Obamacare officially began enrollment this week. The success of the Affordable Care Act may very well be determined by “Payers” in the Healthcare ecosystem, such as federal and state government, employers, insurance companies and individual consumers.UnitedHealth Group, serving more than 70 million consumers and ranked #17 on the Fortune 500 list, is a key “Payer”. UnitedHealth Group’s Head of TeleHealth, Pramod Gaur, is in Israel this week to present at the mHealth Israel conference and discussed his vision for mHealth.

“We see a continuum of care that includes three stages: Wellness and Prevention Care, Acute and Subacute Care, Chronic Disease & End of Life Care. The goal of TeleHealth is to improve overall health and wellbeing across this continuum. TeleHealth allows patients and providers to easily and quickly exchange health data and facilitate continuum of care with improved outcomes”.

TeleHealth

VISUAL: TeleHealth Overview

Although the common perception of TeleHealth may be Smartphone applications (health represents the #3 category in the App Store), TeleHealth applications and technologies include three broad categories:

    1. Remote Patient Monitoring (RPM) : Consumer (home) setting to professional – use of telemetry for store and forward data (vital signs, images, surveys, etc.) to a centralized health data management application. A remote professional monitors patient vital/behavior data and intervenes as necessary.
    2. Telemedicine : Use of real time video and/or audio technology for medical encounter in a professional to professional or professional to patient setting. This may be used with or without telemetry.
    3. mHealth : Telemedicine/RPM with the use of mobile (cellular or Wi-Fi) technology. Applicable with common off the shelf mobile products.

TeleHealth fills an important gap in a patient’s medical record that exposes health/social aspects in consumer’s life at home, work, or while on the road

Consumer Health Record Visual

The Business Challenge facing TeleHealth will be to integrate these technologies into the five existing payment models:

  1. Traditional Fee for Service
  1. Capitated/Negotiated Rates

• ACO (Accountable Care Organizations)

• PCMH (Patient-Centered Medical Home)

• Bundle Payment

• Episode of Care

  1. Employer Wellness/Prevention Incentives
  1. Pre-Tax Spending Accounts

• Health Savings Account

• Flexible Savings Account

  1. Over the Counter - Self Pay

The opportunity for TeleHealth, and to a larger extent Obamacare, is to address the largest population pool, those that are healthy and wish to stay that way.

VISUAL: Population Pools

Below are some recent TeleHealth examples from UnitedHealth. You can hear Pramod Gaur (UnitedHealth) and the perspective / examples of other “Payers”, including Rob Egan (CMO, Aetna) and Rajni Aneja (Clinical Transformation Leader, Humana) at the mHealth Israel conference this week. They will also be Judges in the mHealth Business Contest (http://www.mhealthisrael.com/contest/registration) this week, to identify technologies that will drive the future of mHealth.

Levi Shapiro is a Partner at TMT Strategic Advisors, a research and strategy firm focusing on the technology, media and telecom sectors. He can be reached at levi@tmtstrat.com or via twitter: Levi Shapiro@levshapiro

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