In a keynote speech delivered Dec. 14 at the Kaiser Permanente Institute for Health Policy’s Forum on Telehealth in Washington, D.C., Burstin, who will assume the role of executive vice president and CEO of the Council of Medical Specialty Societies next month, called telehealth’s distribution across the U.S. uneven and its assessment among providers mixed.
“We still have urban and rural areas that have substantial deficits in access,” she said. In particular, Burstin called access to specialty care such as mental health difficult. Especially challenging, she said, are issues like training, tech support (particularly for smaller organizations) and reimbursement.
“We need education and training of the entire team,” Burstin said. “This isn’t just about docs … as somebody who teaches residents, my residents have never encountered telehealth. They have never had that experience.”
Integrated Systems Make for Effective Telehealth Measures
Challenges aside, Burstin noted that telehealth use at integrated organizations such as Kaiser and the Department of Veterans Affairs has been successful because it’s seen as a norm in care rather than an exception.
“In many of these [integrated organizations], telehealth is part of the same system. The same clinicians provide both in-person and remote care. They have the same electronic platform,” Burstin said. “We need to think about what those experiences are. What are the opportunities to spread some of what [Kaiser Permanente] has done so beautifully to others?”
Coming up with a way to effectively measure the success and impact of telehealth is critical, she said, especially with all of the complications and moving parts to such setups.
“We also have to think about what are the special kinds of measures that we can add to our measurement framework that may give us a better glimpse into maybe what telehealth brings to the table that may not be just looked at with our traditional quality measures,” Burstin said. “So, measures like timeliness, travel time, costs, in addition to the patient experience and outcomes.”
Telehealth Providers Should ‘Be Big and Bold’
In a recent survey conducted by the Center for Connected Medicine — a collaborative healthcare executive briefing center operated by the University of Pittsburgh Medical Center, IBM, Lenovo Health, Nokia and GE Healthcare — 35 of the largest health systems in the U.S. were asked about their reasons for implementing telehealth and remote monitoring technologies. Seventy-five percent of executives cite improving the quality and safety of care as their top reason, and the report notes that many leaders say they pursued use of such services “despite the lack of reimbursement.”
To move forward, however, Burstin said providers can’t just look at access and quality outcomes without considering costs.
“We collectively as a community need to think through where there may be examples of where, in fact, telehealth has increased costs,” she said.
Additionally, organizations must think outside the box when considering telehealth going forward, Burstin stressed. She used the example of researchers at Memorial Sloan Kettering Cancer Center deploying remote monitoring to allow patients to report symptoms to clinicians, which led to improved quality of life and longer overall survival.
“We have to be big and bold here,” she said. “We have to think about using these services in ways we may never have imagined.”