The headlines tell us that telehealth (or digital health or virtual health, or whatever you call it) is going to remake health and human service delivery—Virtual Mental Health Delivery Systems Evolve, The Inescapability Of Your Virtual Presence, and When New Contracts Mean New Technology: 4 Things To Remember. But, as usual in health and human services, adoption of new technology is uneven at best—see Failure To Launch and Is 2019 The Year Of The Telehealth Tipping Point?.
Our recent survey of specialty provider organizations found that only 44% of them over $25 million in revenue are using telehealth technologies and about 33% of them under $25 million are using these technologies (see The Tech-Enabled Provider Organization: The 2017 OPEN MINDS Health & Human Services Technology Survey) but we don’t know to what extent. And adoption among prescribers is still relatively small—a recent study of Medicare psychiatrists found that 5% were using tech platforms to deliver services (see About 5% Of Medicare Psychiatrists Provide Telemental Health Services).
The reasons for the uneven adoption are many. The differences in payer policy—Medicare, Medicaid, military, commercial insurance, a range of employers, the 4,000+ health plans in the U.S., and the patchwork of state and federal law. Interestingly, this regulatory and policy backdrop is becoming more similar. But I think there are some fundamental paradoxes of management in the health and human service field that are slowing the adoption of this (and other) technologies.
“Integration” is a challenge to tech adoption—Since the passage of the Patient Protection & Affordable Care Act of 2010 (PPACA), the resulting landscape with no plan limits and no pre-existing condition exclusions has focused the health care field on better coordination of consumer care—and integration. Integration is an ill-defined goal, but depending on the situation, involves collapsing previous boundaries between service delivery, consumer health information, and financial incentives. Managers face challenges in evolving their current service lines to fit in “integrated” service delivery systems: new service capabilities, health information exchange, shared financial incentives, and more. Adding virtual health to the mix is adding a new complication at a complicated time. (For more on these integration challenges, see Tech Capabilities In An Era Of Integration & Value, For Successful ‘Integration’, It Takes Interoperability & Patience, and Integration, Interoperability & Consumer Engagement.)
The “playbook” for virtual health best practices is still being written—Virtual health is increasingly being viewed as essential for addressing consumer expectations (more rapid access), workforce shortages (out-of-area specialists and tech substitution), and value-based reimbursement optimization (lower price points). But few administrative “best practice” models are available. Scheduling systems, compensation systems, and clinical best practices (to name a few) all need to be changed. (For more on the current state of best practices, see Crossing The Digital Health Chasm, Virtual Health As Strategy—Starting With Telehealth, and Digital Transformations Demand Digital Dexterity.)
Moving from new technology as expense to new technology as transformative—When adding virtual health technologies to their organizations, most health and human service executives miss the transformative opportunities. Over the past six months, the executives I met with are looking at telehealth to provide additional psychiatric capacity for current services or to increase productivity of current clinical team members by real-time filling in for “no show” appointments. These are great uses for the technology, but they are not transformative—they are focused on conventional ways of delivering services. Like other fields, the transformative uses of new technology happening outside of traditional provider organizations—a very specific threat (see Thinking About Partnering With A Tech Start-Up?, What Should Your Organization Be Spending On Tech?, and Planning For The Digital Reinvention Of Your Market).
Executives view digital health as an “added cost”, rather than an investment—This paradox is based on the last one. A recent survey (see The Industry 4.0 Paradox) found that 94% of 361 executives surveyed across 11 countries identified digital transformation as a top strategic priority, while only 68% think it will increase profitability. But the rationale for that response is obvious—if the technology is not transformational in terms of competitive advantage and new revenue, it is simply an added expense and nothing more.
If your organization delivers health and human services and you do not have a strategy for incorporating technology in your service delivery (see Making The Right Tech Investments For Your Organization: An OPEN MINDS Executive Seminar On Technology Budgeting & Planning, Using Tech Tools To Build A High-Performing Organization and The Strategy Of Tech Investment) and a structured process for evaluating tech investments (see Do You Have The Right Tech Strategy? An Executive Seminar On Technology Selection & Budgeting, More Tools For Tech ROI and Training Is Key To Getting Tech ROI), your organization is already behind the curve. I think telehealth alone (forget about all the other emerging tech innovations) will give organizations an advantage on access statistics, recruitment, and price points—to name just a few benefits. For more on the executive team role in digital adoption and digital transformation, check out these resources in the OPEN MINDS Industry Library:
- Digital Transformations Demand Digital Dexterity
- 4 Steps To Develop Digital Dexterity In Your Workplace
- What Do The Disruptors Need To Be Disruptive?
- The Disruption Of Strategy
- The Strategy Of Tech Investment
- Planning Your Treatment Tech Investment
- Getting That Return On Your Tech Investment
- What Should Your Organization Be Spending On Tech?
For even more join me on June 6 in New Orleans, Louisiana for The 2019 OPEN MINDS Consumer Engagement Technologies Summit, featuring Andrea Auxier, Ph.D., Senior Vice President, Product Development, New Directions; Chris Thompson, Chief Operating Officer, Monarch; Davis Park, Executive Director, Front Porch Center for Innovation & Wellbeing; Larry Smith, Chief Operating Officer, Grand Lake Mental Health Center; and Neal A. Bowen, Ph.D., Chief Mental Health Officer, Hidalgo Medical Services.