Today's post is inspired by a presentation I attended at the Northeast Home Health Leadership Summit last month in Boston. The speaker was Dr. Randall S. Moore, CEO of American Telecare Inc. Randall's company makes Telehealth equipment, but he caught my ear when he said, and repeated, that he doesn't believe Telehealth should be reimbursed. As you'll read in the post below, it's not his vision that his company shouldn't make money. Instead he challenged the participants to think differently about how to get paid. If, for example, Telehealth can be proven to reduce the cost of hospitalizations and lower the cost of care for an individual or class of individuals, wouldn't the people paying the big bills be willing to pay a much smaller amount for the Telehealth system and for the home health agency who monitors it in exchange for the savings? Of course they would, but our healthcare fee-for-service system doesn't reward or encourage such behavior, so in many cases it doesn't get done. Dr. Moore gives us a recipe for getting it done, which we share a glimpse of here.
Dr. Moore began his presentation by citing a few great books and authors, both of which have been reviewed on this blog. The first was Clayton Christensen's The Innovator's Prescription, which was Ankota's book of the year in 2009. The other was George Halvorson's Healthcare Won't Reform Itself. Note also that a video of Kaiser Chief George Halvorson is available here. But he moved quickly to his formula for reform without permission, by first listing some ingredients:
- Deliver a compelling return: (Dr. Moore asked for a volunteer to buy a $20 bill for $15 - there was skepticism at first but who wouldn't take that deal?)
- Solve a critical problem / Address a Top Priority (this will grab attention)
- Realize that a new outcome will require a new process (Expecting a different outcome from the same process is insanity)
- Make things better by making them easier - not harder
- Explain your improvements in monetary terms. (improving quality is nice, but saving money fosters buy-in)
These aren't the easiest ingredients to get ahold of, instead they require teams (which bridge the traditional silos of healthcare) to work together and they require genuine ingenuity in the healthcare delivery process. To draw an analogy, the success of the iPod isn't because Apple made a better or cheaper MP3 player than everyone else, but rather it's because they reinvented the music delivery process so that you can get a song for $1 and the record companies and artists can get their share of the profit. If Apple can do it, so can we, and in fact we can deliver much more value and savings than the iPod, so why not.
How can home care save money, let me count the ways:
- A hospital day costs $1,800
- A skilled nursing facility day costs $500
Whereas home care has the "value menu" for under $100:
- A home telehealth day (equipment and nursing) costs $20
- A home health aide for 4 hours costs $76
- Home infusion costs $90
- Home Dialysis costs $90
- The cost of an avoided readmission is $0 (free)
- and the value to the patient of a day outside the hospital is priceless
Given that healthcare reform is not going to happen overnight, let's start reforming it ourselves.
Ankota is very interested in helping agencies to redefine the delivery of care. If you are having trouble getting your software to support the new models of care you seek to deliver, please contact us and give us a chance to help out. For Ankota's white paper on transitional care, click here or contact Ankota.