VALUE-BASED CARE THROUGH TELEMEDICINE FOR PATIENTS

Piyanun Yenjit Founder, Apuk Co., Ltd.

1. How would you define valuebased care in the context of telemedicine, and what role does it play in improving patient outcomes?

Value-based care refers to the ratio of the quality of care to the cost of care. The familiarity between doctors and patients, the reduction of inequities, and the increased use of technology have all contributed to an improvement in the quality of telemedicine. As a result, the value of telemedicine is growing in terms of the variety of telemedicine modules that can serve consumer requirements, such as improving accessibility to healthcare, quality, and population health.

Telemedicine plays a significant role in improving patient outcomes through accessibility improvements. It reduces the waiting time, allowing patients to receive treatment more quickly. Additionally, it brings the patient and the physician closer, reducing the need for frequent hospital or clinic visits and lowering transportation expenses.

2.What are the main advantages or benefits of using telemedicine to deliver value-based care compared to traditional in-person care models?

The primary advantage of telemedicine lies in its capacity to enhance access to healthcare services, particularly for individuals who encounter obstacles to receiving traditional in-person care. Here are the main benefits of telemedicine:

Time-saving and convenience: Telemedicine eliminates the need for traveling, waiting in crowded waiting rooms, and taking time off work or school. This convenience saves time and reduces overall healthcare-related expenses for patients.

• Improved access to care: By eliminating geographical barriers, telemedicine enables patients to receive medical consultations regardless of their location. It is particularly beneficial for individuals in rural or remote areas where access to healthcare facilities may be limited. Telemedicine also benefits patients with mobility issues or those who have difficulty traveling to a healthcare provider.

• Broadened specialist availability: Patients have the opportunity to consult with specialists located in various cities or even different countries, all without the requirement of extensive travel.

• Cost savings: Telemedicine eliminates transportation expenses, reduces the need for hospital visits, and minimizes the associated costs of in-person care. Additionally, telemedicine can reduce hospital readmissions and emergency department visits by enabling timely remote monitoring and intervention.

• Continuity of care: Telemedicine allows for ongoing monitoring and follow-up care, particularly for patients with chronic conditions. Healthcare professionals can remotely track patients' health status.

3.How do you ensure that telemedicine services maintain a high standard of quality and patient safety while focusing on valuebased care?

Quality monitoring is essential not only for telemedicine but also for in-person medical visits. Understanding the context of telemedicine is crucial to effective auditing and ensuring the maintenance of quality and patient safety in telemedicine services. International standards such as JCI and various HIMSS Analysis tools are beginning to define the benchmarks for telemedicine. Additionally, the Telehealth Certification standards encompass relevant areas for telemedicine implementation and delivery.

4. What challenges or barriers exist in implementing value-based care through telemedicine, and how do you address them?

• Doctor competency: The doctor's lack of training in the telemedicine approach necessitates the acquisition of additional skills, including the ability to gather patient information and provide a summary without relying on a physical examination.

• Doctor concerns: The primary concern for doctors is the liability risk associated with telemedicine. In certain countries, regulatory frameworks may not adequately support or address this liability risk for doctors.

• Customer perception: Many customers still prefer face-to-face visits over telemedicine services. Concerns about data privacy also contribute to their reluctance.

• Payor concerns on fraud: Payors may be concerned about the potential for fraud due to limitations in patient identification during telemedicine encounters. This can lead to hesitancy in promoting telemedicine services.

In summary, addressing the challenges and barriers in implementing value-based care through telemedicine requires a multi-faceted approach. This includes providing training to doctors, collaborating with regulators to establish clear guidelines, and educating customers about the benefits and data privacy protections of telemedicine. By doing so, we can increase telemedicine utilization and promote its effective integration into value-based care.

5. What strategies or approaches can be used to measure and track the value delivered through telemedicine services, particularly in terms of patient satisfaction and outcomes?

• Define and track specific outcomes relevant to the telemedicine service, such as the percentage of offline visits after a telemedicine service and the percentage of revisit to telemedicine. High percentages of offline visits or revisit to telemedicine may indicate potential shortcomings or failures in the telemedicine service.

In addition, to gain a comprehensive understanding of the success or failure of telemedicine services, it is essential to consider a broader range of metrics and factors. These include patient satisfaction, clinical outcomes, cost-effectiveness, and care coordination. Furthermore, seeking feedback from patients and healthcare providers through surveys, qualitative interviews, or focus groups can provide invaluable perspectives on the effectiveness of telemedicine services. By analyzing these aspects, valuable insights can be gained into the challenges, barriers, and opportunities for improvement in telemedicine delivery.

6. How can we ensure that patients receive personalized and patientcentered care when utilizing telemedicine services within a valuebased care framework?

• Telemedicine protocols: Telemedicine programs need to ensure that they have appropriate protocols in place to deliver high-quality care remotely. This includes having mechanisms to accurately assess patients and provide appropriate treatment recommendations.

• Patient education: Patients should be educated about the nature of telemedicine services, including their limitations, potential risks, and benefits involved.

• Secure Data Transmission: Implementing secure data transmission protocols is crucial to protect patient information.

• Qualified healthcare providers: Healthcare providers should have qualified and competent staff for telemedicine services. This involves having healthcare professionals who are trained and experienced in providing remote care services.

• Outcome monitoring: Monitoring patient outcomes for continuous quality improvement.

7. Can you provide examples of specific telemedicine interventions or initiatives that have demonstrated significant value-based care outcomes for patients?

Mild diseases such as upper respiratory tract infections or diarrhea are scenarios that reflect the effectiveness of telemedicine.

These conditions often require only historytaking and do not necessitate advanced assessment skills or investigations. Early assessment through telemedicine can prevent further complications and reduce the cost of care by avoiding unnecessary admissions.

Here are some examples:

• Telemedicine for Chronic Disease: Telemedicine enables regular consultations for patients with chronic diseases like diabetes or heart disease. Patients can receive guidance on medication, self-care, and lifestyle adjustments from healthcare providers.

• Tele-rehabilitation: Virtual visits can deliver rehabilitation services and physical therapy, allowing patients to perform exercises and receive guidance from therapists. Telerehabilitation is particularly beneficial for patients with limited access to in-person rehabilitation services, improving their quality of life.

• Tele-triage: Tele-triage services provide initial assessments and guidance for non-emergency conditions remotely. This helps determine appropriate care pathways and reduces unnecessary visits to the emergency room.

• Telemonitoring for Home Health: Telemonitoring programs utilize connected devices to remotely monitor patients' vital signs, such as blood pressure, heart rate, and oxygen levels, in their home environment. These examples illustrate how telemedicine interventions have demonstrated significant value-based care outcomes. Telemedicine services can be applied in various healthcare delivery areas and have shown efficiency in improving access, reducing costs, increasing patient satisfaction, and optimizing care coordination for a wide range of conditions and patient populations.

8. How can we engage patients and promote active participation in their care through telemedicine while maintaining a focus on value-based principles?

Reimbursement is the key to engagement. Moreover, highlighting the benefits of telemedicine, such as reduced waiting times for follow-up visits or offering discounts on medication costs or doctor’s fees, can further enhance patient engagement.

9. How can we incorporate the social determinants of health into a telemedicine-based value-based care approach to address health disparities and promote equitable outcomes? telemedicine services and ensure effective value-based care delivery?

Telemedicine can effectively address several health disparities, especially healthcare accessibility. Patients in remote areas can easily connect with healthcare professionals timely. This advantage is particularly significant for individuals with chronic diseases who require regular follow-up for improved clinical outcomes. However, it is important to ensure the availability of supporting staff and units, such as local public health technical officers and pharmacies, in these areas to support telemedicine services. Telemedicine can also facilitate virtual care teams to enable coordination and collaboration among multidisciplinary healthcare professionals, who can collectively develop and implement care plans. With the use of telemedicine, healthcare professionals can assess patients, including gathering information about social determinants of health, such as education, housing, social security, food security, and safety. Telemedicine also enables the use of data analytics to identify patients at a higher risk for health disparities based on social determinants. Healthcare providers can then provide patient education that is tailored to address specific social determinants as well.

• Online self-assessment can help patients find the most suitable doctors for telemedicine consultations. Based on the responses provided by patients in the online self-assessment, an algorithm can consider the patient's condition factors using medical logic. Once the patient completes the selfassessment questionnaire, the matching algorithm can analyze the responses and identify doctors who are the best fit for the patient's needs. Factors such as specialty, experience, availability, and patient preferences can be taken into account. Recommended doctors or healthcare providers who are well-suited to the patient's specific health concerns can then be matched, followed by the implementation of a scheduling system that allows patients to easily book telemedicine consultations.

• Strong network connectivity with data security protection.

• Remote Patient Monitoring using connected devices enables the remote monitoring of patient vital signs and health. For example, patients with chronic conditions like diabetes or hypertension can use glucometers and blood pressure monitors at home, and the data can be transmitted to healthcare providers for real-time monitoring. This approach facilitates early detection of abnormal conditions, timely intervention, and improved patient outcomes.

• Technology to bridge telemedicine gaps, such as the use of face scanning to measure vital signs.

• Integration with personal health or social apps like WhatsApp or Line.

• System integration with related support services such as pharmacies or rehabilitation centers is crucial, and standardized data is a key factor for successful integration.

11. How do you collaborate with other healthcare providers, including specialists and primary care physicians, in the delivery of value-based care through telemedicine?

Telemedicine allows healthcare providers to collaborate and seek second opinions from specialists or other healthcare professionals located elsewhere. This collaboration is supported by checking doctor availability and facilitating appointment requests, which are common features that patients often require after receiving assessment results. These features can be implemented through connection technologies such as APIs or simpler channels like email. Regardless of the connection channel, ensuring a wellprepared doctor schedule in the hospital is essential for successful collaboration and accessibility. Healthcare providers must have well-organized doctor schedules to ensure timely availability. Integrating technology and utilizing medical data science can further enhance collaboration and help find the best match between a patient's condition and an appropriate physician.

12. Looking ahead, what innovations or developments do you foresee in the field of valuebased care through telemedicine, and how do you plan to adapt and leverage them for the benefit of patients?

Pushing forward telemedicine into the doctor's curriculum will allow doctors to become more familiar with and specialize in telemedicine services.

Providing benefits such as reimbursement, discount medication, and other incentives. Key concepts and ideas include the following:

• Patients and physicians should aim to meet as soon as possible to ensure timely access to healthcare services.

• Performing online self-assessments before consulting with physicians can help patients communicate effectively. It allows them to gather valuable information about their health, such as symptoms or conditions, medical history, family history, underlying conditions, lifestyle factors, medication history, allergies, immunization history, etc. This information helps physicians understand patient health and provide appropriate care.

• Using patient input, technology, and medical data science, matching factors can provide guidance such as:

Patient's likely differential diagnosis (DDX) or conditions that require further investigation or specialist consultation. The key objective is not to obtain the most precise diagnosis but to show a full list of possible diagnoses and their possibility score.

• Utilizing technology, such as APIs, location tracking, or big data analysis, to match patient conditions with appropriate physicians and providers based on specialty, service, and location.

• Leveraging telemedicine and other technology-driven solutions to increase accessibility for patients, enabling them to access remote care services.

• Checking doctor availability and facilitating appointment requests, which are common features that patients need after receiving the assessment result. These features require connection technology such as APIs or simpler channels like email. However, ensuring a well-prepared doctor schedule in the hospital remains a key success factor, regardless of the connection channel. Patients might process reimbursement via telemedicine, and they could even receive medication and supplies via tele-pharmacy, for instance. AUTHOR BIO Piyanun Yenjit is a country manager of HIMSS Thailand and founder of APUK, a healthcare digital transformation consultant and micro services provider, focusing on improvement in patient safety, process efficiency, and business growth. She is also experienced in electronic medical records with structured data implementation compatible with various quality assurance standards.