Team 4 presentation telehealth

Telehealth:
A Macro-Trend in the Health Care Industry
and the Job Oppotunities
Tyler Little
Yewsee Ng
Samuel Sandy
University of Maryland University College

Overview
 Telehealth
 Economics of telehealth; related job opportunities.
 Telehealth and demographics; related job opportunities
 Technology and telehealth; related job opportunities
 Telehealth and legislation; related job opportunities
 Telehealth and personal lifestyle and behavioral interventions;
related job opportunities
 Conclusion
 References

What is Telehealth
Definition:
The delivery and coordination of health and health-related services
using telecommunications and digital communication technologies.

Why Telehealth?
In the year 2017, American Well, the leading telehealth company in the U.S.,
conducted a consumer survey and concluded that 20% of consumers would
switch their primary care provider (PCP) if another PCP in their area provided
telehealth consultations.
Numbers were calculated in the following way: 323M (U.S. Population, U.S. Census Bureau, 2016) x 77% (U.S. Population Age 18+,
U.S. Census Bureau, 2016) x 20% (Consumers with a PCP who would switch PCP for video visits, American Well 2017 Consumer
Survey) = 50M (Source: American Well [https://www.americanwell.com/50m-americans-would-switch-their-pcp-to-a-doctor-who-
offers-telehealth/])

Economics of Telehealth
Health care expenditure in the U.S.:
 In the year of 2017, the U.S. spent $10,209.40 per capita on health
care that accounts for 17.25% gross domestic products (GDP)
(OECD, 2018).
 The Center of Medicare and Medicaid Services (CMS) forecasted
the likely upwards trend regarding health care spending from the
year 2016-2025 at a rate of 1.2% faster than GDP, eventually
reaching 19.9% at the year 2025 (CMS, 2016).

The National Health Expenditure in the
U.S. as percent of GDP from 1960 to
2018.
(Source: STATISTA)
[https://www.statista.com/statistics/184968/us-
health-expenditure-as-percent-of-gdp-since-1960/]

 The white paper by Smart Rural Community (SRC) that titled
“Anticipating Economic Returns of Rural Telehealth” quantified
various savings that were accomplished by the telehealth model
(Schadelbauer, 2017).
 According to Schadelbauer (2017), the national average estimated
for cost-related savings annually per medical facility from telehealth
include travel expense savings of $5,718, lost wages savings of
$3,431 and hospital cost savings of $20,841 (Schadelbauer, 2017).
 The quantified benefits are both an encouragement and validation
for the telehealth model.

 The current health care landscape places heavy emphasis on value-
based care, instead of fee-for-service that was once the payment
model for medical services.
 Value-based care is to pay the health care providers based on the
quality of medical services to patients, rather than the quantity.

Example of a success story of value-based care using the Telehealth platform:
 Mercy Virtual Care, a bed-less hospital in Chesterfield, Missouri, that depends on the
telehealth model to deliver virtual care to patients regardless of locations, continues to be
successful to balance the books.
 Mercy Virtual Care has stayed in the black because the payment system thrives on
efficiency and preserving wellness of patients, a concept stemmed from the value-based
payment (Allen, 2017).
 Mercy Victual's telehealth strategies had successfully reduced over 90,000 days of total
intensive care patient stays throughout several years, which accounted for $50 million of
savings (Brohan, 2017).
 The resulting outcomes were significant in both the quality of care and reduction of
expenditure.

Jobs Opportunities Related to the
Economy of Telehealth
 Virtual health programs in hospitals drive the need of:
Telehealth coordinators,
Telehealth project managers,
Telehealth supporting administrative staff.
 Non-medical administrators will oversee the operation of telehealth,
orchestrating the team effort that involves the medical providers, the
auxiliary staff, the information technology (IT) support staff, and the
patients to foster the goal and missions of telehealth.

Telehealth and Demographics
Telehealth is an important model for rural areas.
Since the year 2010, the increment of rural hospitals closures
has resulted in a big struggle for communities of rural areas to
find accessible health care (Wishner, Solleveld, Rudowitz,
Paradise, & Antonisse, 2016).
The telehealth platform is an ideal model to deliver medical
consultations to the patients independent of the location.
By bringing the medical care straight to the households,
telehealth eliminates the struggle of long-distance drives to
attend medical appointments, thereby saving patients’ time and
resources as patients connect with health care providers
directly through mobile devices.

 Telehealth is equally important under the urban settings.
 FAIR Health, an independent non-profit organization that collects
and manages the nation’s largest database of privately billed health
insurance claims, reported an increment of telehealth usage amongst
the urban communities from the year 2015 until year 2016,
matching and even surpass the rural communities in FAIR Health’s
white paper (FAIR Health, 2018).
 The increment in telehealth adoption suggests the spreading
acceptance and availability of alternative venues of care, benefiting
demographics of different localities.

 Telehealth is also helpful to address racial disparities in health care.
 The racial disparities in hypertension is noticeable among African
Americans than non-Hispanic whites in the United States (Cooper et al.,
2013).
 According to Cooper et al. (2013), factors that lead to the disparities
include barriers to access to health care, as well as adherence and
guideline compliance at the patients, providers, health care systems, and
community levels. Overcoming these challenges can be difficult, and
telehealth can serve as a useful tool.
 The usage of telecommunication technologies such as telephone, texting
and SMS, and computer or smartphone type software, can monitor blood
pressure for patients living in both urban and rural communities (Ye et al.,
2018).
 In order to reduce hypertension amongst the high-risk communities, the
telehealth platform provides systematic approach to intervene to monitor
blood pressure, to improve access to healthcare, to achieve better health
outcomes, and to save cost.

Job Opportunities Related to
As health care systems continue to venture into telehealth and
telemedicine, health care providers, including doctors and nurses from
a variety of specialties, are needed to provide the medical
consultations through the telehealth platform.

Telehealth Technology
 Telehealth enables health care providers to communicate through
numerous electronics such as mobile phones, computers, laptops,
and even watches.
 Telehealth technology are convenient, direct, time and cost-
effective.
 Telehealth technology enables patients to order or refill drug
prescriptions, upload food logs, or upload dosing and blood sugar
levels to be reviewed by the health care providers on the mobile
phones (Mayo Clinic, 2017).
 The patient portal, a feature commonly available on the telehealth
platform, allows direct communication between patients and
doctors.

Telehealth Technology
 Telehealth patients can get instant feedback from the health care
providers and access to test results sooner.
 Telehealth technology offers virtual appointments for patients
instead of the traditional face-to-face consultations.
 Telehealth can offer services for those that are not able to visit a
doctor.
 Telehealth is used in more countries for convenience and
affordability in low-income areas.

Telehealth Job Opportunities
 Medical facilities and private
practices are investing more and
more in Healthcare Information
Technology (HIT).
 With technology developments and
improvements in the making, HIT
jobs will be in high demand for
experts that are good at integration
with home monitoring systems and
repairs.
 Telehealth cybersecurity jobs will
double by 2020 due to major cyber
attacks (Bowman, 2018).

Telehealth and Legislation
 In February 2018, Congress passed new laws to cover telehealth
services for stroke and end-stage-renal-disease (ESRD) patients
(Findlay, 2018).
 In April 2018, Congresswoman Matsui and Congressman Harper
introduced a new bipartisan bill “Improving Access to Remote
Behavioral Health Treatment Act.
 Later that year Congresswoman Matsui and Congressman Cardenas
introduced the “Access to Telehealth Services for Opioid Use
Disorders Act.
 In September 2018, the “Mental Health Telemedicine Expansion
Act” was introduced to the House with the intention of increasing
the access to mental health services through telehealth (Wicklund,
2018).

Jobs Related to
Telehealth Legislation
 Health policy analyst, a
position in the public health
sector to gather, analyze, and
develop new policies and
strategies, is in need by both
the government agencies and
the non-profit organizations.

Telehealth for Personal Lifestyles
and Behavioral Intervention
 Obesity and diabetes are two major public health problems in the U.S.
 More than one-third of adults in the U.S. are obese (Apovian, 2013), and 9.7% of
the adult population in the U.S. is diagnosed with diabetes (Petersen, 2017).
 Not only has the high prevalence of obesity and diabetes resulted in reduced
productivity in the workforce, but the associated health care expenditures are also
enormous.
 The estimated national cost of diabetes in 2017 was $327 billion, between which
$237 billion (73%) denoted direct health care expenditures due to diabetes, and
$90 billion (27%) denoted lost productivity from “work-related absenteeism,
reduced productivity at work and home, unemployment from chronic disability,
and premature mortality” (Petersen, 2017).

Adult obesity rates continue to increase since 1996, rising from 30.5% in
1999-2000 to 39.6% in 2015-2016. (McCarthy, 2017)
Source: https://www.forbes.com/sites/niallmccarthy/2017/10/16/u-s-obesity-
rates-have-hit-an-all-time-high-infographic/#7a5191084bad

The continuous rising trend of the number and percentage of U.S.
population with diagnosed diabetes.
Source: The CDC
(https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf)

 Obesity and diabetes are both consequences of behavioral lifestyles
choices that are negatively impacted by excess body weight.
 Effective weight management is imperative to improve the outcome
of both obesity and diabetes. Evidence-based lifestyle interventions
are powerful in providing education and monitoring to generate
health improvements (West, Coulon, Monroe, & Wilson, 2016).
 Behavioral and lifestyles interventions integrated dietary change and
increased physical activities through behavior modification
strategies to produce substantial weight loss in individuals who are
overweight or obese with diabetes (West et al., 2016).

 Telehealth is an ideal model to carry out behavioral and lifestyles
intervention in the form of digital health coaching.
 Pew Research Center (2018) reported that 77% of Americans are
smartphones users. The convenience of mobile apps allows users to
monitor steps, document food and calorie intake, chart the progress,
and seek counseling should users have any questions.

 In 2017, a study collaborated Vida Health, a commercial mobile phone-based health
coaching intervention for weight loss, and a large national insurance provider, enrolled
adult members who were overweight (body mass index [BMI] > 25kg/m2) to participate in
a four months intensive coaching through phone calls, live videos, and text messages
through Vida Health app (Mao, Chen, Magana, Barajas, & Olayiwola, 2017).
 During the process, the researcher also distributed a wireless scale, pedometer, and blood
pressure cuff to the participants. The participants’ weight was recorded upon enrollment
and at the end of four months. Mao et al. (2017) reported an average of 9.46% weight loss
in the cohort after four months of digital coaching a percentage that is positive and
significant.
 Due to the omnipresence of smartphones, telehealth through the format of digital health
coaching is an innovative and cost-effective solution to execute weight management
intervention.

Behavioral Intervention
 Telehealth technology is the model of choice to control the growing
diabetes epidemic.
 It is estimated that more than 84 million Americans adults are
prediabetic (American Diabetes Association, 2015).

National Diabetes Prevention Program by the CDC.
Source: https://www.cdc.gov/diabetes/library/socialmedia/infographics/ndpp.html

 With the goal of reducing the incidence of diabetes in the population that is at risk, the Center of
Disease Control and Prevention (CDC) created a weight loss and behavioral change program known as
the National Diabetes Prevention Program (DPP) through the telehealth platform.
 The ease of mHealth technologies allows providers of health systems, physicians groups, or
community-based groups to connect with prediabetic individuals and provide personalized programs to
improve health and overall wellness.
 Vadheim et al. (2017) studied the difference in participation, monitoring of diet and physical activity,
and weight loss in participants receiving the intervention on site and those who went through the DPP
program virtually through telehealth from the year 2008 to the year 2015.
 The researchers found no statistically significant differences in the number of intervention sessions, in
the mean weight loss or reduction, and in the percentage who achieved 7% weight loss goal between
telehealth or on-site participants (Vadheim et al., 2017). This study suggests comparative outcomes of
intervention through on-site and telehealth participation, indicating the effectiveness of the telehealth
paradigm.

Jobs Opportunities Related to
Telehealth Health Coaching
 Digital health coaching is an important position in the health care
industry as the health coaches play vital roles to promote or
safeguard the health of the general public.
 Example of telehealth health coaches:
o digital health coaches,
o digital diabetes educator,
o digital health manager

Conclusion
 Telehealth is not just a macro-trend in the health care industry; it is a
paradigm shift that will improve quality of care for the patients and
reduce health care spending, on top of other advantages such as
being convenient, time-saving, and high accessibility.
 Given the importance of the health care industry, job opportunities
related to the telehealth platform are crucial to the success of health
care organizations and hence call for detailed attention from the
Human Resources Department.

References
 Allen, A. (2017, November 8). A hospital without patients. Politico. Retrieved from
https://www.politico.com/agenda/story/2017/11/08/virtual-hospital-mercy-st-louis-000573
 American Well. (2017, January 23). One in five consumers would switch to a doctor that
offers telehealth visits. Retrieved from https://www.americanwell.com/press-release/one-
in-five-consumers-would-switch-to-a-doctor-that-offers-telehealth-visits/
 American Diabetes Association [ADA]. (2015). Statistics about diabetes. Retrieved from
http://www.diabetes.org/diabetes-basics/statistics/
 Apovian, C. (2013, August 16). The clinical and economic consequences of obesity. The
American Journal of Managed Care. Retrieved from
https://www.ajmc.com/journals/supplement/2013/a433_aug13_obesity/a433_13aug_apovia
n_s219to28

References
 Brohan, M. (2017, September 25). Mercy’s $300 million investment in digital healthcare is
paying off. Digital Commerce 360. Retrieved from
https://www.digitalcommerce360.com/2017/09/25/mercy-healths-300-million-investment-
in-digital-healthcare-is-paying-off/
 Bowman, B. (2018). Healthcare information technology jobs outlook. Hospital IT Jobs.
Retrieved from: https://www.hospitalitjobs.com/healthcare-information-technology-jobs-
outlook/
 Centers for Medicare and Medicaid Services [CMS]. (2016). National health expenditures
projections 2016-2025. CMS. Retrieved from https://www.cms.gov/Research-Statistics-
Data-and-Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/Downloads/proj2016.pdf
 Cooper, L. A. et al. (2013, June 4). A multi-level system quality improvement intervention
to reduce racial disparities in hypertension care and control: study protocol.
Implementation Science. 8(60). doi: 10.1186/1748-5908-8-60

References
 CTeL. (2018, Sep 26). House bill would eliminate telehealth originating site restrictions.
Center for Telehealth & e-Health Law. Retrieved from: https://ctel.org/2018/09/house-bill-
would-eliminate-telehealth-originating-site-restrictions/
 Fanburg, J. D., & Walzman, J. J. (2018, September 12). Telehealth and the law: The
challenge of reimbursement. Contemporary OB/GYN. Retrieved from
http://www.contemporaryobgyn.net/telemedicine/telehealth-and-law-challenge-
reimbursement
 Findlay, S. (2018, May 9). Hoping to see your doctor via telemedicine? Here’s a quick
guide. Kaiser Health News. Retrieved from https://khn.org/news/hoping-to-see-your-
doctor-via-telemedicine-heres-a-quick-guide/

References
 Mao, A. Y., Chen, C., Magana, C., Barajas, K. C., & Olayiwola, J. N., (2017, August 6). A
mobile phone-based health coaching intervention for weight loss and blood pressure
reduction in a national payer population: a retrospective study. Journal of Medical Internet
Research. 5(6). DOI: 10.2196/mhealth.7591
 Malambo, P., Kengne, A. P., Lambert, E. V., Villers, A. D., and Puoane, T. (2016, May 19).
Association between perceived built environment and prevalent hypertension among South
Africa adults. Advances in Epidemiology. 2016. http://dx.doi.org/10.1155/2016/1038715
 Mayo Clinic. (2017, August 16). Technology meets healthcare. Mayo Clinic. Retrieved
from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-
20044878

References
 Petersen, M. P. (2018, May). Economic cost of diabetes in the U.S. in 2017. Diabetes Care.
41(5): 917-928. https://doi.org/10.2337/dci18-0007
 Pew Research Center. (2018, February 5). Mobile fact sheet. Retrieved from
http://www.pewinternet.org/fact-sheet/mobile/
 Schadelbauer, R. (2017, March). Anticipating economic returns of rural telehealth. Report
prepared for NTCA-The Rural Broadband Association. Retrieved from
https://www.ntca.org/sites/default/files/documents/2017-
12/SRC_whitepaper_anticipatingeconomicreturns.pdf
 Sullivan, T. (2018, May 15). Telehealth bill introduced in the house. Policy & Medicine.
Retrieved from https://www.policymed.com/2018/05/telehealth-bill-introduced-in-the-
house.html

References
 Vadheim, L. M., Patch, K., Brokaw, S. M., Carpenedo, D., Butcher, M. K., Helgerson, S.
D., Harwell, T. S. (2017, April 17). Telehealth delivery of the diabetes prevention program
to rural communities. Translational Behavioral Medicine. 7(2): 286-291.
doi: [10.1007/s13142-017-0496-y]
 West, D., Coulon, S. M., Monroe, C., & Wilson, D. (2016, October). Evidence-based
lifestyle interventions for obesity and Type-2 diabetes: The Look AHEAD intensive
lifestyle intervention as exemplar. American Psychologist. 71(7). 614-627. DOI:
10.1037/a0040394
 Wicklund, E. (2018, September 18). New bill takes aim at originating site restrictions for
telehealth. mHealth Intelligence. Retrieved from
https://mhealthintelligence.com/news/new-bill-takes-aim-at-originating-site-restrictions-
for-telehealth
 Wishner, J., Solleveld, P., Rudowitz, R., Paradise, J., & Antonisse, L. (2016, July 7). A look
at rural hospital closures and implications for access to care: three case studies. Henry J
Kaiser Family Foundation. Retrieved from: https://www.kff.org/medicaid/issue-brief/a-
look-at-rural-hospital-closures-and-implications-for-access-to-care/

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