Proliferation of mobile devices and tablets, a drive toward managing and sharing risk, and a need for efficiently and safely managing care are driving significant innovations in healthcare technology. Here are a few trends to watch in 2019.
1. Telehealth
Few technologies have spiked as sharply as telehealth has over the last several years. Eased legal restrictions, lower equipment costs, improved bandwidth, and the convenience of patients using their person laptop, tablet, or mobile device from the comfort of home are a few things driving the increase.
Telehealth is legal in all 50 states and two-thirds have passed “parity” laws, which require health plans to reimburse for telehealth services at the same or equivalent rate as paid for in-person services. Further, the Interstate Medical Licensure Compact, agreed to by at least 18 states, enables providers to practice telehealth across state lines.
Telehealth is not only being used to conduct visits that used to require a trip to the office. Nurses use telehealth to check-in with patients after hospital discharge. Pharmacists use it to conduct medication reconciliation and patient education. Physicians use it to consult with each other about referrals and complex cases. And it delivers great returns. In a recent survey of more than 300 clinical and IT professionals, 58% said telehealth increased provider satisfaction, 51% said it improved efficiency or timeliness of care delivery, and 47% reported an increased savings to the practice/facility.
And whether the services are delivered using live video or store-and-forward (whereby one party records and transmits something for the other party to review), reimbursement changes taking effect in 2019 are going to push its use forward even faster. This fall, CMS included a new code for “Virtual Check-Ins” in the 2019 Medicare Physician Fee Schedule Final Rule. Beginning January 1, 2019, providers will be able to bill for a brief non-face-to-face check-in with a patient via communication technology, to assess whether the patient’s condition necessitates and office visit, using HCPCS code GVCI1.
As more organizations take on risk and providers get comfortable delivering care virtually, we will continue to see increased spending and adoption of telehealth by health systems and provider organizations.
2. Remote monitoring
These technologies support connectivity between patients and care providers post-discharge, between physician visits, or from anywhere they are receiving care. For example, a platform that enables nurses to manage chronic conditions and monitor medication adherence. Or patients to send photos of an incision or rash to their provider. The data provides insight into behaviors and information about patients we didn’t have access to outside of the exam or operating room even ten years ago.
Patients love the utility of these technologies, which has increased as the number of people who use mobile devices has increased. Unless a provider organization is at risk, the amount of data produced by these apps has had slower adoption. Simply put, fee-for-service reimbursement didn’t cover the expense. Not that this has stopped the enormous growth of these technologies, which has a global market size estimated to be $31.326B by the end of 2023.
Adoption speed may change in 2019 when CMS modifies the way providers are reimbursed for remote chronic care management, using code 99091. Among other things, CMS will allow non-physicians to bill this code, which will now cover more services, such as onboarding patients into a program or educating them about equipment. Tracking and documentation will be easier too. Add to this the fact that the use of some remote technologies can be billed using the new Virtual Check-in code mentioned above, and remote monitoring has a strong business case.
3. Internet of Things (IoT)
From ingestible sensors and implanted devices that monitor data and transmit alerts to clinicians when something changes, to closed loop insulin delivery systems and inhalers that know when the patient hasn’t used them, the number of devices and data feeds that are connected through the Internet continues to explode. According to MarketWatch, the IoT market in healthcare is predicted to be $158B by 2022.
To date, the IoT devices and apps that have gained traction are those that automate the collection of critical clinical data, or help manage chronic conditions and at risk patients. Where things are heading now is toward integration of health, wellness, and personal tracking systems with electronic medical records (EMRs) and other medical systems. As fee-for-service reimbursement moves toward value based care and risk sharing arrangements, I think we’ll see this integration happen at a swift pace.
4. Artificial Intelligence (AI)
AI technology is used fairly extensively in other industries, but it’s still pretty nascent in healthcare. The first thought many people jump to is being diagnosed by a handheld AI device after it’s used to scan them.
Today, the most mainstream use of this technology is AI-assisted robotic surgery, which supports minimally invasive procedures in orthopedics, cardiovascular services, and other specialties, as well as radiology image interpretation. Outcomes from these these technologies have been positive. One study that included 379 orthopedic patients showed a five-fold reduction in complication rates. Another found that a machine learning algorithm could read 3D imaging scans 1,000 times faster than a radiologist.
As for AI diagnostics and integrated machine-human devices, algorithm concerns and ethics aside, we’re not there yet. But AI’s potential impact on care delivery, cost, and efficiency is amazing when you consider the integration of machine-based intelligence with human health. So it’s an important technology for all healthcare executives to have on their radar screen. To that end, in a recent survey of healthcare executives by OptumIQ, 75% said they are actively implementing or have plans to execute an AI strategy.
According to responses from those in organizations that are already investing in or implementing the technology, uses of AI include administrative operations, detecting patterns of potential healthcare fraud or waste, and monitoring users with IoT devices such as wearable technology.
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