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Live Video Reshaping Patient Encounters

By Delbert L. Arrendale

Until 2016, live video technology had been bulky, expensive, insecure, and often unstable. Most state laws did not reimburse for video encounters between providers and patients. This is changing, as the passage of new “parity” laws authorize Medicaid and private insurance payments at the same rate (parity) as an office visit. More than 40 states have passed parity laws and as a result, use of live video telehealth delivery is poised to explode.

In 1979, experts predicted televideo encounters between patients and their doctors would significantly expand care to underserved rural populations where patients are most in need of wellness, behavioral, and critical care. Live video has not progressed as quickly because of costs, payment, and security concerns. Will Medicaid, Medicare, the private insurance sector, or the patient pay? Is patient health information secure and treated in a HIPAA-compliant manner? Use of non-HIPAA-compliant platforms, such as Skype and Facetime, created concern; poor video connectivity made for negative clinical efficacy.

Recently, entrepreneurs have released affordable, HIPAA-compliant video applications as parity laws are passed state by state. Until recently, video within an EHR—or on premise, site-to-site video conferencing—was so costly that only the biggest EHR companies or the most exclusive health delivery systems could afford to add integrated video to their continuum of care.

Today’s market is driven by three dynamics: outcomes, patient satisfaction, and reimbursements. Live video encounters satisfy all three. In a recent survey reported by mHealthIntelligence.com, 20% of consumers would switch to a doctor offering virtual office visits using live video. Over the last three years, the number of states with Medicaid and private insurance parity laws has doubled. With legislation pending in eight more states, telemedicine parity has majority rule, and private payers will soon be reimbursing for virtual care nationwide.

As hurdles are cleared around payment, and the Centers for Medicare & Medicaid Services demands better outcomes, live video and virtual patient-to-provider encounters become more relevant, their adoption driven by convenience and lower costs. But virtual doctor’s office visits are just the tip of the iceberg. Key applications for live video include remote monitoring and care for stroke, rehab, behavioral health, school nursing, and home health. With the growth of telehealth, it is predicted that walk-in clinic visits and costs will be significantly reduced.

Within health care, those who can afford the technology adopt early and those who cannot are forced to wait for cost reductions. Reimbursement regulations often delay and limit who can employ new technologies such as live video. Behavioral health is adopting live video patient-to-provider sessions to help address the nationwide opioid epidemic.

Coastal Horizons Center of Wilmington, North Carolina, a critical access behavioral health agency, has begun live video for patient encounters and improving clinical efficiencies. Ryan Estes, Coastal Horizons’ treatment operations director, says, “Until now, Coastal Horizons could not afford to offer live video to our providers and clients. While we ventured into live video in the past, it was unsuccessful, bulky, and expensive.

“We are expanding our services to include site-to-site encounters even without parity laws here in [North Carolina],” Estes continues. “Parity Laws in [North Carolina] are coming, and we are preparing now to deliver site-to-home video sessions when parity is passed by working with companies like 2MI Software Solutions to expand on live video services into the home.

“States with parity laws enable quicker adoption of live video, as [return on investment] is immediate. Reducing travel time for our in-home providers with live video conferences increases the number of patients our providers see. Remote follow-up enables better outcomes.”

Scott Allen, CEO of 2MI Software Solutions, a Raleigh, North Carolina, telehealth company, says, “2MI began with the goal of offering high-quality, secure, and affordable live video services. In states where parity laws exist, our cloud-based live video SaaS solution is economical. Up-front costs are low and cost reduction delivers immediate payback. Medicaid incentives even promote the use of telehealth services by paying an additional ‘distant site fee’ for certain services.

“Behavioral Health is a special focus with [substance use disorder] services reimbursed by new legislation and private insurance policies.”

As legislation and reimbursement continue to favor the use of telehealth, vendors and EHR platforms incorporating patient-to-provider video conferencing will add providers across health care sectors. Barriers will quickly fall and video encounters with health care providers will become the norm. By the end of 2019, almost every state in the United States will have passed parity laws, heightening the wave of telehealth video encounter growth.

— Delbert L. Arrendale is CEO of Arrendale Associates, Inc.