Telemedicine and Value-Based Healthcare
- Dr. Gillie Gabay
- Apr 1
- 5 min read
Telemedicine, the ability to conduct virtual encounters between patients and providers, plays a pivotal role in the advancement of value-based healthcare. Telemedicine offers innovative solutions to improve patient accessibility and reduce costs.
In models of value-based healthcare, providers are incentivized to improve patient outcomes while minimizing unnecessary healthcare expenditures. Telemedicine facilitates these benefits by enabling remote consultations, monitoring, and management of chronic conditions, which can lead to improved patient engagement and better self- management of diseases.
Telemedicine extends healthcare services to underserved and rural populations, where access to specialists or healthcare facilities may be limited. Telemedicine opens up opportunities for patients to receive timely consultations and care, from top specialists, reducing delays in diagnosis and treatment that can lead to deterioration in health conditions requiring costly interventions and jeopardizing patient life quality.
For patients with chronic conditions like diabetes, hypertension, or chronic kidney disease, virtual encounters allow frequent check ins allowing continuous monitoring by the provider and higher adherence of patients. This presents a shift in focus from treating illnesses to identifying potential risks early on and intervening before the health condition worsens, thereby reducing hospitalizations, and emergency room visits.
Telemedicine provides patients with more control over their healthcare by allowing them to schedule appointments and access care from the comfort of their homes. Increased engagement leads to better adherence to treatment plans, lifestyle modifications, and preventive care, all of which are essential to achieving the goals of value-based healthcare.
For health systems, telemedicine reduces the need for in-person visits and enables efficient management of patient care remotely, lowering operational costs for providers and enabling them to reinvest the savings into improving patient care, for example by fostering more effective patient-provider relationships Such relationships are central to value-based healthcare models. While across countries vast expenditures are invested in infrastructures for digital health, including telemedicine, this technology, despite its benefits, is underutilized.
Despite its potential, telemedicine presents several barriers to its implementation both from the perspectives of providers and patients. Providers may face challenges in acquiring and maintaining adequate infrastructure. Also, providers may be discouraged from having patient encounters which are moderated by a computer. In addition, busy providers may not be compensated for the time they invest in telemedicine services. Telemedicine subject providers to their management's control, hindering a sense of autonomy. Last, not all healthcare conditions are suitable for remote management. Providers may face difficulty in diagnosing or treating certain conditions through telemedicine due to limitations in physical examination, diagnostic testing, and the inability to provide hands-on care. Figure 1 presents provider's barriers to telemedicine
As for barriers from patients' perspectives, one significant barrier to telemedicine is the patient’s ability to use the necessary technology. Older adults or individuals with lower levels of digital literacy may struggle to navigate telemedicine platforms, making them less likely to engage in virtual care options. Patients may not have a stable, reliable internet connection, smartphones, or computers to participate in telemedicine. In low-income or rural areas, these technological resources may be scarce, inhibiting the adoption of telehealth services. While telemedicine platforms are designed to be secure, some patients remain concerned about the privacy and security of their personal health information when using online telemedicine platforms. These concerns can prevent patients from fully embracing telemedicine as a preferred method of care delivery. Our studies with 1000 patients and 600 elderly chronically ill patients demonstrated that some patients may feel that telemedicine lacks the personal touch that in-person visits offer. This inability to physically meet with their providers can lead patients to feelings of disconnectedness or reduced satisfaction with the care experience. Figure 2 presents patient barriers to telemedicine.
Beyond these barriers an important question is does Telemedicine enhance the quality of care?
To effectively integrate telemedicine into value-based healthcare models and overcome the barriers faced by both providers and patients, a multifaceted approach is required involving policy changes, technological improvements, and initiatives aimed at enhancing patient and provider engagement by improving quality of care to telemedicine.
Healthcare systems should design user-friendly telemedicine platforms, with secure video conferencing tools, and remote monitoring devices. Providers can be trained to use telemedicine effectively while tailoring the communication they use in telemedicine to psychosocial segments of patients.
Policymakers should establish reimbursement policies that adequately cover telemedicine services in a uniform and comprehensive structure covering the entire spectrum of telemedicine for consultations, remote monitoring, and chronic disease management. The reimbursement must recognize the cost-effectiveness of telemedicine and reward providers for improving patient outcomes and reducing their risk (e.g., lowering readmissions and visits to the emergency department).
Providers should assess the suitability of telemedicine for various clinical scenarios. Clear guidelines should be established about which conditions can be effectively managed through telemedicine, and when in-person visits are necessary. Developing comprehensive decision-support tools will help providers determine when remote consultations are appropriate. For certain conditions, hybrid care models that combine in-person and virtual visits could be used to maintain a balance between the convenience of telemedicine and the necessity of physical examinations. This model would allow providers to use telemedicine for follow-up visits and routine check-ins while reserving in-person visits for more complex cases.
Educational initiatives to teach patients how to use telemedicine platforms effectively through tutorials, user guides, and live customer support can help patients navigate telemedicine tools. Additionally, healthcare providers should offer in-person training sessions for patients who may need extra assistance, particularly older adults and those with limited technical skills. Healthcare systems can provide patients from underserved populations with access to tablets, or other devices to bridge the digital divide and enable more patients to benefit from telemedicine services. Ensuring that patients from rural or low-income areas have access to reliable high-speed internet is critical calling policymakers and governments to improve broadband infrastructure in underserved areas, ensuring equitable access to telemedicine services.
To enhance quality of care, providers should ensure that virtual visits are as personal and engaging as in-person visits by focusing on strong communication skills, using video to create a more personal connection, and allowing time for patients to express concerns and ask questions. Creating a welcoming virtual environment can help patients feel more comfortable and engaged during remote consultations and increase their use of telemedicine services. Tailoring telemedicine services to meet the needs of individual patients can improve satisfaction and quality of care. Providers should ensure that telemedicine is designed to be flexible, accommodating patients' preferences, such as offering consultations during non-traditional hours, or using communication channels that suit the patient’s comfort level.
Removing barriers to the adoption of telemedicine requires concerted efforts of multiple stakeholders, providers, policymakers, technology vendors, patients, and their families. Telemedicine can become a cornerstone of value-based healthcare. By addressing the barriers, healthcare systems can leverage telemedicine to improve access, reduce costs, enhance patient experience, and improve outcomes, ultimately achieving the goals of value-based care.