had mixed levels of success for various outcome measures, including system-centric ones such as total cost of services and utilization of secondary care (emergency department [ED] use and inpatient hospitalization) as well as patient-centered ones such as self-assessed health status.
A possible explanation for the variable success could be that many solutions are designed primarily by health system administrators, not the patient “customers” who best understand their own needs. Little has been published about patients’ views on the care models that target their complex health care needs, which aspects of current care delivery high-need, high-cost patients find beneficial, nor how health systems can partner with patients to design and implement solutions. Better serving high-need, high-cost patients must begin with improving our understanding of their needs and perspectives.
Digital tech is slowly but surely creeping into the medical sphere. Just consider the ways in which patients are clamoring for more telemedicine and virtual doctor visit options while medical schools are harnessing virtual reality systems like Microsoft’s Hololens to teach anatomy to young surgeons. Now, a new study suggests that virtual physical therapy (PT) may be more effective and cheaper than the old-school variety.
The research was conducted by Cleveland Clinic scientists, centered on technology developed by Reflexion Health, and was published in the Journal of Knee Surgery(because, well, it featured patients going through PT after hip or knee surgeries).
Use of telemedicine in a sports medicine setting may provide efficient care to patients, reduced costs and high levels of patient satisfaction, according to results.
Alfred AtandaJr., MD, and colleagues compared time for clinical visits and wait times between patients younger than 18 years who had either a telemedicine visit or an in-person visit at a tertiary pediatric orthopedic center. Researchers calculated costs to patients and department, and a five-item satisfaction survey was completed by patients regarding their telemedicine experience.
Compared with in-patient visits, results showed patients who had a telemedicine visit had shorter visits and shorter wait times, greater percentages of time spent with the provider, lower labor costs and lower travel costs. Researchers found telemedicine visits saved families 85 miles of driving and $50 in costs per visit. Telemedicine visits also saved $24 per patient in labor cost. Overall, researchers noted more than 90% of patients who had a telemedicine visit were satisfied with the service.
More patients are willing than not to consider staying at home for video-based appointments with a health care provider, but the consumer demand for such an option still has a way to go before it could be characterized as overwhelming, according to a new study from the Mayo Clinic.
In a survey of 263 patients who recently received outpatient treatment at the Mayo Clinic Center, researchers found that about 66% of respondents said that they were “somewhat likely” (28.1%) or “very likely” (38%) to accept an invitation to meet with their provider by way of video from their homes. The survey included questions about familiarity with video calls, what kinds of technology patients owned, patient assessments of the value of video appointments, and costs of travel to the local institution, among other topics. Findings were published in the September issue of Telemedicine and e-Health.
The newly confirmed Secretary of Health and Human Services can put another item on her “to do” list—changing Medicare payment policy to allow for accountable care organizations (ACOs) to receive payment for telehealth and remote patient monitoring, including when used as part of physical therapy. At least that’s what a coalition of health care-related organizations and a tech corporation would like to see, anyway.
According to a June 11 article in Medscape, organizations including the Alliance for Connected Care, the American Telemedicine Association, and the National Association of ACOs have requested that Secretary Sylvia Matthews Burwell look at expanding Medicare’s coverage of telehealth beyond beneficiaries in rural areas who must travel to “originating sites.” This could be done, the letters argue, if Burwell were to waive restrictions in the Medicare Shared Savings Program.