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M2M, Telehealth and ObamaCare- 36 Million Ways to Find ROI

By Carl Ford January 09, 2013

As the Fiscal Cliff continues to make politicians practice the art of focusing on everything but the real issues, once again the rules are changing to the point where innovators are going to be the highlight of 2013. One key aspect of ObamaCare is that 36 million more people are going from uninsured to insured, and yet it’s not clear how they are going to be serviced.  

Telehealth solutions are probably going to be a place where the insurance agencies are going to look for benefits; everything from mall kiosks being connected to doctors’ to smart phone apps that speed the diagnosis. A few years back we had an opportunity to analyze a predicative systems’ value on patient care.

The team of doctors we brought in told us that there were a few questions that were basic to the patient visit: getting data about weight, pulse, temperature, blood pressure, breathing, historical comparisons and then current complaints. From this data comes the diagnosis, prescription and follow up. All pretty standard and all part of the existing system.

The recent interview with Dr. Roy Scheunberg, CEO of American Well, pointed out that 36 million people are going to be added to an already strained system. In our quest of showing the ROI, the ability for servicing the 36 million newly insured is a window of opportunity for fast- moving doctors and insurance companies that can take advantage of the bottom line. 

The bottom line for Telehealth platforms is that the cost savings need to be bundled with ease of use and they have to be dramatic. At the present moment, online healthcare systems are only reimbursable in 19 states. Right now there is an effort to expand the use of telehealth with federal payments in The Telehealth Promotion Act of 2012 (HR 6719).

The cost savings are then shared amongst several players, the insurance company, the doctor and the patient. For the insurance company it’s a numbers game; for the doctor it’s numbers and billable hours; but for the patient, it’s getting quick quality healthcare.

Reaching out to patients includes the urban housebound, and the remote rural patient. Solutions that match to a patient’s situation have the added requirement of figuring out how to ensure accurate recording and registering of the system.

In Telehealth, the ROI can be calculated based on how we recognize costs today. As the 36 million get added to the denominator, the numerator has some pretty straight forward calculations. The government should be expecting that measuring success should be based on the cost of services. However, the issues of high-cost patients with previous conditions should be treated as another ROI opportunity.

How far can we take Telehealth solutions?

It can be as simple as teleconferencing or smartphone apps, or as complicated as remote patient monitoring solutions such as what St. Jude has implemented with IBM.

ROI then is at the key of telehealth implementations today, and it is probably the reason Paul Jacobs, CEO of Qualcomm, gave it center stage at CES. But this is not a simple sale, it’s a process to get these devices from approval to adoption.

But you can see we are heading there at a healthy pace.




Edited by Stefanie Mosca

Partner, Crossfire Media

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