As healthcare entities across the spectrum move to a more integrated and advanced technology offering, the face of healthcare is changing very quickly. For many organizations, technology has advanced the use of at-home monitoring devices, integrated complex care management, and digital connectivity for data and electronic health record inputs outside organizations. However, the biggest area we see both payers and health systems investing in is the telehealth space.
In the early 2000s, telehealth was a relatively new concept that some larger companies were pioneering. It’s now a major component of how medicine is delivered. Between 2005 and 2017, the number of behavioral health virtual consultations conducted in the U.S. grew 56% annually, according to Business Insider Intelligence. In 2015, 76% of Americans said they would prioritize convenience and access over human interaction, showing that the country is leaning more towards a virtual or retail offering.
Over the years, telehealth has proven to be a much more cost-effective and increasingly convenient way to provide basic care, leading to widespread public interest and billions of dollars invested. According to some researchers, the global telehealth sector is predicted to grow to a staggering $266.8 billion by 2026.
2020’s unforeseen impact
One thing no one counted on was the outbreak of COVID-19 and the impact it would have on the U.S and world economies, much less the unavoidable changes to retail, travel, work environments, and access to healthcare. Early on, COVID-19 triggered overuse of the healthcare system as we knew it. As the virus spread fear over the availability of specialized care, this led to the sudden but almost complete shift to routine and non-emergent visits utilizing a tech-enabled model versus an in-person one.
Prior to COVID-19 there were several barriers still facing full telehealth adoption, including:
- HIPAA and other data-sharing privacy laws.
- Allowing “phone consults” to count as visits for reimbursement.
- The inability for doctors to practice across state lines.
- Ensuring tech was in place to access visits from shelter-in-place settings.
- Waiving needs for prior condition or pre-screen testing.
- Rx laws around narcotics and controlled substance or new drugs.
Many of these barriers have now been fully overcome. To meet the demand for shelter-in-place healthcare, several changes to regulations happened quickly. These include the Drug Enforcement Administration loosening the restrictions on e-prescribing controlled substances to meet the patient’s needs, and allowing providers to practice in areas in which they are not licensed—both of which are examples of “state of emergency” legislation.
According to the CDC, the number of telehealth visits increased by 50% during the first quarter of 2020. However, there was a subset of people who complained it wasn’t user friendly, required software they didn’t have or had to download, or felt the quality of the visit was lacking. As feedback continues to come in post-lockdown and healthcare as we knew it starts to show signs of return, organizations will need to keep the insights gained during the pandemic in mind in order to be successful.
Enabling the payer
The Coronavirus Aid, Relief, and Economic Security (CARES) Act included additional funding to the Telehealth Network Grant Program. This increased the award from $8.7 million a year for telehealth technologies used in rural areas and medically underserved areas to $29 million for five years, starting in 2021.
The Center for Medicare and Medicaid (CMS) also changed its payment structure going forward for payment of “audio only” visits for those that don’t have access to smart phones or computers. It now allows for behavioral health and some pre-screen visits to be covered, and loosens the face-to-face requirement for services such as hospice. Additionally, Medicare Advantage plans have long covered telehealth visits not covered under traditional Medicare. Finally, CMS has advised plans that they may waive or reduce cost sharing for telehealth services, as long as plans do this uniformly for all similarly situated enrollees.
Several commercial or employer-sponsored plans have covered a telehealth benefit of some kind, which in some cases are owned by a larger health system (e.g., Cleveland Clinic), while others use a network of licensed practitioners providing virtual care through mobile and videoconferencing applications and platforms (e.g., Teladoc Health). The convenience of virtual visits among an overall healthy population has not raised any concern around quality—and is significantly less expensive.
The benefits of adoption of telemedicine are manifold, such as ensuring network adequacy and making sure that access to quality physicians is not just a privilege of those with top-notch insurance. The current shift to outcome-based payments and value-based arrangements may encourage ongoing monitoring of specific groups to inform better health consequences.
Enabling the provider
For those who want to take part in building a proprietary telemedicine offering, there is a significant financial investment. It also takes time: from hiring programmers and developers to building the platform, to creating the interfaces for integration into the electronic medical records and protection of privacy software. During the pandemic, some of the legislation hurdles were lessened but the subscription to existing platforms or the building of new ones is still daunting, to say the least. For smaller systems, the use of applications like Zoom or even Facetime was allowed; however, it is unclear whether that will continue to be allowed post state of emergency.
Health systems also need to plan for expanding use of telemedicine from a staffing perspective. In true clinical settings, health systems need to decide which providers they will divert to phone lines and/or video visits, and how to manage their patient flow while still ensuring enough staff to manage in-person care. Currently there are designated hours of office visits and virtual visits to keep the flow of traffic and possible spread of infection to a minimum. Clinicians must also consider how and to what extent current liability and malpractice coverage covers virtual visits. The expansion to telemedicine could carry a higher premium as there is increased room for error or misdiagnosis.
Finally, the question of quality when evaluating patients remotely from their homes compared to in-person is one that cannot be easily solved. With the advances in remote monitoring devices that can detect heartrate, blood pressure, O2 saturation, and body temperature, most vitals in chronic patients can be solved for. While more at-home tests appear on the market that can be issued by providers, there is still a long way to go for more serious conditions.
For existing care and chronic disease management programs offered by large health systems and payers alike, though, it’s a perfect use case. The ability for a provider and a specialist to have a virtual peer-to-peer or treatment discussion will undoubtedly expand the use of and favorability of telemedicine offered in a clinical setting. Ultimately, its use in current treatment plans or side-by-side care will be a driving factor in the expansion of telehealth applications in the near and long-term, turning the patient-care continuum on its head.
What this means for healthcare
For consumers, the concept of virtual medicine—which took on futuristic tones in the not too distant past—is not only growing in its adoption but in capability and quality as well. Telehealth enables consumers to access care from anywhere, avoid risk of spreading or catching disease, and enjoy a quality of care outside the institutional setting.
For providers, it allows lower-level practitioners to carry higher loads and increases the number of patients seen, which then leads to higher reimbursements. This in turn expands the reach to high-risk consumers that may have limited access, thus improving the management of chronic conditions and overall health outcomes.Finally, for payers, it provides a key component to the reimbursement schedule that lowers rates, a long time ask of consumers. Allowing payers and providers to utilize virtual platforms enhances the care management and in-home models that payers have focused on for years, which adds to the value of a plan. And lastly, it allows the expansion of networks beyond the geographic location of a member, solving long-held challenges for many payers.