Coordinated Telehealth for the Affordable Care Act

As the Affordable Care Act (ACA) takes effect, new regulations and policies will alter the face of American healthcare, but there is no guarantee that the system will respond appropriately. In fact, if we continue with business as usual in the face of this new opportunity, then we will surely drive our country towards bankruptcy. This means that we need to rethink our care models: and telehealth may be the answer.

The ACA is a response to over 30 years of skyrocketing costs to care for an increasing elderly and ill population - and we baby boomers are dramatically adding to those numbers. These stats, coupled with 32 million newly insured Americans, will test an already strained care delivery system. The best responses to this increased challenge will be a renewed focus on prevention (over treatment) and staffing efficiencies, the latter of which has not occurred in healthcare despite the fact that we have witnessed this in every other industry. With 56% of our $2.8 trillion annual healthcare spend accounted for by personnel - we just can't afford to throw more people at the problem.

As the Chief Medical Officer for Telehealth at Philips Healthcare - and as a physician myself - I can tell you we must do more with less. Telehealth, or technology-assisted remote care, offers the opportunity to provide the access, quality and cost that will be necessary to increase prevention and leverage our current workforce. But what does telehealth mean? What it should mean is a coordinated and comprehensive methodology for health systems to manage people and patients across the care continuum - from hospital to home.

This potential can be seen when one intensive care specialist and three critical care nurses using a tele-ICU can co-manage 130-150 intensive care unit beds across hundreds of miles, covering nights and weekends, when there are no specialists at the bedside. This leverage is enabled by sophisticated algorithms and data presentation modalities that help the care team identify at-risk patients and intervene to prevent complications. This improved access results in better outcomes and cost savings, and this model must be extrapolated across the entire care continuum.

By providing two-way audio-video and physiologic monitors, the same methodologies used in the tele-ICU will enable home health nurses, health coaches, pharmacists and physicians to remotely monitor hundreds of patients: contacting them in their homes to alter medications and suggesting lifestyle changes, thereby avoiding trips to doctors' offices or emergency departments.

In this new high-tech high-touch world, teams of physicians, nurses, pharmacists, social workers and health coaches from a telehealth center will coordinate their respective activities and seamlessly transition people and patients as needed. For example, people at home with an emergency will have their history, medications and vitals sent directly to the ambulance team, so it knows what to expect; and treatment can be directed by remote physicians, thus preventing potential harm. When patients are discharged from the hospital they will not enter the black hole of medicine like they do now, but will have a team monitoring them. Patients will view their discharge instructions (that were recorded in the hospital) on their web-based portal, fully understanding what is required of them.

As we begin to implement integrated telehealth, it is clear that this is an important step forward for American healthcare. While the ACA catalyzed the movement towards better care models, there is still much work to be done to remedy our strained systems because business as usual is bad for our health.