A variety of technologies—virtual check-ins, remote monitoring through biosensing wearables, and so on—might address such issues. But Mehrotra also sees potential problems, which is why he thinks it’s important to get the incentives right.
“Telehealth is uniquely susceptible to overutilization—when something is made as convenient as possible, then it is prone to having overutilization,” he said, in an interview.
The challenge is in encouraging increased utilization—without having it go past the point of usefulness. “If one sees that telehealth does not lead to an increase in utilization, then that’s bad. We want telehealth to increase access.”
“The thing I want to push people on is, does that increased utilization lead to better health outcomes?” he asked, continuing by pointing out the need to study potential spillover effects—whether positive or negative. “And I think sometimes I don’t see people making that next leap. I see assumptions that (telehealth is) going to replace an in-person visit.”
To combat that potential for overuse, Mehrotra emphasizes getting the incentives right—preferably through accountable care organizations, bundled care and the like. The benefit with that, he noted in his testimony, is it saves the need for administrators to set the prices—which “might be even more difficult to value from a practical perspective” than analog services.
On the other hand, Mehrotra thinks that providers under proper incentives will ensure that they’re using the most effective telehealth services in the proper populations at the proper times. As examples of what questions ACOs are asking about telehealth, he said, “I’ve been involved with some ACOs—what are we going to do about post-acute care? Can telemedicine be a mechanism for us to address this huge variation we’re seeing? Or rehospitalization? Or across our network, can we use telemedicine to prevent transfers to the high-cost place? They’re thinking about e-consults in that light. I see a lot of momentum in that ACO world for telehealth.”
The proper incentives also address overuse, he said. “They’re going to be very conscious of that. They’re going to be tracking that carefully. If they see what they view as overutilization, they’re going to be very conscious of that and try and change those incentives, change the structure in which the care is delivered, to make sure that telehealth is being used in the most prudent way possible.”
Follow Darius Tahir on Twitter: @dariustahir
