title: Moving Beyond the Walls of the Clinic: Opportunities and Challenges to the Future of Telehealth in Heart Failure.
abstract: Telehealth offers an innovative approach to improve heart failure care that expands beyond traditional management strategies. Yet the use of telehealth in heart failure is infrequent because of several obstacles. Fundamentally, the evidence is inconsistent across studies of telehealth interventions in heart failure, which limits the ability of cardiologists to make general conclusions. Where encouraging evidence exists, there are logistical challenges to broad-scale implementation as a result of insufficient understanding of how to transform telemedicine strategies into clinical practice effectively. Ultimately, when implementation is reasonable, the application of these efforts remains hampered by regulatory, reimbursement, and other policy issues. The primary aim of this paper is to describe these challenges and to outline a path forward to apply telehealth approaches to heart failure in conjunction with payment reform and pragmatic research study design.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Ariane M
authors.initials: AM
authors.lastname: Fraiche
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina. Electronic address: zubin.eapen@duke.edu.
authors.forename: Zubin J
authors.initials: ZJ
authors.lastname: Eapen
authors.affiliation: Duke-Margolis Center for Health Policy, Durham, North Carolina.
authors.forename: Mark B
authors.initials: MB
authors.lastname: McClellan
mesh_terms: D002309:Cardiology / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods*; D019468:Disease Management; D019317:Evidence-Based Medicine; D018588:Fee-for-Service Plans; D006291:Health Policy; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D006278:Medicare; D000072641:Medicare Access and CHIP Reauthorization Act of 2015; D009934:Organization and Administration; D012051:Reimbursement Mechanisms; D012052:Reimbursement, Incentive; D017216:Telemedicine / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods*; D014481:United States
keywords: Medicare Access and CHIP Reauthorization Act (MACRA); Merit-Based Incentive Payment System; alternative payment models; clinical research networks; health care policy reform; telehealth; telemonitoring