Telehealth Grows Up: Virtual Care Seen for Advancing More than Just Access to Care
Dr. Cynthia Horner, Medical Director, Amwell
Since the emergence of COVID-19 in the U.S., the majority of telehealth detractors have come to appreciate the power of access and convenience that telehealth offers. At the start of the pandemic, as hospitals closed their doors to non-COVID patients and doctors’ offices shut down, telehealth proved to be a critical tool bringing medical care to patients in need. One year later, as more patients are vaccinated and a sense of normalcy returns to the healthcare landscape, the true value of telehealth can be found not only in its ability to improve access to care, but also in its ability to advance the quality of care being delivered leading to better outcomes.
Telehealth allows providers to practice at the top of their license. The pandemic has led to a deficit of providers across several specialties. From primary care to specialty care or behavioral health, providers are seeking a variety of ways to connect to patients. Some are simply looking for more convenient ways to fit patients into their schedule, and some retiring early or choosing different career paths entirely, making it more important than ever to support today’s providers and enable them to focus on what matters most – their patients.
One way telehealth can help is by helping to triage patients, allowing doctors to focus on the highest-need patients. Take Pediatric Associates, for example. The largest privately-owned primary care pediatric practice in the country adapted their established pediatric triage protocols to include telehealth visits and as a result, reduced emergency room (ER) use among high ER utilizers for low-acuity conditions by 60%. By directing only the most critical patients to the ER, and providing alternative care options to the rest, Pediatric Associates is ensuring that patients receive the right level of care and providers spend their time with the patients who need them most.
Telehealth can also support providers by automating monotonous yet time-intensive tasks like billing and note-taking. Using natural language processing, chatbots and automation technologies the intake process can be imported directly into the patient’s record and the clinician’s note can be tailored to the visit specifics. With burnout being a major concern across the industry, especially since the start of the pandemic, and research showing that specialists most willing to practice via telehealth are also among the most burnt out, the importance of virtual care has never been greater to our health system.
Telehealth identifies and bridges gaps in care. Virtual primary care (VPC) programs are an excellent example of how telehealth can be used to not only increase access but also to identify gaps in care. By combining the best of what primary care has to offer with asynchronous messaging, automated reminders and care coordination capabilities, providers can easily identify existing care gaps and help patients close them through in-network orders for additional testing or referrals to other specialists. The result is a patient who is more engaged in their healthcare journey and more informed about what they need to do to be their healthiest self, with appointment reminders and easy to follow next steps helping them along the way.
The pandemic has also rightly focused broad attention on another gap in care – the growing national disparity between the number of behavioral health providers and the demand for these services. Dignity Health used telehealth to close this behavioral health gap, using its virtual care program to increase access to psychiatrists for patients experiencing a psychiatric emergency. Specifically, health system providers use telehealth to treat acute patients in the moment instead of having to wait hours or days for a psychiatrist to come onsite. As a result, the average bedside response time has been reduced to under 50 minutes.
Hybrid models of care can lead to better outcomes. Having largely emerged during the pandemic, hybrid care models combine virtual and in-person experiences across the full continuum of care. This model joins the physical with the digital to create a cohesive experience and has already demonstrated better patient adherence and preventative care measures. For example, Penn State’s novel hybrid cardiac rehab, which offers patients the ability to complete much of their cardiac rehabilitation program at home, is seeing high patient satisfaction and strong results. The program includes teaching patients exercises that can be performed at home so they can continue exercising even after the conclusion of the program. This instills healthy habits that patients can perform on their own for years to come.
Another example of a hybrid care program leading to better care outcomes comes from Nemours. During the pandemic the pediatric health system experienced a drastic decrease in well visits and vaccination appointments, which are critical for keeping children healthy and safe. By deploying a hybrid care program which offered families the option to virtually connect with their PCP and then physically receive their immunizations at a pop-up tent, the health system performed 4.6% more immunizations in 2020 compared to 2019, despite being behind initially.
Telehealth is here to stay but just how much will be determined by our ability to see it for what it truly is – more than just a tool to increase access, and rather a tool to truly redefine healthcare as we know it, creating better, higher quality experiences for all.