Research
May 18, 2021
20 Minute Read
As an industry, we need to continue to advance the use of telehealth—but we also need to remember that there’s danger of a backlash against technology, characterized by disillusionment and disinvestment.
This briefing, divided into two parts, reviews the progress that’s been made and examine future uses of telehealth. While it is easy to get caught up in day-to-day execution, we must think broadly about the potential of these new technologies to get maximum value for patients.
The ambition for telehealth is to use technology to incorporate all facets of health care: not just medicine and treatment. Telehealth technology should consider lifestyle and social factors, and it should look at how care can be delivered, ranging from the patient’s home to an acute care facility.
To assess our progress on achieving this ambition, first consider the seismic shift in telehealth.
As shown in the graph below, virtual visits accounted for only 1% of all clinical visits in the U.S. before the Covid-19 pandemic. That rose to over half of all visits in April 2020, during the initial wave and consequent fear of the disease. But what’s important to note is that the percentage of clinical visits that were virtual settled between 15% and 20% across the last six months of the year—it didn’t return to the pre-pandemic level.
Virtual visits as percentage of total visits
Even though virtual visits went down from the high last spring, the increase in virtual visits from pre-pandemic levels to today’s new normal is remarkable.
It’s easy to think of telehealth as simply a more convenient way for patients to connect with primary or urgent care providers. But virtual visits in specialty areas grew significantly as well.
Percentage of providers using virtual visits, 2019–2020
The graph above shows six of the specialties where the utilization of virtual visits by providers grew the most between 2019 and 2020. Each of these specialties saw its rate increase by over 70%. Pulmonology is especially notable. Only 12% of pulmonologists surveyed had virtual visits in 2019, but 100% of those providers used virtual visits the following year. Clearly, this isn’t just about primary care.
Download part one of the full briefing to continue reading about Covid-19's impact on telehealth, including which specialty surprised the industry with its unanimous provider and patient support.
The first step to establishing telehealth’s permanence in the future is to overcome resistance on policy changes. This isn’t a new challenge—and despite recent progress made in telehealth adoption, it is still a large hurdle.
There are three major reasons for this resistance. First, for many alternative care delivery methods like telehealth, there have not been good estimates of cost, leaving open the possibility that MedPAC, CMS, and Congress may fall back on pre-pandemic perspectives on telehealth. According to the minutes from MedPAC meetings at the end of 2020 and beginning of 2021, the costs of telehealth visits are estimations, with words like “should” and “probably” modifying dollar amounts. There aren’t many sources reflecting the true cost of providing care and the associated downstream costs.
Concrete data outlining costs would help dispel the belief that telehealth is only additive to care, serving as an “extra” that doesn’t replace any points on the care continuum. The theory that using digital tools will still require in-person care could be debunked with data around telehealth visit costs. Most telehealth applications are designed specifically to avoid duplicative care. However, the inaccurate view of telehealth as an “extra” is still entrenched among policymakers, payers, clinicians and patients.
As the industry tries to move forward, telehealth starts from a frustrating, and unfortunately familiar place: digital innovation and the opportunities to apply it to health care will require changes to legislation, regulation, and reimbursement. CMS and state Medicaid programs have made some progress, but it’s not yet transformational.
Looking forward, there are three opportunities to look beyond virtual visits toward truly transformative use of telehealth:
1. Asynchronous care: This refers to exchanging information outside of a real-time interaction. Examples of this technology already exist as a component of the digital front door to increase efficiency in low-acuity care, and for ongoing care management and monitoring.
2. Remote monitoring: There are many examples of remote monitoring across chronic care and inpatient monitoring. Three examples are shown below. In each of these examples, the remote monitoring intervention contributed to improved readmission rates and better adherence.
3. Helping clinicians practice at top of license: Burnout was a metastatic issue in health care before Covid-19, and now it could be considered its own epidemic. Clinicians are consumers of technology, too, both the consumer technology that patients use and the technology used in their day-to-day work. Unfortunately, that technology is often not very well integrated into their workflows. More than half of physicians report that their telehealth applications are not integrated in their electronic health record (EHR), and half of physicians are using more than one telehealth platform to connect with patients.
Many elements throughout the care journey are overdue for a digital refresh, and not all involve physicians. To understand how AI and automation are posed to overtake administrative tasks, download the full briefing.
Given the unprecedented use of telehealth in 2020, previously elusive data may finally exist. However, the data that is needed goes further than utilization. Data that makes a case for the efficacy of digital tools and a genuine mode of care delivery is critical.
The five data points detailed below come from the Alliance for Connected Care, who asked provider organizations to submit telehealth data to build a set of data that would be persuasive to policymakers. They want to prove telehealth does not create more utilization of services, including downstream services, than in-person care. Beyond utilization, they want data that shows telehealth solves specific problems.
This is the same data commercial payers want: data that helps them understand immediate and longitudinal costs.
While this is a good framework for making the general case for telehealth utilization, it’s not the only data needed. For a thorough list of data points, and other goals that telehealth data can help us accomplish, download part two of the full briefing.
