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Telehealth Gains Momentum In Obamacare Era

The Affordable Care Act's focus on population health and cost-cutting is encouraging providers and insurers to invest in remote healthcare technologies.

patients after-hours via email and phone, she was seeking a more flexible professional environment. Dr. Boxer is now a full-time physician at Online Care Group.

"I can work from home. I can also travel. All I need is Internet access, a private room, and my lab coat. Patients are able to access me directly," she told us. "I really liked that idea of skipping the middle man. There are so many middle people in medicine. I loved the idea of compressing that into a direct-to-physician visit. I probably talk more about individual patient cases than I did when I was solo. It's a very efficient manner of giving and receiving care."

Online Care Group, which uses American Well's platform for its service, has about 500,000 consultants. On-staff physicians fulfill more than 90% of consultations, said Dr. Antall. Staff doctors communicate with each other via Microsoft Lync and use Citrix GoToMeeting for webinars and training sessions, said Dr. Boxer.

"It's wonderful to have this rich, intellectual exchange that is disappearing in the brick-and-mortar world," she said. "I think the most I've seen in one shift is 23 patients. It's very easy and quick to communicate without all the trappings of the face-to-face relationship."

Of course, telehealth doesn't suit every situation, patient, or doctor. Online Care Group will not prescribe narcotics or muscle relaxants, for example. And some patients must see a doctor in an office setting: if they are pregnant, have a wound, or have chest pains, for example.

Telehealth augments healthcare providers' population health and patient experience programs, and helps reduce hospital readmission rates, according to advocates.  

The University of Virginia Medical Center, the UVa Center for Telehealth, and the Mid-Atlantic Telehealth Resource Center all use telehealth services provider Broad Axe Care Coordination's C3 program to support patients recently discharged after a heart attack or those with heart failure, pneumonia, or chronic obstructive pulmonary disease (COPD), according to local media. Between its launch in September and April, the telehealth program is credited with reducing readmissions. Only 10.4% of patients enrolled in C3 re-entered the hospital within 30 days of release, over that time period, compared with 21.4% of similar patients in 2010-2012, UVa Medical said.

Yet rules continue to limit adoption. Even though 20 states have parity laws that require insurers to pay for telehealth services, some payers don't follow this requirement. Other states mandate that telehealth services must occur at a provider location, negating the benefits of making remote service available at the patient's home or office, Andall said. Meanwhile, he added, some of the rural areas most in need of the service have insufficient bandwidth to support telehealth.

On April 21, the Federation of State Medical Boards is scheduled to vote on a new telehealth proposal clarifying that, for purposes of state regulation, care occurs where the patient, not the physician, is located. The rule aims to ensure standards remain the same for both in-person and virtual services.

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