How telehealth can save money, improve outcomes and advance equity

Tanya Albert Henry , Contributing News Writer

AMA News Wire

How telehealth can save money, improve outcomes and advance equity

Sep 25, 2023

As hospitals and health systems continue to figure out how to best integrate telehealth into the care options they offer patients, the benefits of technology go well beyond just the dollars and cents.

Two years ago, the AMA worked with Manatt Health and released case studies on organizations that measured the value of their virtual care programs using the AMA Return on Health Framework. The framework looks at how telemedicine impacts not only financial and operational outcomes, but also clinical outcomes, quality and safety; access to care, patient, family and caregiver experiences; clinician experiences and health equity.

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In an episode of the “AMA STEPS Forward® Podcast,” neurologist Lee Schwamm, MD, detailed the progress that Massachusetts General Hospital has seen with the teleneurology and telestroke services since the initial case study done in 2021.

Dr. Schwamm—former director for the Center for Telehealth at Mass General Brigham—worked on the original case study of the telestroke and teleneurology programs. Started in the late 1990s, today about 15 physicians provide telestroke consults and 12 physicians provide teleneurology consults to community hospitals, many of which don’t have on-site neurologist.

The programs have helped keep patients in community hospitals, improved access to care and promoted health equity, Dr. Schwamm said.

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“We need a new generation of fearless leaders who are going to take the plunge and have figured out and created very trustworthy, very sophisticated economic models that tell them just how much value creation they’re getting, and these downstream revenue impacts that everybody wants to take credit for,” said Dr. Schwamm, now chief digital health officer and associate dean of digital health strategy and transformation at Yale New Haven Health System and Yale University School of Medicine.

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Dr. Schwamm said that one of the unexpected, exciting parts of their teleneurology program was the shorter time from request, to consult, to definitive diagnosis and a management plan for the patient when compared with in-person.

That’s led to “a significant reduction in the length of stay,” and not because transfers increased out of the community hospital to Mass General. Data showed there was the same proportion of transfers, discharges to home and discharges to other facilities compared with outcomes before the telehealth program.

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Instead, those little delays that seem insignificant by themselves back up “like airplanes circling for the runway,” Dr. Schwamm said. If a physician misses an opportunity for a magnetic resonance imaging (MRI) exam, it can be another 24 hours before it’s done, and then another 24 hours for someone to look at it, and another 24 hours before the electroencephalogram (EEG) is done.

“As opposed to getting the expert opinion upfront, maybe you don’t even get the EEG or maybe you get the MRI that day because you ordered it by 10 a.m. not by 4 p.m.,” he said.

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Telestroke “dramatically” increased the racial, geographic and urban-rural diversity of patients for which Mass General provided care, Dr. Schwamm said. Digging into the data, they found that social drivers of health didn’t affect the time to treatment or patient outcomes.

“That demonstrates once again that standardized frameworks, standardized protocols and high-reliability systems tend to eradicate a lot of the implicit bias that may be present when we evaluate patients on a more informal basis,” he said.