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Telehealth Satisfaction Up Snags Remain, Home Care Cuts Medicare Costs & more -The HSB Blog 10/13/20

Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist, J.D. Power Finds

Event: (10/1) On October 1st, J.D. Power released its 2020 U.S. Telehealth Satisfaction Study noting that while “public awareness with Telehealth is higher due to ...COVID-19, the barriers for the consumer to engage with the technology has been a consistent theme” in their research.

Description: The survey of approximately 4,200 healthcare consumers who have used telehealth services within the last 12 months, was conducted from June-July 2020. The survey measures consumer satisfaction based on 4 factors (in order of importance): customer service, consultation, enrollment and billing/payment. Among the key finding of the study were: 1) overall customer satisfaction scores for telehealth were among the highest of all healthcare, 2) barriers to access still exist with 52% of telehealth users stating they had encountered at least one barrier that made it difficult to use telehealth: with the most common complaints being services were too limited (24%), technology requirements were confusing (17%), or there was lack of awareness around cost (15%). Researchers found that many of those who were less satisfied with telehealth had lower self-reported health, lower wellness levels, and an overall lower health status

Implications: While overall telehealth patient satisfaction scores have risen, both technical and access barriers remain (with technical audio issues being the most frequently reported problem). Driven to telehealth largely by the COVID pandemic with 46% of respondents indicating safety as the main driver for utilization, providers and payers now need to address how to make the technology even easier and more accessible. It is especially important for those in under resourced communities which may have technological limitations as well as for seniors who may struggle with the technology due to physiological issues (hearing or vision loss, etc).

Avalere Analysis Shows Home Care Services Reduce Medicare Spending

Event: (10/2) Healthcare consulting firm Avalere recently released an analysis that showed Medicare Fee-for-Service (FFS) patients getting home-based care services experienced a reduction in Medicare spending compared to patients who did not receive home based care and actually saw an increase in spending. Specifically Avalere determined the average Medicare FFS change in per-beneficiary-per-month (PBPM) was a decrease of about 5% for those with home care versus an increase of approximately 16% for those without home care.The study also found the spending difference was higher among Medicare beneficiaries with functional limitations and multiple chronic conditions.

Description: Avalere conducted a retrospective study to analyze the comprehensive effect of home care interventions on Medicare spending. The Avalere retrospective study conducted from 2009 through 2018, compared 31,000 Medicare beneficiaries with home care services between 2012 and 2017 and those without home care services. This suggests a lower spend over time with home care services. Similarly, condition-specific subpopulation PBPM spending was low for home care services. The conditions compared were Diabetes with Chronic complications (-$227 vs +$324), chronic heart failure (-$175 vs +$432), and chronic obstructive pulmonary disease (-$155 vs +$410).

Implications: The analysis recommends home care services as an efficient means to manage frail beneficiaries with chronic conditions against a difficult experience of a significant decline in their health and high-cost healthcare services. Homecare can save Medicare money by preventing unnecessary emergency department visits, hospitalizations, and readmissions. While additional research is mandated to concretely determine which home care services are causally linked to lower spending, the analysis shows a correlation between the delivery of home care services and reduced spending over time.

Startup Aimed at Helping Patients Understand Doctor’s Orders Abridge Launches

Event: (10/6) On October 6th, a new startup called Abridge was launched fueled by $15 million in funding. Abridge is an app that uses machine learning to record a patient's doctor's visit and then turns that recording into a patient focused transcript that simplifies details of their symptoms, conditions, procedures and medications.The app is designed to increase patient understanding of their diagnosis and adherence to their treatment plan.

Description: Patient adherence has long been a problem in healthcare with the CDC noting that 20% of new prescriptions are never filled and over 50% of prescriptions are taken incorrectly. According to the CDC this lack of adherence is a combination of intentional factors such as inability to pay and unintentional factors such as a patients lack of understanding of how to use the medication. Abridge was built on the basis that everyone needs an easy way to remember and understand the details of their care. The new platform aims to help patients follow their provider’s advice and educate patients about their health, by recording the doctor’s visits and translating the conversation into an understandable transcript.

Implications: With access to digital tools like Abridge, patients will be more comfortable and confident at their medical appointments and it will allow them to understand and question unfamiliar terms that may interfere with diagnosis and treatment. As a result patients will be better able to understand provider instructions and gain more insight into their plan of care. With Abridge’s automated speech-recognition technology at their disposal, patients will be able to take a more active role as an engaged consumer in their own care. This approach should lead to increased medication adherence and improved health behaviors both of which should contribute to higher quality outcomes at lower costs.

COVID-19 and Psychological Distress-Changes in Internet Searches for Mental Health Issues in New York During the Pandemic

Event: (10/5) The Journal of the American Medical Association (JAMA) recently published a research letter looking at trends in internet searches for mental health issues in NY during the COVID pandemic. In order to better understand the pandemic’s impact on mental health the authors used Google Trends data to examine internet search histories for people living in NY state for the terms “suicide”, “anxiety”, “panic attack”, “insomnia” and, “depression” during the period from 3/22/20 (when NY state entered a COVID lockdown) through 5/14/20 (when portions of the state began a phased reopening).

Description: To better understand the mental health concerns and the impact the pandemic had on mental health the authors used trends in search data as a proxy for increase or decrease in disease. According to the authors searches for anxiety significantly increased following the lockdown and remained on average 18% higher than expected prior to lockdown for a period of three weeks. Searches for the term panic attacks rose dramatically (56%) in the first week following closures and remained at elevated levels for five weeks. Similarly searches for the term insomnia rose 21% than historical data would predict during the lockdown and remained at those higher levels throughout the lockdown. Somewhat surprisingly, searches for the terms suicide and depression didn’t exhibit a significant increase from pre-COVID patterns, with the authors theorizing that this might be due to the impact of a feeling of solidarity with others facing the same situation.

Implications: The study lends credence to the idea of using digital tools/data like internet search terms/trends in social media to get real time indications of changes in the mental health of a population. This type of data could be very useful both in tracking the longitudinal health of certain geographic populations as well as tracking the emotional health of a population in response to specific traumatizing natural or man made events (storms, fires, terrorism, etc.). By giving public health officials a more rapid view into changes in mental health, data like the above may empower a more proactive response from public health officials. This could, theoretically lessen the impact of such incidents on a population's mental health and thus lower the cost of care.

Healthtech Startup Your.MD Raises €25m from FTSE 100 company

Event: (10/05) European startup newsletter, Sifted recently ran an article that London-based healthtech startup Your.MD has raised €25m (~$29.5M USD) in fresh funds from Reckitt Benckiser (“RB”) to roll out its "health hubs" concept. Your.MD has developed a self-care app, Healthily, that helps users learn, assess, navigate, improve, and track specific behaviors that lead to better health.

Description: Your.MD is using artificial intelligence to help users make better decisions around health. Unlike some others however, it does not make a diagnosis. Rather Your.MD is using AI to help users check their symptoms and advises users on what they should do next, whether it be talking to a doctor, ordering tests and medications, or finding a specialist. The company also views the app as a way to help lessen the strain on the healthcare system. The app provides a symptom mapper that shows users how their symptoms compare to others around the world. According to the company, it has seen a 350% increase in the number of users over the last 12 months, from 6m users from January to August 2019 to 26m the same period this year with part of the increase attributable to Your.MD’s COVID-19 symptom mapper, which had more than 4M visits.

Implications: Firms like Your.MD which allow users to measure and monitor their own health help patients save time from unnecessary doctor consultations and empowers them to stay engaged and responsible in the management of their own health. In addition, Your.MD’s partnership with RB shows the strength of working with strategic investors, such as RB, which owns several over the counter brands such as Strepsils (similar to Cepacol), Gaviscon and Nurofen (Ibuprofen) which have broad consumer reach. As healthcare becomes more retail oriented this will become increasingly important.

Event: (10/6) A recent article from PR Newswire noted that AdventHealth, a healthcare system based in Florida, rolled out its tele-ICU care services. This is an extension of its existing partnership with Advanced ICU Care, as it joins other AdventHealth hospitals that have telehealth-enabled ICUs. The partnership involves remote inpatient telemetry monitoring in addition to virtual ICU services.

Description: AdventHealth Lake Wales, is a 160-bed acute care facility that strongly believes in whole person health as well as quality care. In 2014, AdventHealth created a partnership with Advanced ICU care, which is one the nation’s leading provider of high-acuity telemedicine. This partnership provides tele-ICU services that support frontline critical teams in the ICU. Tele-ICU services consist of an off-site command center in which a critical care team made up of intensivists and critical care nurses are connected with patients in distant ICUs to exchange health information through real-time audio, visual, and electronic devices.

Implications: The new tele-ICU installation will move AdventHealth Lake Wales towards achieving the AdventHealth three-tiered care goal for critical care which includes lowering mortality rates, supporting bedside providers and improving data capture to support best practice compliance. In addition, tele-ICUs can also help to support immediate and ongoing acute care needs. Given the influx of patients in need of critical care during the ongoing pandemic combined with the need to keep providers and caretakers out of harm's way, telehealth can play a vital role in delivering needed care safely.


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