Question

explain doctor Joseph kvedar video on connected heath symposium? in 100 words

Answer 1

Ans) The base case analysis found that, given the assumptions above, compared with the standard model of no telehealth consultation and transfer of patients with suspected moderate or severe TBI to a trauma center, the telemedicine model results in an incremental cost savings of $1,937 per patient from the perspective of the health care system and payers.

- Sensitivity analyses indicate that telehealth may be cost-saving to the health care system and payers, but these I-11savings are dependent on the exact costs and relative differences in costs for the different types
of hospitalizations (i.e., the costs of the Level I or II trauma center for a patient not requiring a
neurosurgical intervention (NSI) and the costs for a patient not transferred and cared for at the local hospital).
- Specifically, the sensitivity analyses identified that the parameter that had the highest
influence on the model results and that could change the direction of conclusion (e.g. cause the telehealth model to be more expensive) was if the cost of treating patients who did not require NSI in a trauma center reached the top of its range. In addition, when community hospital costs for NSI patients approached the upper end of its range, closing the difference in cost between community hospital and trauma center admissions, the telemedicine model became more costly.
- Furthermore, the assumption of equivalence in outcomes is fundamental to the relevance of these findings.

- In a scenario where mortality outcomes are not equivalent, any difference in costs could
be easily outweighed by incremental differences in life years gained or lost.

- These findings may be most relevant to alternative payment and service delivery models, such as accountable care organizations, and value based insurance designs, which have the
ability to allocate patients to different settings, or from the perspective of payers/insurers who are responsible for reimbursement across several types of hospitals.

- Telehealth consultations appear to increase efficiency for a multi-hospital health system or payers, in that telehealth can be used to decide to treat patients in a lower cost setting (in this case in the local hospital), rather than
transferring a patient who does not need NSI to a higher cost setting (e.g. a tertiary care center).
- However, if telehealth is only evaluated from the perspective of a single hospital, the conclusion might differ.

- For example, a community hospital may see an increase in revenue from patients who are retained in-house rather than transferred with telehealth but would not see the savings a
health system would from avoiding a more expensive hospitalization.

- From these two different perspectives, the return on an investment in telehealth would differ because the amount of savings or change in revenue are likely different. Modeling could be expanded to compare these perspectives and identify when telehealth does result in savings.
- It is also important to consider that the differences in costs may also vary across regions, depending on what services are available and how the health care system is organized.

- For example, some regions have diverse systems with independent community hospitals while others are covered by larger systems consisting of both community and tertiary care centers under the same umbrella organization.

- According to the 2016 Snapshot of U.S. Health Systems from the Comparative Health System Performance Initiative, these larger systems represent almost 43% of hospitals in the U.S.20 with at least 18 hospitals per system. For these larger systems, the lower overall cost of care when telehealth is used to support treatment of patients who do not need NSI in lower cost hospitals represents a real opportunity for both cost and staff efficiency.

- Furthermore, the reimbursement structure or payment model matters substantially in both the cost estimates and the incentives. For example, in an accountable care model, a large health system could reduce overall costs of care by shifting patients to the lower cost setting while retaining the same per person payment/reimbursement. However, under fee-for-service contracts, the hospitals may be reimbursed based on the location of care (regardless of what was needed) and the insurer/payer may or may not realize a difference in costs, depending on the
reimbursement scheme and DRG modifiers.

- Thus, if the reimbursement in the community
hospital were the same as the trauma center for a patient who did not undergo NSI, then there
would be no cost difference.