Why Telehealth has Finally Reached a Tipping Point
I recently had the opportunity to join a Zoom meeting that consisted of state and local government leaders, hospital CEO’s and top physicians from various health systems and hospitals. The topic was the impact COVID-19 was having on our healthcare systems. As each physician leader spoke about the struggles and opportunities each healthcare system was facing, an interesting theme began to emerge. One-by-one, each physician began to tout the benefits of telemedicine and how it has become an essential tool to care for patients during this pandemic. While there are a growing number of webinars, articles, and news stories highlighting the benefits of telemedicine, this is the first time I had heard a group of physician leaders passionately share how telemedicine is having a positive impact on caring for their patients.
Even though some forward-looking health systems and providers were using telemedicine prior to the COVID-19 global pandemic, there were still many more health systems and providers that had not rolled out a telemedicine solution. It certainly was not considered widely available in many parts of the country prior to the pandemic. In many ways, COVID-19 has thrust technology even further into the spotlight as companies in all sectors look for innovative ways to meet the needs of their customers. Healthcare is no exception to this, and telemedicine is a great example of how technology continues to be leveraged to serve the needs of their patients.
The question I am asked frequently is, “will telemedicine continue to have an impact once COVID is no longer a concern?”. I believe that in order for any solution to be viable long-term, it must meet certain criteria and provide value to all parties who are involved. The following five areas are the key ingredients I see that must be met in order for telemedicine to be successful and sustainable long-term.
1. Technology
Many great ideas and solutions have failed because the technology was not able to perform and meet the expectations of those using the solution. If the technology is not user-friendly, intuitive, or reliable, it will not be sustainable in the future. Recently, several vendors have developed some great platforms that can be used for telehealth. In addition, cameras are now standard in most smartphones and becoming a standard in many laptops as well. The good news is that the technology exists today to support a viable telehealth solution and platform.
Now that we have robust technology platforms, the larger issue we need to address is access to this technology. The technology may be robust, but if individuals do not have access to it, it is of no benefit to them. This is especially true in remote rural and underserved urban areas.
We need to continue to find ways to provide access to technology to those who face socio-economic challenges or other limitations.
In many cases, these are the individuals who would benefit most from chronic disease management. There are several great programs across the country that are focusing on bringing technology access to these underserved areas. My hope is that more organizations and people step forward to help close this technology gap.
2. Consumer/Patient Engagement
In order for telemedicine to be widely adopted, it needs to meet the needs of patients and consumers. Today’s consumers are demanding more services revolve around their schedules and fit their active lifestyles. Healthcare continues to face pressures to become more consumer-focused and provide the convenience that people have come to expect from other services that they use.
Telemedicine helps meet this need and brings healthcare to patients at the location and time of their choosing. Press Ganey, an organization known for patient surveys, released the findings of their telemedicine survey conducted in the first half of 2020. The report stated that:
“Based on the data, patients are overwhelmingly positive about their virtual interactions with their care providers, even when technical issues posed challenges”.
While organizations are still trying to find out the best way to optimize their telemedicine platforms to meet the needs of their patients, it is clear that people are happy with the care they are receiving and want to continue to use this method of care. As telemedicine continues to expand into areas such as specialty consults and behavioral health, the convenience and privacy this offers to consumers will continue to make telemedicine a valuable care delivery option in the future.
3. Provider Engagement
Another critical ingredient necessary for making telemedicine a success is buy-in from the providers. If providers are reluctant to use this technology, they will discourage their patients from utilizing these services as well.
In order for providers to adopt this method of care, it is important that it does not add additional clinical, administrative, or technical burden on them. In my discussions with several providers, they have made it clear that a telemedicine solution integrated into their EHR is critical to ensure they do not need to document in yet another electronic system. Providers need relevant clinical data at their fingertips during the time of the patient visit. The more this information can be in a place where the providers are already used to seeing it, the better the experience the provider will have.
In a survey conducted by the COVID-19 Healthcare Coalition in November of 2020, they captured the opinions of over 1,500 physicians and healthcare providers regarding the use of telemedicine. The results showed strong support for telehealth:
60% reported that telehealth has improved the health of their patients
68% report they are motivated to increase telehealth use in their practices
55% indicated that telehealth improved the satisfaction of their work
More than 80% responded that telehealth improved the timeliness of care for their patient
As this technology continues to mature, integrations into the EHR becomes standard practice, and clinic workflows and practices are created to support this type of visit; I expect adoption and physician satisfaction to increase even further.
4. Clinical Outcomes
All of the demand and support for telemedicine can be in place, but if it delivers unfavorable clinical outcomes, it is doomed for failure.
Telemedicine must provide the same or better clinical outcomes when compared to in-person visits for it to be sustainable long-term.
As an example, the healthcare industry continues to focus on ensuring antibiotics are not overprescribed, and imaging is not overused. The use of telemedicine cannot have a negative impact on these types of clinical objectives.
In an article written for Harvard Business Review, Intermountain Health CEO Dr. Marc Harrison cites 7 “lessons learned” in the area of telemedicine. After studying clinical outcomes, they credited their telehealth program with the following:
A 36.5% reduction in mortality in one year - this equated to 125 fewer deaths.
The rate of antibiotic use was the same in telemedicine as it was in their brick-and-mortar facilities
Clinical outcomes continue to be evaluated as more patients and providers adopt telemedicine. While clinical outcomes need to be tracked long-term, early evidence continues to show that patients utilizing telemedicine have an equal or better clinical outcome in several areas. We will need to continue to track this trend to ensure outcomes continue to meet or exceed those of an in-person visit for various types of care.
5. Reimbursement
The final ingredient needed to ensure the long-term success of telemedicine is the need for it to be financially viable. Prior to the COVID-19 pandemic in early 2020, many commercial and government (state and federal) payers did not have a consistent model allowing for reimbursement of telemedicine services. In many ways, this was the biggest factor in limiting the overall rollout of telemedicine prior to COVID-19. Many payers did not reimburse for this care or did so at a greatly reduced rate, which made it difficult for healthcare providers to view this as a financially viable option for care.
In response to COVID-19, large payers such as Medicare, Medicaid, Blue Cross and Blue Shield, Humana, and others have either expanded payments or agreed to reimburse telemedicine visits at the same rate as in-person visits. In doing so, they removed the financial barrier that has kept many health systems and providers from fully adopting this model of care.
The changes made by the payers are a big step to ensuring that telemedicine will remain a financially sustainable model for providers and health systems.
Several payers have made these changes permanent, paving the way for this model of care delivery to become sustainable long-term.
I believe, based on what we see today with these five areas, that telehealth has all of the ingredients for a bright and sustainable future. Work needs to continue on the expansion of telehealth services into broader clinical areas, standardization and integration of wearable technology, and addressing the growing access problem in underserved rural and urban areas. Even with the challenges and opportunities that lay ahead, it is clear that telehealth will play an essential part in the evolution of healthcare delivery, both now and in the future.