The Pandemic Changed Telehealth; Next, Telehealth May Change Healthcare
Bimal Shah, MD, Chief Medical Officer, Product, Analytics & Quality, Teladoc Health
As the COVID pandemic was straining the healthcare system, it was simultaneously giving us a glimpse of what future care delivery might look like. That future will assuredly be more virtual, with the potential to be more convenient, proactive, efficient and foster higher satisfaction for both patients and clinicians. This blog post explores the future of virtual care, including how the pandemic and other developments are influencing it.
An Overnight Sensation That Was Years in the Making
In February 2020, the month immediately preceding the U.S. Public Health Emergency being declared for COVID-19, telehealth accounted for only 0.001% of Medicare primary care visits; that April, nearly half of such visits were conducted virtually.[i] And while COVID may be viewed as a once-in-a-generation event, its structural effects on care delivery strategy and patient expectations will endure long after the pandemic has subsided. More than three quarters of Americans are now interested in using telehealth going forward; only 11% were pre-pandemic. One lasting effect of the pandemic is that telehealth has gone from something the public viewed as a novelty to a must-have capability for meeting patient expectations. In 2021, 36% of U.S. adults said if their current physician did not offer telehealth, they would consider leaving the practice for one that did.[ii]
One of the overlooked aspects of the COVID-driven surge in telehealth use is that patient utilization and provider infrastructure for virtual care were already growing significantly. That groundwork is why so many clinicians were able to successfully pivot to accommodate pandemic-related telehealth demand. It is also a reason that once the pandemic subsides, virtual care will remain at an elevated level. No less an authority than Seema Verma, the head of the U.S. Centers for Medicare & Medicaid Services (CMS) said: “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back…”[iii]
Many telehealth consults conducted during the pandemic weren’t up to the usual standard – there was limited patient and clinician training on new modalities to connect, video connections were not optimized, remote patient monitoring equipment often wasn’t utilized and multi-party visits involving family members, specialists, social workers or other involved parties besides the patient and practitioner were not always possible – yet most patients liked these virtual visits anyway, and want to have more in the future.
We believe telehealth will not only account for a larger share of future healthcare delivery, but the nature of virtual care itself will change – in ways that have the potential to change traditional care and financial models.
Here’s an example of how it could happen. Many chronic condition patients have regular, in-person check-ins with their clinicians, yet often end up visiting emergency departments because acute problems develop. Virtual care that is enhanced by the ever-expanding range of patient sensors and home monitoring equipment provides the potential for an always-on monitoring model. Such models differ from today’s because they don’t depend on episodic events or periodic assessments to give patients the intervention they need. Artificial intelligence can even be used to conduct some of the monitoring, helping physicians, nurse practitioners and PAs all to practice at the top of their respective licenses. Proactive care through remote monitoring represents a huge opportunity for patients with chronic heart conditions alone – an estimated 1 million Americans already have remote cardiac monitors.[iv]
Further, remote monitoring and AI-driven big data processing enables patients to be grouped by risk factors, and for more targeted health management and treatment plans to be developed. Some virtual care companies have even started to examine taking capitated risk for an entire population of individuals with a single chronic (or even acute) condition directly from self-insured employers and health plans. That is an example of how expanded virtual care could fundamentally change other aspects of the healthcare system.
The pandemic has provided a path forward for expanded virtual care. The technology is already available to serve significantly more patients and satisfy more of their care needs than it is being used for today. Healthcare providers have expanded their offerings, and more significantly, patients are ready and willing for more virtual care. Perhaps for the first time in telehealth’s history, there will be more momentum coming from patients to expand virtual care than from clinicians.
[i] HHS Press Office. HHS Issues New Report Highlighting Dramatic Trends in Medicare Beneficiary Telehealth Utilization amid COVID-19. U.S. Department of Health & Human Services. July 28, 2020. Accessed March 14, 2021. https://www.hhs.gov/about/news/2020/07/28/hhs-issues-new-report-highlighting-dramatic-trends-in-medicare-beneficiary-telehealth-utilization-amid-covid-19.html.
[ii] COVID-19 Market Pulse. U.S. Healthcare Needs and Attitudes in the Age of COVID-19. National Crisis Is Driving Increased Consumer Interest in Telehealth. Black Book Research. Accessed March 14, 2021. https://blackbookmarketresearch.com/administrator/img/0188_SGP_COVID-19%20Market%20Pulse_r2.pdf.
[iii] HHS Press Office. HHS Issues New Report Highlighting Dramatic Trends in Medicare Beneficiary Telehealth Utilization amid COVID-19. U.S. Department of Health & Human Services. July 28, 2020. Accessed March 14, 2021. https://www.hhs.gov/about/news/2020/07/28/hhs-issues-new-report-highlighting-dramatic-trends-in-medicare-beneficiary-telehealth-utilization-amid-covid-19.html.
[iv] AHA Center for Health Innovation Market Insights report, citing data from the American Telemedicine Association.