Standing at the Threshold of 2012

It’s been a great year. 2011 left many old timers in telemedicine enjoying the newfound enthusiasm about telemedicine, telehealth and all the other related expressions (mHealth, e-health, etc.) that describe this field. Bells were pealing. Hypers were hyping. Prognosticators were predicting. We were overwhelmed with an ocean of hullabaloo about the wonders of telecommunications technology and health care. We were awash with inventors, entrepreneurs, investors and captains of other industries leaping into the frenzy like groups of whirling dervishes all vying to profess the most superlative expectation. Truly it is wonderful to see.

Woo hoo!

Back on earth the day-to-day reality for telemedicine remains on delivering care, modifying clinical processes, changing public policy and, oh yes, making a profit. Nevertheless, I believe we stand in December 2011 at a significantly different place than last December. The change is not so much in the hype or even the numbers (although they are significant) but that we have witnessed a fundamental shift in the landscape, leaving this field poised for enormous change during the twelve to twenty four months ahead.

Special thanks is deserved to three groups that have made all of this possible. First, ATA’s Board of Directors reflects the dramatic shift in attention toward telemedicine with a unique mix of clinicians that provide health care through telemedicine joined by several captains of industry, private payers, government agencies and non-profit groups from the United States and other countries. Under the leadership of Dr. Bernard Harris the Board has provided guidance and unwavering support for ATA as we sail ahead. Second, my thanks to the hundreds of volunteer leaders and thousands of members of ATA whose enthusiasm, hard work and insights have contributed both to ATA’s success and the tremendous progress for telemedicine this year. Finally, the ATA staff, a small band of incredibly talented, dedicated and very hard working group of professionals. Few in the Association business can believe that a staff of only eleven full time employees manages all of ATA. Thanks to the use of a number of great contractors and innovative use of technology, the staff has been able to make ATA one of the fastest growing Associations in the country and an effective, widely recognized leader in health care throughout the world.

From the start, a key value of this Association has been to focus on transformation and not building castles. But it still amazes me that, from a small group of idealists and true believers that gathered together in 1993, ATA is on the verge of helping to transform the world of healthcare.

Moving Our Eggs Out Of One Basket

According to Gary Capistrant, ATA’s resident expert on all things related to health policy, at least 73 million Americans, almost one quarter of the population, are now covered under some form of managed care. Such plans eschew the fee-for-service approach in favor of a fixed sum to provide health services with flexibility in what and how such services are provided. Importantly, federal restrictions on the use of telemedicine don’t apply to such managed care plans.

Managed care comes in many flavors. Medicare Advantage is offered mostly as a private managed care insurance plan and covers about 25 percent of all Medicare patients. About two thirds of state-run Medicaid patients are now enrolled in Medicaid managed care programs. Health reform, leading to 32 million more Medicaid enrollees will skyrocket that number in the next five years. On the private side, employer and private plans are all shifting away from traditional fee for service models and embracing various forms of bundling payments, incentives for cost reduction and coordination of care.

How important is this? Cigna, a traditional fee-for-service insurer is spending $3.8 billion to buy HealthSpring, which has 340,000 customers in its Medicare Advantage program in 11 states. Private insurers around the nation are rushing to turn their portfolio of covered lived from fee-for-service to managed care and, to further control costs, are becoming owners and managers of their own medical facilities and health services. It will be interesting to see if this leads to such dilemmas as United Health doctors pressing for privileges at a hospital owned by Aetna.

The rush toward alternative payment models is already shifting decision-making on services from the payer to the provider. To prepare, we need to shift traditional lobbying for a new CPT code or national payment policy toward efforts to convince health systems and even local providers on the benefits of using telemedicine.