Establishing Viable Virtual Health as Net Neutrality Ends

While efforts to make changes to the Patient Protection and Affordable Care Act (ACA) have been loud, direct and headline grabbing, the potential reversal of net neutrality policy has proven to be subtle, methodical and insidious. Yet, its impact on access to high-quality care could potentially be as consequential as any health care legislation currently under consideration, especially for patients who rely on virtual health services.

While often discussed, net neutrality is not widely understood. At its core, net neutrality is the concept that internet service providers (ISPs; such as Comcast, Verizon and ATT) must stream data at the same speed regardless of the source or nature of the content. Net neutrality prohibits ISPs from entering into business relationships that incent them to either artificially speed up or slow down data.

After several years of failed attempts, in 2015 the Federal Communications Commission (FCC) formalized net neutrality by enacting the “Open Internet Order.” However, under the new administration, the FCC is now taking steps to overturn this order and eliminate net neutrality. Overturning net neutrality is likely to add layers of cost to internet access, adversely affecting virtual health services that rely on affordable, high-speed broadband to effectively operate.

Net Neutrality’s Impact on Health Care
The elimination of net neutrality rules would exacerbate the limited access to high-speed internet that exists in many areas of the country. In rolling back the protections currently in place, ISPs will be permitted to enter into “pay for prioritization” business arrangements. This could lead to faster streaming speeds for preferred health care providers over others or for products produced by preferred vendors. It may also come in the form of offering high-speed internet that is available to anyone, but at a premium cost.

Regardless of form, these additional costs threaten to disproportionately impact resource-constrained hospitals, many of whom serve patient populations who rely on virtual services to obtain high-quality care.

Modify Your Strategy
This policy change will have ripple effects across the health care landscape, and may result in changes to virtual health business models, impacts on health system relationships, and changes in virtual health strategy. While the exact impact of this change in legislation is unclear, it is clear that it will introduce uncertainty.

Understandably, additional risk associated with technology adoption leaves many health care leaders uncomfortable and reticent to include new technologies in their strategic plans. However, investing in technologies that produce value in the following 2 key areas will leave you well-positioned regardless of the short-term legislative changes that occur.

1. Prioritize Virtual Visits With Measurable ROI
Carolinas HealthCare System has built a virtual cardiology program that supports coordinated care to potentially high-cost patients.  Teleconsults are facilitated for patients who are undergoing a primary care visit, but have been flagged as being high-risk for cardiovascular conditions. These patients are “referred” during their primary care visit and then remain in the office for a video visit with a cardiologist.

Takeaway: Programs that produce greater margins through combined downstream revenue generation and cost savings are able to justify additional costs, thereby politic-proofing the return on investment (ROI).

2. Pursue Tech-Enabled Care That Does Not Require High-Speed Internet
Partners HealthCare has developed several products that are focused on extending the reach of the organization. Patients undergoing transplant surgery, anticoagulation therapy, or oral anticancer therapy are given an iPad mini that is loaded with an app specially designed to provide daily self-care reminders and notifications of lapses in adherence.

Resulting insights into patient activity have led to improved rates of adherence to recommended therapy and have generated significant cost savings.

Takeaway: Approaches that require minimal internet reliance while producing significant financial and clinical impact will increase in value with potential elimination of net neutrality.

Invest in Technologies That Fit Within the Broader Enterprise Strategy
When considering adopting technology, it is important to develop a strategy that not only addresses the 2 critical areas listed above, but also fits within the broader enterprise strategy.

Quality, safety, patient experience and cost efficiency are the cornerstones of any good enterprise strategy.  For example, Carolinas’ virtual cardiology program provides a time-efficient “super” visit, which is mindful of patients’ time while providing high-quality, proactive care.  Partners HealthCare’s self-care app program also delivers on these fronts. Its patient-centric program empowers patients with targeted reminders that result in improved care plan adherence and clinical outcomes. Importantly, this is done autonomously with no additional effort required of the care team.

Targeted investments such as these will be even more paramount with the elimination of net neutrality.  As new technologies are evaluated, think through the following questions, “Why are we considering this technology?” and “What challenge are we addressing by adopting this technology?”  By addressing these questions, leadership can ensure that adopted technologies generate value in proportion to the internet (and other) costs they incur.

Finally, “future proofing” investments is essential to maximize returns and mitigate risk. Accomplishing this includes:

  • Constructing scenarios for future practice patterns
  • Weighing acquisition options
  • Matching the right solution with the right care setting.

Most importantly, achieving a mix of technologies that produce a net neutral or net positive ROI for the system, as well as measureable nonmonetary benefits, is critical to the sustainability of any technology strategy. Taking these steps will help insulate organizations from any legislative shifts that occur in the coming years.

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