Blockchain, telehealth promise more efficiency as healthcare looks to bounce back from COVID-19

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The battle against COVID-19 continues, with the pandemic exposing flaws and cracks in global healthcare systems that speak to big inefficiencies in the sector.

These inefficiencies, many of them administrative in nature, touch all aspects of healthcare, from payers to providers, to public and private programs. The industry is stressed and in need of relief.

Thanks to emergent technologies, though, relief may be at hand. Blockchain and telehealth are changing the way healthcare does business, and their increasing maturity has created an opportunity to change the status quo. 

The pandemic has acted as an accelerant of sorts for the development and evolution of these technologies, and they're poised to take on greater prominence as the pandemic slowly fades.

Blockchain in particular, with its notion of a distributed ledger, allows a level of interoperability that doesn't yet exist in any wide-scale form. Interoperability – the ability for disparate electronic health records systems to communicate with one another – has long been seen as a holy grail in healthcare.

Realizing that goal will bring a heightened level of efficiency to the system, from payment mechanisms to the ability of patients to get data and services in real time.

Interoperability took on added importance on April 5, when the information blocking rule released by the Office of the National Coordinator in March 2020, went into effect. The ONC rule requires health IT vendors, providers and health information exchanges to allow patients to have easy access to their health records through third-party apps.

Under the rule, providers may not inhibit the access or exchange of health information, except under eight specific exceptions.

Blockchain can ease information access and prevent the potential for fraud and waste, according to Dr. David Randall, former insurance regulator, current academic writer and resident scholar with the American Research and Policy Institute.

Randall offered the example of nonemergency medical transport. In basic terms, Medicaid allows for the use of NEMT, which allows individuals to use transportation to get to appointments for a variety of purposes.

According to Randall, numerous GAP studies have found great waste, and in some cases, fraud and abuse within the system, to the point that Randall estimates that as much as 32% of the associated costs are actually wasteful.

"By using blockchain, you can substantially decrease the fraud, waste and abuse within NEMT through use of the platform and an interactive transport program like Uber or Lyft," he said.

"The benefits are A), patients are not going to have missed appointments, and B), patients no longer abuse NEMT for free rides."

Other opportunities for increased efficiency exist, including eliminating paper and outmoded practices, such as push pins and the use of paper vouchers to pay vendors. By using blockchain to make this interoperable, documentation and ledgers can be done in real time.

'THE MOTHER OF ALL INVENTIONS'

As for telehealth, it's having a bit of a moment. In 2020, virtual care was expected to account for more than 20% of all medical visits in the U.S., which in turn is projected to drive $29 billion in total healthcare services.

Those numbers were revealed in September in Doximity's 2020 State of Telemedicine Report, which also found that up to $106 billion of current U.S. healthcare spend could be virtualized by 2023.

This highlights the high rates of adoption among both patients and physicians. The impetus felt among providers to offer safe, secure and easy-to-use virtual services as demand for telehealth continues to grow.

That demand is indeed growing. With many access and reimbursement hurdles at least temporarily lifted due to federal policy changes, more consumers have received a taste of what telehealth is like.

And most like it, at least enough to want to keep using it after the pandemic has become a memory. An April Sykes survey polled 2,000 Americans and found that nearly 88% want to continue using telehealth for nonurgent consultations after COVID-19 has passed, while almost 80% say it's possible to receive quality care.

"Necessity is the mother of all inventions," said Randall. "It was necessary for the technology to be used and to evolve as a result of what everyone has gone through over the past year. Will this be around in five years? Absolutely yes, because of the efficiencies it promotes.

"Several hundred academic studies have looked at whether telehealth is efficient, whether you're getting good patient outcomes. You can say with great confidence that it is reducing costs, specifically administrative costs, and they indicate you're not getting adverse health outcomes."

Most states, he said, have adopted new reimbursement methodologies within their systems. And while this has resulted in pushback from specialty provider trade groups, which are concerned about how this will affect their revenues, the technology has made such inroads over the past year that it has essentially reached a tipping point, with more widespread adoption sure to become the norm.

Globally, some healthcare systems are faring better than others when it comes to technology adoption and overall efficiency. The U.S. has unfortunately lagged in this regard. Randall points to Europe, specifically the Swiss system, as being particularly hardy.

The Swiss system is a hybrid public/private model that includes both a government-run public option and a robust private insurance marketplace. Most Westernized healthcare systems have some degree of privatization, said Randall, and many of the hybrid models are more efficient than the U.S. system. There are lessons to be learned there.

In the meantime, the pandemic has accelerated many of the trends that were already in place in terms of using technology to increase access, efficiencies and patient adherence. Those trends won't be stopping.

"I don't think there's any turning back in terms of the deployment of these technologies in the future, and certainly in the U.S.," said Randall.

"The public health programs are using it and they're going to continue to use it, because they're starting to see administrative efficiencies, as well as decreased costs and in some cases decreased utilization of services without adverse health outcomes."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com