In addition to post-acute patients, telehealth is also used to monitor ambulatory patients – those who have been diagnosed with a disease at an ambulatory care facility but have not been hospitalised. However, telehealth has a much larger penetration in post-acute care as compared to ambulatory care patients as the majority of patients are only considered for home monitoring following hospital discharge to prevent readmission. In the U.S., for example, 140,000 post-acute patients were estimated to have been monitored by telehealth in 2012, as compared to 80,000 ambulatory patients.



Figure 1: World telehealth patients (thousands) by disease.


“A major challenge for telehealth, is for it to reach the wider population of ambulatory care patients. However, the clinical and economic outcomes for telehealth are more established for post-acute care patients. Indeed, even for post-acute care patients, telehealth is usually prescribed only in the most severe cases, and where patients have been hospitalised more than once in a year,“ commented Theo Ahadome, senior analyst at InMedica.

CHF currently accounts for the majority of telehealth patients; in addition to being one of the largest cost-burdens for hospitalisation, the clinical outcomes of telehealth for CHF patients are most established. The number of telehealth patients with COPD is also projected to grow strongly as telehealth focus continues to expand to respiratory diseases. The successful results of the Whole System Demonstrator (WSD) program in the U.K. are serving as strong evidence-base for the benefits of telehealth for COPD patients. However, by 2017, Diabetes is forecast to account for the second largest share of telehealth patients, overtaking COPD. Home monitoring of glucose levels for diabetes patients is more established through personal glucose monitors. There is an increasing drive to integrate these monitors with telehealth systems, allowing care givers access to patient glucose data.

Over the next five years, InMedica identifies four main drivers of telehealth demand:

Federal-driven demand: Readmission penalties introduced by the U.S. Centre for Medicare and Medicaid Services (CMS) are driving providers to adopt telehealth as a means of reducing readmission penalties. Faced with increasing healthcare expenditure, other governments, including the U.K., France and China are also promoting telehealth as a long-term cost-saving measure.

Provider-driven demand: Healthcare providers want to use telehealth to increase ties to patients and improve quality of care. In many cases this is being done irrespective of the lack of a clear financial return on investment.

Payer-driven demand: Telehealth is also being increasingly used by insurance providers to increase their competitiveness and reduce in-patient pay-outs, by working directly with telehealth suppliers to monitor their patient base.

Patient-driven demand: There is currently very little demand from patients actively seeking out and requesting telehealth services from their payer or provider. Patient-driven demand is mostly limited to rural/non-metropolitan areas where there is a poor availability of clinics and physicians. As fitness awareness increases and consumers adopt personal devices to track their fitness, they will also increasingly seek professional devices to remotely track disease state.

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