Telehealth and telecommunicating with physicians in real time have been referenced in glowing terms as a means to reshape the industry. The service checks all the boxes: Consumer-centric, lower costs, on-demand service for an instant gratification-seeking culture and an opportunity for business innovation in a demanding industry.
Advances in technology and a generally more connected, internet-enabled society within the last decade have allowed telehealth interest among providers to increase. Aspects driving growth include high rates of chronic disease, rising healthcare costs, technological advances and increased awareness of the benefits of remote patient monitoring.
Some use cases and benefits have been made clear. For example, some researchers found patients were seen six times faster at rural hospitals that used telemedicine in their emergency department than hospitals without that option. The other side of the coin, however, belies that the industry has received a clear ROI on its use.
Whether the service will balloon to a large-scale care delivery platform or stick to use cases such as inspecting insect bites and treating the flu remains to be seen.
Use cases made clear
As the need for connectivity has grown in certain situations, clear use cases for telehealth have been made.
Telehealth played a major role in delivering care when Hurricanes Harvey and Irma hit the U.S. mainland last summer. Teladoc, American Well and other telehealth vendors provided consultations, monitored patients and refilled prescriptions as governors in Texas and five southeastern states declared emergencies that eased restrictions on out-of-state providers.
Virtual care also played a role in this past winter’s flu outbreak. On a recent earnings call, Teladoc CEO Jason Gorevic said peak days in January averaged 8,000 visits — one in five of which was flu-related.
Amelia Bischoff, telehealth manager at Palmetto Health, says behavioral health is a big part of their virtual program, along with convenient sick care, episodic care, neonatal intensive care, pediatric intensive care and community-based paramedics. Palmetto has been able to deploy EMT units with essential resources to assist patients and avoid unnecessary ED visits.
As telehealth has shifted from consumer-facing programs and employer programs to include more health systems and physician practices, hospitals are looking at telehealth as part of a broader tableau of digital engagement strategies.
“Today’s consumers demand the convenience of virtual care, and we intend to continue fulfilling that demand as a method of delivering care to our patients,” Scott Arnold, senior vice president for information systems at Tampa General Hospital, told Healthcare Dive. Tampa General Hospital views telemedicine as an essential part of the healthcare delivery model and growing services for non-emergent cases such as cold, flu, allergies, bladder infections, diarrhea and medication consult.
Telehealth vendors have had to rethink their offerings and how they market those services. While employers are interested in eligibility and claims management, what hospitals care about is how telehealth integrates with their EHRs, how to keep providers happy and how to ensure a great patient experience, Alan Roga, president of hospital and health systems at Dallas-based Teladoc, told Healthcare Dive.
Not everyone, however, is convinced that telehealth is the white knight people are hoping for. “I remember when Segway came out and there were all these articles about how it was going to help people get around, and ultimately it found its niche in tourism and cities,” Jay Parkinson, founder and CEO of virtual primary care company Sherpaa, told Healthcare Dive. “It feels like that’s what telehealth is ... [I]t’s going to revolutionize a niche.”
He sees an important role for uses like telestroke and expanding access to rural patients, but believes most telehealth visits handle simple ailments like pink eye. He also feels the random relationship between patients and telehealth doctors undermines care continuity and follow-up.
“It just doesn't move the needle” on healthcare overall, Parkinson says.
Clearly, barriers remain to widespread use of telemedicine. Among the biggest are awareness and reimbursement.
People need to know that the technology is available. One study found eight in 10 consumers don’t know if their insurance plan pays for telehealth and how to access those services if it does. Nearly half (46%) said they would feel uncomfortable with a virtual visit.
There may be a move in some quarters away from the term "telehealth," which patients may associate with telephones and telephonic care. Virtual care may be more encompassing of where the technology is going, suggests Bischoff, advocating marketing and education for the service.
“We try to determine what patients know, where the gaps are, and then tailor our messaging accordingly based on what our consumers value most,” Bischoff told Healthcare Dive last month.
Trust that the care is legit is also an issue. Patients want to know that the doctor belongs to a credible institution.
Coverage is another major impediment to telehealth adoption. There has been an uptick in federal reimbursement programs and some state-by-state initiatives, but not to the extent that enables most health systems with very low margins to participate in telemedicine, says Niki Buchanan, business leader for population health management at Philips, which is partnering with American Well to provide customers with telehealth services.
“Pairing guaranteed reimbursement opportunities along with the change management workflows needed in clinical behavior change is the secret sauce to advancing these efforts,” she told Healthcare Dive.
Others see positive signs that the reimbursement squeeze is easing. “If you’re a health insurance company today and telehealth is not part of the benefit, you are the oddball,” says Roy Schoenberg, president and CEO of American Well. “You are going to be in a really tough place to compete for business by the time it gets to open enrollment.”
Congress also gave telehealth a high five, including the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 in its recent budget deal. The legislation, which takes effect Jan. 1, 2020, extends telehealth access to Medicare recipients with chronic conditions and creates incentives for beneficiaries to receive telehealth services through accountable care organizations.
Buchanan also sees challenges around clinical practice. “We’ve seen our most innovative customers call out the need for clinicians to practice at the top of their license with the riskiest patients in clinic, and focus all other labor and supporting staff on innovative techniques out of clinic,” she said. “It’s not until we see this clinical redesign component focusing on patients as consumers that we will see the massive shift in this adoption.”
When it comes to return on investment, results vary.
Without strong reimbursement, Tampa General hasn't seen a material impact on ROI. But leaders are hopeful the increasing popularity of telehealth will generate more clinic visits for more acute cases that require an in-person medical exam. As technology and wearable devices improve, telehealth clinicians should have information to treat a wider array of both chronic and acute conditions.
On the other hand, where hospitals are targeting use cases and have risk associated with an insurance carrier, for example, consumer adoption can be as high or higher than in employer populations, Roga says.
“We have organizations that their ROI [on telehealth] is massive because they’re very good at using it,” he told Healthcare Dive. “If you look at adoption of specific use cases, let’s say surgical discharge, it’s nearly 100% because you have the surgeon and the care team driving a follow-up visit. So you don’t have to message and do the whole surround sound marketing [effort] to try to get a consumer to change their behavior and choose telehealth.”
It’s not a simple equation either, Bischoff says, adding that telehealth introduces a new price point to financial investment and ROI. “Traditionally, in the finance world, we look at expenses going out and then revenue coming in, with some modifications,” she says. “Now we’re having to look at it in a different way to showcase value, and finance is a big indicator along with not only experience but how can we maybe translate quality, experience, some of the other facets into that dollar figure to show value.”
One thing Palmetto has started to do is look at the financial impact of moving patients waiting to be seen in person to a virtual setting.
A key component in evaluating impact is data analytics, Bischoff says. Organizations need good business intelligence to drive telehealth programs, plus an understanding of their patients’ needs and intuitive systems that can consolidate information and guide operations and strategy decisions.
A tool for a network
As telehealth matures, it is moving beyond technology companies to providers and payers with brand recognition. That’s how it should be, says Schoenberg. “You want to get telehealth from where you want to get healthcare," he says, adding that transformation will accelerate adoption.
“For a platform to deliver services and survive is to understand that we are secondary in this game, that we need to create the networks, that we need to create the portability of the services that really are sticking … and allow those to be proliferated to where the patients are,” he said.
Ultimately, for telehealth to have an impact, organizations need to treat it as an important tool in the broader continuum of value-based care. Doctors and operations and strategy leaders need to understand that telehealth is a complementary service — one that fits nicely in the care spectrum, Bischoff says.
For Schoenberg, that means seeing telehealth as a distribution system, much like Amazon in retail.
“To take a physician cycle from one place and use it where it could be effective, where it could deliver value somewhere else in your ecosystem or the broader national ecosystem means rewriting healthcare distribution altogether,” he said.
Jeff Byers contributed to this post.