This guest post, by Henrik Ahlén of Alfa Bravo, is part one of two in a series of articles about the need for new ways to pay for eHealth.
Today, most eHealth services are used for fitness activities and various forms of self care. But the biggest benefit is for patients with chronic diseases. This group stands for around seventy five percent of the total healthcare budget in most countries, so there is an enormous potential here.
But What is eHealth, and What is the Problem with Current Reimbursement Models?
Here, in part one of this series of articles, I explain this and why there is a need for new reimbursement models for new types of eHealth services.
Part two will describe a way to create reimbursement models that will drive innovation and broad implementation of eHealth applications.
What is a Good eHealth Service?
eHealth is about digital services via internet (computers, tablets) and smartphones. A fundamental goal should be that the eHealth applications should be useful for both patients and healthcare staff/clinics, and at the same time save money. So we must strive to develop eHealth services that are:
Patient centered, empowering the patient in her care process and enabling a better control of her health status through continuous follow up.
Improving the health, by letting patients with chronic diseases report their health statuses and medical data continuously via the internet, instead of only during doctor visits. This enables the patients to be more engaged in their care. They learn about lifestyle habits that are affecting their individual health. eHealth services that are used by the patient in the home can also trigger an alarm when monitored data show a critical trend, which allows for early intervention that can prevent many cases of hospitalization, (seventy four percent decrease in the US).
Streamlining the healthcare process, by lowering the pressure from patients that used to come for routine visits and enabling visits that are more personal and based on the patient’s own reported data and prepared questions. The staff can then focus more on the types of healthcare services [provided] and [on] patients that specifically require in person care.
eHealth applications can also enable earlier detection of chronic diseases based on input gathered online that shortens the journey from first symptoms to diagnosis and proper treatment. This can lead to better health throughout life and large savings for society. This can be achieved by quality assured, interactive online tests that guide anyone with early symptoms through the healthcare process and streamline, or in some cases, eliminate the remittance process.
There are already online services where anyone can buy medical tests and blood panels at their own expense, have them done at a nearby medical lab, and then own and control the resulting medical data. This gives valuable insights to those that want to know and learn more about their health status. But what is often missing now is a way for the patient to transfer this data to the healthcare provider…to facilitate…diagnosis.
Coming soon are medical devices for use at home, with which anyone can perform various medical tests themselves, for example, blood sedimentation rates in order to verify possible infections. This will save a lot of time for the citizen and reduce the workload for the staff in both primary and specialist care. There are also applications that let primary care doctors send imaging and medical data to specialists for quick analysis, enabling faster access to specialist care for those that need it.
Saving money and staff time, both patients and [healthcare providers] get shorter lead times. The patients are saving travel time and reducing their lost income due to healthcare visits. Patients with chronic diseases can continue to work for longer, adding to the GDP.
Cooperating, eHealth services should be able, when it is beneficial, to exchange data with other relevant e-services, such as personal health accounts, medical health records, and decision support systems in the health services. In many cases, eHealth services can help the patient to enable family and relatives to give active health support, even when they live far away.
eHealth is Not About IT
Please note that eHealth services should not be seen as technical information technology services, but as complementary medical tools for improving healthcare and self care. Compare with when the banks started offering online services, such as internet banking and mobile payment apps, to their customers.
Examples of eHealth Services
DiabetesTools, Sweden, self care for diabetics
Focus Cura Home Monitoring, the Netherlands, home care system for patients with chronic diseases
Health Tap, USA, sixty five thousand doctors offering telemedicine consultations
Livanda, Sweden, cognitive behavioral therapy online
PatientsLikeMe, USA, community for patients
RxEye, Sweden, platform for radiology diagnostics
Scanadu Scout, USA, portable medical scanner for home use
WebMD, USA, health information portal
(Please help me list more examples that are in use today and have English homepages.)
What is a Reimbursement Model?
A reimbursement model for eHealth services describes the value created by the service and how the suppliers and the healthcare clinics that are using it for their patients are to be compensated: who shall pay, how the reimbursement shall be calculated, and what parties shall get the money. The reimbursement can be flexible (pay per user or per use of the service) or fixed (a fixed sum per month).
In most countries there are discussions about healthcare reimbursement models and eHealth services, discussions that have delayed the introduction of useful eHealth services for years.
But there are at least three levels of eHealth services that are possible to offer now:
- Simple and time saving digital tools for communication between healthcare professionals and patients, such as email, chat, and online video meetings.
- Mobile apps and internet services for patients and citizens, as well as healthcare professionals, that can be used within the current healthcare system, such as online video consultations, apps for cognitive behavioral therapy, and decision support systems for patients and doctors.
- Tools for patients with chronic diseases that enable them to stay in their homes and manage a large part of their own care, assisted by remote monitoring of critical parameters by [healthcare providers]. The patient registers different vitals daily with medical devices that automatically transfer the data and send an alert if something needs intervention. Using an iPad or similar tablet, the patient can, at any time, get a personal video meeting with a nurse or doctor. This service is appreciated by patients in the Netherlands and other countries where it is already widely used. There it also leads to immense cost savings due to the reduced need for hospitalizations.
There is also a global trend to change the existing fee for service model to a more value based model, which means paying for achieved health instead of per visit, procedure, or medication. This [shift] has to take long time to develop, as it is a controversial model that changes the entire healthcare system. But eHealth services will play an important role also here, since they are cost efficient and make it easier to follow up on healthcare results.
Here is an article about president Obama’s proposal for a new reimbursment model for US doctors.
What are the Obstacles?
The two major obstacles for the development and broad use of eHealth services are the lack of reimbursement models and the complexity of the [healthcare] systems. Current [reimbursement] models are often not possible to apply to eHealth services. There is also a lack of reimbursement models for new types of health services that can only be performed by eHealth tools.
For example, in most cases, there is no way of compensating for when a doctor reduces the need for physical visits by using online video meetings instead of physical meetings, or when a patient is using a mobile app and sensors in her home to manage her own health status and report it to [her healthcare provider], when needed.
Who Should be Reimbursed?
- The supplier must be able to finance the development, operation, and support. The supplier can be an organization within the national health service, a private eHealth company, or a nonprofit organization, such as a patient community.
- A healthcare clinic that is using the eHealth service as a complement to their traditional services must also get reimbursement from this. Today, many clinics are relying on reimbursement for routine visits, so the loss of income when patients show up [less frequently] should be compensated.
- Specialists providing telemedicine (working with patients via video link) must be reimbursed, for example, dermatologists that examine pictures of possible skin moles and other specialists that are following up on medical data from the patients.
Who Will Create the New eHealth Services?
There is a huge need for many types of new eHealth services, and the global development pace is accelerating, both for services that are used in the national health service and for digital tools that patients are using for self care.
It is important [that] the national health services are actively engaged in both the development and the quality assurance in this development. Many eHealth solutions are already developed within the healthcare systems, but it is not likely that [the national health services] will be able to develop and operate all of the new eHealth services that are needed. Applications for internal use, patient information services, and, for example, services for patients with rare diseases, could well be developed by the health services.
But a large [portion] of broad eHealth applications are developed faster and more cost efficiently by external producers that can spread their development costs and operation [among] larger user groups, nationally or internationally. Such producers could be private companies in eHealth, medical technology, or pharmaceuticals, but also patient communities, industrial organizations, and nonprofits.
How Will the New Reimbursement Models be Developed?
There are lots of eHealth pilot projects in operation in many countries, most of them are financed by public grants and developed by academic institutions. Many of these pilots have created useful applications, but they seldom leave their pilot stages to become nationally spread services.
The developers and suppliers experience that it is difficult to find ways to be paid for the development, operation, and support of the eHealth applications, decreasing their interest in innovation.
The lack of reimbursement models makes the healthcare clinics reluctant to use [eHealth services], as they see that they are not paid for helping their patients use them. They often lose revenue if their patients pay fewer visits.
So there is little or no incentive for a doctor that wants to offer remote care via internet. It is also hard for suppliers to sell eHealth applications to healthcare clinics, even when it is proven that they are saving money and improving health and patient satisfaction.
So healthcare clinics are staggering under the increasing work loads, and patients must still allocate time to come [in for a visit] for most types of healthcare, even such visits that many today would prefer to do online. This is not sustainable today, even less so in the coming years, with the growing healthcare needs from our aging populations!
The National Health Service in the UK is realizing this. See this interview in the Guardian with the National Health Service Medical Director, “Wearable technology plays a crucial part in [National Health Service] future”: “Over the next few years the [National Health Service] will push forward with ‘a huge rollout’ of such devices as part of ‘a revolution in self care.’
How to speed up eHealth use? Read part two on Thursday.
Part two in this series of articles will cover new reimbursement models that enable rapid implementation and wide use of useful eHealth services.