No technology has had such a rapid ascent in adoption in the past year as telehealth. In the early months of the pandemic, telemedicine comprised nearly a third of all visits. The weekly number of visits increased twenty-three-fold compared with the pre-pandemic period. Teladoc, the leading company in the space, reported that its number of visits more than doubled, from 4.1 million in 2019 to an estimated 10.6 million in 2020. Nearly a year into the pandemic, the emerging data points to telehealth being an essential component of care delivery going forward. However, as in-person visits start to pick up, telehealth visits are dropping off from the peaks of the early months of the pandemic.
Telehealth now stands at a crossroads. The shift to virtual care is real. However, CMS guidelines for telehealth reimbursements, which had loosened in the immediate wake of the pandemic, are yet to become permanent. Health systems are therefore being cautious about pressing forward with further investments (and falling back to the more predictable fee-for-service model of payments that favors in-person visits).
At the same time, the need for additional investments in optimizing telehealth programs has never been greater, since there isn’t a one-size-fits-all telehealth solution that addresses patient populations’ needs. Healthcare and technology providers must recognize the importance of demographics, geography, and specialties in designing for virtual care. Telehealth looks different for millennials and retirees, rural and urban inner-city populations, and population groups with fundamentally different healthcare needs.
In healthcare, certain specialties are more amenable to telehealth than others. While the number of virtual mental health visits has risen sharply, the same is not valid for other specialties that require in-person visits, such as cancer care and vision care. While most people may think of telehealth as real-time video visits, audio visits have been a more significant telehealth component, especially among low-income populations. Telehealth cannot grow while ignoring the digital divide that has become a serious concern that impacts access to care for our most vulnerable populations.
While there is broad consensus that a permanent shift to virtual care and telehealth is underway, my firm’s work with health systems and our conversations with healthcare executives indicates three major aspects to consider while making significant investments in telehealth programs.
Technology maturity in patient populations: Delivering telehealth services requires not just deploying the available technology and providing reliable access through adequate bandwidth and surge capacity; it also requires an understanding of the patient population’s ability to access care with the smartphones and devices they have. Ray Lowe, CIO of Altamed healthcare in Southern California, points out that their patient population, which is mainly lower-income Latino communities covered by Medicaid, does not necessarily have access to the latest iOS devices; his telehealth solutions, therefore, have to be designed to be backward compatible with earlier generations of devices.
Bandwidth access can be an issue as well for these populations, requiring applications to be light and deliver the most critical functionalities in an easily accessible way. A related, and increasingly important aspect at the forefront of virtual care models is bilingual support during telehealth visits. Telehealth platforms must the ability to include participation from language translators in real-time during virtual visits.
Designing telehealth to be part of the bigger technology transformation roadmap: A big challenge for telehealth and virtual care models is integrating seamlessly into the overall clinical workflow in the broader applications ecosystem. Telehealth platforms must not just plug and play with electronic health record (EHR) systems but also seamlessly interoperate with other standalone digital front door tools and other enterprise-class platforms such as CRM. For their part, healthcare providers are moving beyond a patchwork of ad-hoc digital patient engagement tools to building seamless digital patient experiences.
Health systems are also beginning to embrace cloud computing models, with over a third of healthcare providers estimated to have adopted a hybrid cloud model in 2020. In addition to improved data-sharing and advanced analytics insights at the point of care, cloud-based models can streamline workflows and improve digital collaboration among clinicians.
Cloud-based models can also come in handy during crises. Pamela Landis, VP of digital patient engagement at Hackensack Meridian Health in New Jersey, has leveraged the unprecedented scaling opportunity offered by the cloud to cope with increased web traffic for vaccine appointments. However, the interconnected ecosystem of health IT applications also brings inevitable challenges with security and privacy that must be addressed in developing and managing technology partnerships to deliver virtual care seamlessly.
Having an end goal for telehealth adoption: A big question facing most health systems is what percentage of overall healthcare services will move to a virtual care model in future. Estimates vary from 20% to 80% of all ambulatory care. Part of the shift will be driven by changing consumer preferences and emerging competition from “digital first” healthcare providers.
In anticipation, many health systems have established goals for shifting a portion of in-person visits to virtual and in-home visits. Achieving such goals requires a telehealth technology implementation roadmap. Seasoned executives recommend a gradual approach to manage the risks and change readiness this entails. Pamela Arora, SVP of strategic technology at Children’s Health Dallas, favors a “pilot first and scale next” approach to technology-led transformations. She also advises wherever possible to walk in the clinician’s shoes, and in the patient families’ shoes to understand their experience and their struggles before implementing changes. She reasons that stakeholders are willing to extend a little more latitude during pilots so that any initial challenges with the technology can be fixed before scaling up for enterprise deployment.
As health systems roll out multiple virtual care programs, including remote patient monitoring, the need for interoperability becomes a critical success factor in enabling seamless experiences for patients and caregivers. A joint study by CHIME and KLAS highlights significant progress with interoperability but points out that a lack of understanding of provider workflows by technology vendors is holding back faster progress with technology implementations.
We are still in the very early stages of a shift to a new care delivery model that emphasizes virtual over in-person visits. As with all things related to healthcare, it will come down to the payment models. The reimbursement environment for virtual care is yet to fully catch up with in-person care. We are beginning to see individual states taking steps to safeguard virtual care access for their populations.
The emergence of “virtual-first” health insurance products that require plan members to engage in a virtual visit first before seeking in-person care will nudge health systems to invest further in telehealth. Ultimately, the path forward will be driven by consumer choice, healthcare economics, and marketplace competition. The technology is already here.