Telehealth and the Triple Aim

Since 2008, CCHP has been monitoring the nation’s rapidly transforming health care policy landscape. In 2014, CCHP embarked upon an eight-month project to critically assess the current and potential future role of telehealth in strengthening health care delivery within the dimensions of the Triple Aim objectives of national health reform—improved quality, health outcomes and reduced costs. The “Telehealth and the Triple Aim” project led to a deeper understanding of the barriers inhibiting the full adoption of telehealth, and a series of action recommendations for how telehealth can best advance value-based approaches to health care delivery.

The Telehealth and the Triple Aim project included several phases of work:

• Convening an advisory board on Telehealth and the Triple Aim.  CCHP invited providers, practitioners, and payers with diverse backgrounds, together with experts in telehealth policy and research, to participate as project advisors. The advisory board met monthly to provide project leadership, guide the project approach, identify evidence and review deliverables.
• Conducting expert interviews.  Interviews were conducted with numerous key stakeholders in telehealth delivery, policy, technology and financing. Interviews informed the current context of telehealth.  Discussions explored telehealth delivery across public and private settings and assessed the impact of the changing policy and reimbursement on telehealth adoption.
• Understanding current levels of telehealth adoption and highlighting success criteria.  The project reviewed available resources to chart current adoption and use of telehealth among providers in the United States.  In addition, the team captured the “paths to maturity” that both teledermatology and telemental health, respectively, followed over the last twenty years, identifying key drivers of success for future telehealth growth.
• Reviewing the telehealth evidence base to support the key drivers of telehealth adoption.  CCHP reviewed the evidence base that exists in meta-analysis, systematic reviews, and project activity to assess comparable evidence and potential gaps in the current telehealth evidence base against Triple Aim objectives.  The review highlighted areas that may require additional focus, resources and/or agreement among researchers and practitioners.
• Conducting a national convening of a cross-sector of telehealth experts. Forty thought-leaders from provider, payer, research, consumer group, policy and technology organizations across the country were brought together to engage in a dialogue to identify adoption barriers and help shape recommendations for advancing the integration of telehealth within the context of the Triple Aim.
• Forming recommendations for short and long-term activities to increase telehealth’s achievement of the Triple Aim.  The eight-month Telehealth and the Triple Aim project resulted in a final report that outlines short and long-term activities required to move telehealth forward.  Importantly, these recommendations represent consensus among industry and government stakeholders and define the respective roles these stakeholder organizations should undertake.

The Six Key Drivers

One of this project’s most important observations was that changes in policy alone are insufficient for achieving widespread adoption of telehealth care.  By examining the “paths to maturity” of two well-established specialties, teledermatology and telemental health, it became clear that a solid evidence base, and improved financing and reimbursement are also key drivers of telehealth adoption. These coupled with the “on the ground” drivers of consumer support, provider leadership and advances in technology comprise the six key drivers that together can achieve the optimal integration of telehealth practices into the health care delivery.

1. Policy – state and federal government legislative and administrative policy, as well as private sector institutional policy.
2. Financing –coverage of care that incorporates telehealth
3. Evidence – research and field studies that demonstrate improved quality and outcomes, and reduced costs.
4. Technology – advancements that improve usability, access, and decrease costs.
5. Practice Change – successfully transforming health systems to take full advantage of telehealth benefits and integrating these practices into standards of care.
6. Consumer Demand – meeting patient needs, and fostering acceptance and confidence in telehealth.

The movement toward value-based coverage, coupled with the anticipated increase in the number of insured patients have created a renewed focus on how to position telehealth as an attractive alternative to traditional care modalities for achieving the Triple Aim objectives.  The six key drivers of telehealth adoption reflect a call to action for CCHP and its key stakeholders for achieving optimal integration into a fully connected health care system.

Would you like to know more? Read the final report: Recommendations from the CCHP Telehealth and the Triple Aim Project: Advancing Telehealth Knowledge and Practice.