This guest post, by Henrik Ahlén of Alfa Bravo, is part two of two in a series of articles about the need for new ways to pay for eHealth. Click here to read part one.
Real Reimbursement for eHealth Use is Better Than Grant Funding
Research and development grants are of course very important for long term development, but in eHealth, there is now a big need for faster ways to introduce services that can be used on a larger scale. The technology of today is better and more cost efficient than ever. There is now a widely spread infrastructure with internet, smartphones, and tablets, and we already know how to build useful services. So now is the time to start reaping the benefit from this integration.
There is a need for a market that enables the creation of useful eHealth services that are based on concrete needs and can be used in healthcare and by citizens and patients today. The prerequisite for this is that both healthcare providers and the eHealth suppliers can get reimbursement. Reimbursement based on actual usage and created value is a better driving force for achieving this than project development grants.
Proposal That Stimulates Development and Healthcare Adoption
1. Update the existing reimbursement models now.
Start by adding eHealth services to the existing reimbursement models. For example, a patient visit to a doctor or nurse should be reimbursed with the same amount if it is done via internet.
2. Create an independent fund for development of new reimbursement models for the healthcare system.
There is a need for new forms of reimbursement models for those eHealth services that support new ways of providing healthcare, self care, and rehabilitation.
A public fund is needed for this, a fund that invites suppliers of eHealth services, both from within the national health service and from external organizations, to apply for pilot projects with one to two years of reimbursement that is paid to the healthcare providers for their use of these services.
A suitable reimbursement model is determined for those services that are considered to create real health benefits. To get started quickly, prioritize applications that can be used with a minimum of integration with other information technology systems during the pilot period. Usability and concrete benefit for patients and/or healthcare professionals must be the primary requirements.
These services shall be used for care being provided today by the existing healthcare providers on local and regional levels.
Support the Health Services, Not the Suppliers!
The core concept of this proposal is that the economic support from the fund is not transferred directly to the supplier of the service, but to the health clinics that are using the service. Also, reimbursement is based on the actual usage and/or the measured value of the service.
The health clinic receives support from the fund. This support is aimed at covering the direct costs of the service and compensating for the loss of traditional reimbursement for patient visits. This will entice health clinics to start using eHealth services. The supplier of the service must first have it developed. Then the supplier can sell it to the health clinics to get their share of reimbursement for the service from the health clinics during the pilot period.
During the pilot period, the money flows from the fund -> healthcare -> suppliers. This puts healthcare in the driver’s seat, and the suppliers get real money for their services. This will build up very valuable real life experience from large scale use on how the eHealth services work for patients and healthcare professionals, what work flows need to be updated, and what reimbursement models work best for different types of eHealth services. It also makes it easier for the eHealth suppliers to invest in innovation and development, since they can do revenue calculations, just like in other business sectors.
Marketing and Follow Up
Currently, eHealth services are not widely known by most people. It is important to promote these services to healthcare providers, as well as to the general public and various patient groups.
A major advantage of eHealth services is that they make it much easier to gather continuous feedback from their usage, their effects on health status, how they are perceived by both patients and healthcare professionals, and the economic results. A retrospective deep analysis should be performed after the pilot period. This analysis will extract valuable insights that can be used for recommendations on how to proceed and update the reimbursement models.
Dare to Take Risks
All eHealth services may not work as well as intended when they are deployed on a larger scale. Some reimbursement models may lead to abuse or may not provide predicted cost savings. By using my proposed implementation model, this can be done within the limited budget of the fund and give valuable experiences from field use by the patients and the health services. These experiences also create a good basis for the ongoing investigations of eHealth reimbursement models.
Define the Value Chain
In order to be able to develop working reimbursement models, it is important to start by defining the complete value chain.
Where in the value chain does the eHealth service create value?
For example, the value chain may consist of:
Patient – Primary care – Specialist care – Institutional care – Homecare – Geriatric care – Research
Stakeholders That Need Reimbursement
Different types of eHealth services require different reimbursements to the care organizations and the eHealth suppliers.
Health Clinics:
The care organizations that are using the service with their patients, such as a primary care center, specialist clinic, physiotherapist, or psychologist.
eHealth Suppliers:
The organizations that are operating and managing the services. Sometimes they are also also the developers of the eHealth services.
Types of Reimbursement Models
Have a discussion with different types of stakeholders from the value chain about reimbursement models that may be suitable for different types of eHealth services. Here, it is important to think outside the box. It is important to create models that really use the new digital capabilities in the best possible way and are not simply digital avenues to deliver healthcare in the traditional way.
Examples of eHealth Applications
- Patients chatting with a doctor or nurse using their smartphones.
- Patients having online video consultations with their primary care doctor, getting advice and prescriptions without having to visit the clinic.
- Primary care doctors taking pictures and logging data into a mobile application for immediate transfer and evaluation by a remote specialist.
- Patients with chronic diseases, such as heart failure or chronic obstructive pulmonary disease, using a smartphone or table with connected medical sensors for daily monitoring of their parameters, receiving insights into how their lifestyle choices affect their health, receiving automatic alerts when there is a worsening trend in their condition, with an option to have a video consultation with a nurse or doctor.
- Patients with depression using a smartphone application for cognitive behavioral therapy.
- Nurses at specialist clinics using online video consultations for routine follow ups of patients, instead of requiring them to visit.
- Services and applications where the patients are supporting each other in their self care.
Examples of Reimbursement Models
To Health Clinics:
- Reimbursement per use of an internal service, or reimbursement per user per month.
- Reimbursement per online patient consultation.
- Reimbursement for providing monitoring and support using an eHealth application, on a per patient per month basis.
To Suppliers:
- A fixed fee for initiating eHealth services at a clinic or in the home of a patient.
- Reimbursement per support intervention, online consultation, or home visit.
- Reimbursement per month for operation and support of an eHealth service.
For those eHealth services that are provided to the patients by a clinic, all of the reimbursement should go to the clinic. The clinic buys the eHealth service from the supplier and pays the supplier according to the models described. A split model can also be considered, where the reimbursement is split between the clinic and the supplier. When the suppliers are paid based on actual use of their eHealth services, it spurs them to make sure that the services are widely used and work optimally, for both the clinic and the patients.
Additional Things to Investigate
- Map out the current options for reimbursement of eHealth services in various types of healthcare organizations and a summary of all the ongoing studies about eHealth reimbursement models, both nationally and internationally.
- How can models be applied where the clinic receives the full reimbursement for the use of the service and buys the operation and management of it from the supplier?
- Are there types of eHealth services where some forms of patient fees could be a part of the reimbursement?
- How can preventative healthcare services be reimbursed?
- How can abuse be prevented? A common objection against eHealth services is that they can be abused or lead to overconsumption of health are services.
eHealth is Spreading Globally
There is rapidly growing interest and need for eHealth reimbursement models. National health services and eHealth developers and suppliers would benefit if these models could be standardized, whenever possible.
But What is eHealth? Why New Reimbursement Models? Read part one.
Part one in this series explains the problems with current models and why there is a need for new reimbursement models for new types of eHealth services.
Feedback and comments are welcome! Email Henrik Ahlén.