The three options for reducing the need for expensive care so that patients see better outcomes at a lower costs are: to deny care to consumers, reduce payments to providers, or use technology in a way that inspires people, Telcare CEO Jonathan Javitt MD MPH said in a panel at the mHealth Summit event near Washington DC. Editor's note: This article has been updated with clarifying remarks from Javitt, especially to make the distinction between traditional telemedicine and mHealth clearer.
It's clear, Javitt is rooting for the third option, and his fellow panelist telehealth system maker JEMS Technology CEO Kevin Lasser agreed better outcomes and lower costs are achievable through traditional telemedicine technology, but the topic on which the two locked horns was how technology should be used to see these outcomes.
Lasser pushed for more telehealth and wanted to see reimbursement used to fill holes in the healthcare system -- healthcare facility shortage areas that might not fully reimburse if there's another facility within 50 miles of the first, lack of action in the government, and WiFi usage (instead of data).
Approaching the topic from the side of the consumer, Lasser said that if he were at a hockey game and his chest started to hurt, he'd want to see his doctor right away, and the way to do that would be to use telemedicine to see his doctor immediately.
"I don’t want to wait to go to that room to get to see a cardiologist," Lasser said. "Everything has to be untethered."
He said that to get this kind of care, people should look forward to change and focus on reimbursement for traditional telehealth visits.
In an email following the event, Javitt asked MobiHealthNews to include more of his argument: On-stage he pointed out that Lasser was advocating only face-to-face teleconferencing and that a physician getting a call from a hockey game with additional physiologic parameters would have no choice other than to advise the patient to call 911. Javitt went on to describe a number of low-cost mHealth devices that can give a physician or other health professional the anytime, anywhere information needed to render appropriate medical care.
Javitt approached the topic from his experience working with diabetes, which he said was the "paradigm for the rest of our challenge".
In his experience, people with diabetes spend less than an hour a year with their doctor, and spend countless hours on their own trying to figure out how to manage their disease. In the case of an unnamed government organization, he saw 150 people with diabetes, who cost the organization $6,000 per year, lower their costs, but using Telcare, the participants who accepted the program showed a $3,300 per person decrease in cost between 2011 and 2012, while the non-participants showed $200 per person increase in cost.
The important thing to note, according to Javitt, is there's a difference between mHealth "as the term was originally coined" -- the incorporation of mobile communications into healthcare and technology devices so that the patient is plugged directly into the EMR -- and traditional telemedicine, which he believes tries to skirt the 100 mile drive to the doctor with a face-to-face video encounter. Javitt agrees the latter has value, but it's a different conversation than the mHealth conversation.
"There’s no more room in the system for solutions that cost more money," Javitt said. "The system doesn’t have any more money to spend. What the system needs is solutions that replace legacy disconnected devices with connected intelligence."