By Fred Dawson
August 1, 2013 – Cable companies may not have the national footprints of big mobile telecoms, but new initiatives among some MSOs make clear there’s no reason to cede opportunities in the emerging telehealth market to larger competitors.
This applies to cable companies of virtually any size insofar as the many ways in which their networks can be used to support telehealth services invariably stem from initiatives undertaken by hospitals and other health providers at the local level. As Julia McGrath, senior vice president of marketing and business development at Cablevision Lightpath, notes, “We’re seeing an explosion of bandwidth growth in support of health care organizations’ need to move high-resolution imaging files and video content from point to point.”
In other words, in one sense, serving the needs of hospitals, medical practices, long-term care facilities and other players in telehealth is a natural extension of what cable companies are already doing on the commercial services side, where their ability to provide high-capacity fiber connections at lower costs than incumbent telephone companies together with more localized customer service has been a spur to rapid growth. “Over the last couple of years we’ve seen the transport requirements in the health sector grow incrementally from 1gigE to where 10gigE connections have become common, and now we’re seeing it leapfrog the next tier at 40gigE to go directly to 100gigE in the years ahead,” McGrath says.
But as evidenced by new initiatives undertaken by Lightpath and other cable entities, the opportunity has grown beyond basic connectivity to include a wide range of vertical-specific service possibilities now that telehealth has become a major focus in the government, care givers’ and payers’ efforts to reduce costs. “This has been a well-penetrated vertical for us for a long time, and it requires a unique understanding of its needs,” McGrath says. “This has led us to create a suite of services as those needs have evolved.”
Another case in point is Time Warner Cable, which began shaping a more targeted approach to the health vertical in late 2010. “Initially we tried to look at all the key trends and changes in this space by talking to large customers who are among the biggest health care providers in our footprint,” says Satyanarayana Parimi, vice president of product management and vertical markets for TWC BusinessClass. “The major trend we saw was the big push toward digitization in health care, which we knew was going to radically change the way things were done.”
Digitization meant health care providers would need to be able to move records and store them securely, with managed service and cloud support from network service providers. “Once you can move and store digital data, you have the flexibility to use it in new ways, which is where we see the emerging opportunities for telemedicine,” Parimi adds, noting this means greater opportunities ahead for NSPs with access to people’s homes. “Once providers begin using their digital capabilities outside their health care facilities, we see an opportunity to partner with them to reach patients.”
Aligning sales teams to focus on the health care vertical with strong support from product and marketing people has paid off for TWC BusinessClass. Where, three years ago, the company was used by health facilities primarily to back up transport services provided by the ILECs, today it is the primary provider to a growing number of care organizations, Parimi says. “We’ve had some really big wins in the last year and a half with significant revenue growth in this vertical,” he adds.
“With our focus on the vertical with messaging about our fiber networking capabilities we’ve changed the view these health care provider have about us,” he explains. “We’re seeing situations where hospital groups that might have ten or 15 care centers need to be interconnected with fiber.”
This, in turn, generates demand for business-class broadband service over the existing HFC network, he adds. “They need us to provide high bandwidth connections to clinics and doctors so that all locations have access to medical records hosted in the cloud or at the core hospitals,” he says. “We’re linking all these facilities with high-capacity secure connections.”
The Local Advantage
This localized orchestration of services tailored to the needs of a specific health care cluster is a made-for-cable opportunity, notes Karen Schmidt, executive director of product management and strategy at Comcast Business Services.. “Health care is an interesting scenario where maybe a hospital also wants to be connected to the x-ray centers, the doctors’ offices and the clinics,” Schmidt says. “They are a kind of consortium of groups that need to work together and exchange data. We’re still fairly new to this space, but if I were to look at the verticals where there are the most applications, health care is clearly one of them.”
One example of Comcast’s success in this arena involves services it’s providing to Upper Chesapeake Health, a Maryland-based two-hospital system with over 4,000 physicians, team members and volunteers and more than 130,000 outpatients in the network. Having outgrown the bundled T1 service it had relied on, UCH contracted with Comcast Business Ethernet Network Service to link its two hospitals and outpatient facilities, enabling secure exchange of data at up to 1 gigabit per second.
“Comcast was the only vendor to meet every one of our connectivity needs in the required timeframe and at the most cost-effective price,” says Rick Casteel, vice president of information technology for UCH. He notes his organization has also engaged Comcast to expand its network with a link to the University of Maryland Medical System. “This enables us to co-locate some of our network and server infrastructure and eventually install a new electronic medical record system that both organizations will access,” Casteel says.
Comcast is also supplying Ethernet Dedicated Internet service to UCH facilities and their patients. Among other things, this service allows UCH patients to log in over the Internet to access their personal health records.
Such success stories for cable companies are popping up everywhere. Earlier this year, the Bronx-based Kings Harbor Multicare Center, a nursing care facility, announced it had worked with Cablevision’s Lightpath to design a redundant fiber network that enables it to continue using existing analog equipment while supporting access to digital patient records hosted remotely.
The new network replaces a copper-based voice and data infrastructure, providing all the advantages of high-bandwidth fiber while maintaining compatibility with King Harbor’s backup generators and analog-based phone and alarm systems, says Kenneth Scharf, chief information officer at Kings Harbor. “When it was time to choose a new telecommunications provider, Lightpath’s premium customer service was as much a deciding factor as the quality of its network,” Scharf notes. “For any issue we may have, I know exactly who I can call within the company to help get me to a resolution. You can’t put a price tag on that given how important communications is to a healthcare organization like ours.”
Early on the Lightpath service was stress tested on another essential health care performance parameter, namely, robustness. When King Harbor was forced to rely on backup power during Hurricane Sandy, the network continued operating, enabling staff to communicate and provide care throughout the storm. “The performance of the Lightpath network is solid and has held up under some very severe conditions,” Scharf says.
As Lightpath built relationships with hospitals based on its ability to provide them the connectivity they needed, it became clear there was an opportunity to develop a portfolio of services directly suited to the sector’s needs, says Lucas Binder, vice president of business development at Lightpath. “We’re able to work with customers when they’re trying to solve for specific issues, whether it’s the provisions under the Affordable Care Act, EMR management or applications that require collaboration between us, the hospitals and third-party suppliers,” Binder says. “For example, in the datacenter space we’re able to help big health systems like Long Island Jewish leverage public cloud facilities with their own private datacenters with uniform levels of security and complete redundancy across all connections.”
Introduced in mid-2012, the Lightpath Healthcare Services Suite is designed to provide hospitals, medical practices, long-term care facilities and radiology centers support for telemedicine, healthcare, office management, e-learning, EMR (Electronic Medical Records) solutions and an enhanced patient care experience. Products from the suite deliver the high-bandwidth needed to utilize PACS Imaging and Computerized Physician Order Entry (CPOE), host Web conferences for community education initiatives, provide remote consultations, facilitate internal collaboration and conferencing, decrease average length of stay, simplify voice systems and better manage costs.
Lightpath is also looking at various types of collaborative arrangements to expand the options it can offer to health care providers. Last year, for example, the company explored the possibility of supporting video-based e-learning supplied by GetWell Network to help patients in transitional and long-term care stay current with personal treatment requirements as well as new developments related to their conditions.
Use of video conferencing is another area under exploration. “Video conferencing enables hospitals to take advantage of remote health care services for patients,” Binder notes. “And there are doctors working out of independent radiology facilities who want to be able to monitor results and have discussions with customers via video.”
The Residential Service Opportunity
So far, by all accounts, the opportunity to provide residential telemedicine services through affiliations with hospitals or other care organizations has yet to take hold beyond the trial and piecemeal implementation phase. But when it does, cable companies believe they will have a significant advantage in this arena, owing to their high-speed broadband and digital video capabilities.
“If health care professionals need residential services, given our parent company’s heritage and access to homes in our footprint, we’d figure ways to bring solutions to the health care space,” McGrath says. “Right now we’re not hearing that, but I think it’s one of those topics that will get more widely discussed over the next few years.”
“We are looking at trials this year with large providers for virtual visits and also at monitoring with medical devices,” says TWC’s Parimi. Use of VOD infrastructure to support patient education is another promising area, he adds, noting TWC is looking into the results of a VOD trial undertaken by Comcast and United Healthcare last year to test a new approach to obesity management.
“We are getting a lot of inquiries about the possibilities of leveraging our VOD platform to educate patients,” Parimi says. “It’s something we’ve done in partnership with providers in a couple of local markets. Now we’re trying to figure out how to monetize it.”
When it comes to devising reimbursement strategies for telemedicine in general, the most promising area of activity in the near term can be found with accountable care organizations (ACOs), Parimi notes. Hundreds of ACOs have emerged since passage of the Affordable Care Act to exploit government and private insurer incentives aimed at cutting care costs by allowing care providers to share in savings accumulated as a result of cutting back on hospital readmissions, emergency room visits and other costly elements of the traditional approaches to health care.
“What I’m hearing from number of people is the best place to find demand for telemedicine is in the ACO model where the doctors’ or other types of ACO organizations get paid fixed payments per year, and it’s their job to keep patients healthy so that savings for them become profits,” he says. “The first batch of ACOs was created 18 months ago, and we’re working with some of them. They’re very interested in telemedicine. We’re seeing a lot of excitement and energy around this.”
Indeed, while some aspects of telehealth, such as the cloud-based EMR management paradigm, have taken longer to gel than anticipated, there’s no getting around the fact that this sector will be a major opportunity for NSPs, Parimi says. Just the fact that ever more people need care as the number of primary care physicians is shrinking points up the need for alternatives to traditional approaches, he adds.
“How you can see more patients in the time you have available and make money without killing yourself is going to be a big issue for primary care physicians,” he says. “The combination of the push behind ACOs and the reality of not having enough doctors will generate demand for remote care models.
“We haven’t reached the hockey stick yet, but we’re very consciously optimistic about the opportunity for us,” he adds. “This will happen. We just want to make sure we’re there with the right solutions as it unfolds.”