Opinion: Telehealth’s critics have it right: The industry must evolve

For many people, January is a time for new beginnings. But for many telehealth patients, January 2021 means being plunged back into 2019 as Congress prepares to walk back some of the pandemic-related coverage and payment flexibilities it instituted for 33 million seniors and people with disabilities.

In December 2020, I joined telehealth CEOs and health system leaders at the Department of Health and Human Services Telehealth Innovation Summit to make critical asks of the federal government after 2020’s monumental year for virtual care, in which Congress and HHS allowed new reimbursements for telemedicine visits broadly defined.

While 2020’s relaxed regulations were generally praised, many stakeholders, myself included, called on regulators to rethink an important policy change buried in the end-of-year $900 billion congressional bipartisan and bicameral spending and Covid-19 relief package. In it, in-person visits would once again be initially required before tele-behavioral health services would be covered. This notion — that patients and providers need to first meet in person first before moving online — is medically unnecessary and potentially dangerous with a raging pandemic. It is also a hallmark of early telehealth regulations developed because of concerns that telehealth would drive unnecessary visits and create new opportunities for health care fraud and abuse.


This reversion to pre-pandemic policy is a decision that I and other telehealth execs disagree with for several reasons. First, it sets a bad precedent that virtual care is simply an extension of in-person care. Second, it once again limits access for patients who already struggle to access regular, in-person behavioral health care, especially older adults and those who live in rural areas. Third, it gives credence to critics who believe that telehealth broadly defined perpetuates much of what is wrong with today’s health system.

Skeptics have been quick to accuse telehealth platforms of further fragmenting patient care and the patient experience, essentially putting patients on a conveyor belt that has them seeing one provider after the next. They say that valuable information is lost as patients move from one provider to another. They claim that telehealth will lead to overutilization of services, thereby driving up costs.


In truth, some providers and telehealth platforms are causing fragmentation and weakening the doctor-patient relationships. But just as not all brick-and-mortar providers are created equal, not all telehealth providers are created equal, and not all are perpetuating these issues.

Here are three key ways that virtual provider organizations — true complements to in-person providers — are answering the critics and delivering on telehealth’s long-term potential:

Prioritizing patient-provider relationships. To build and maintain patient loyalty, virtual-care organizations have evolved to be more than just the “Uber of health care.” They make it possible for patients to build real, long-term relationships with their providers and care teams rather than hopping from one clinician to the next. This is very different from telehealth programs that put providers online part time between their in-person shifts for one-off visits with no follow-up.

Building patient-provider relationships online means more than providing access to a primary care physician or therapist. Clinician diversity is emerging as a factor driving patients choosing to use telehealth, and studies have shown that a diverse clinical practice drives not just patient satisfaction but also improved outcomes. Some telehealth platforms now offer a wide range of provider options that only the largest, urban health systems have been able to offer to date.

Building for holistic patient care. Telehealth platforms were originally built to support one-time transactional care experiences. Have a sore throat? Schedule a quick telehealth visit. It didn’t matter as much if the records of those individual virtual visits ever made it back to your primary care doctor. But for patients with chronic conditions, such as depression, diabetes, or arthritis, doctor’s notes from one visit to the next become crucially important to track a patient’s progress.

Today’s telehealth platforms are moving toward more holistic patient care, such as primary care with integrated behavioral health and condition management. In doing so, they’re allowing patients to move seamlessly among their various providers in that virtual care network with the help of care navigators, and also into physical care settings thanks to interoperable health record systems.

While there is still more work to be done, virtual care companies that create integrated care teams and interoperable health records will deliver the experience that individuals have come to expect from industries like banking and shopping and, in turn, will ultimately win patient loyalty.

Getting paid for quality of care, not just quantity: Much of the criticism of telehealth leading to increased costs stems from concerns that telehealth will drive an increase in unnecessary visits and create new opportunities for health care fraud and abuse. But what critics are missing is that many virtual-first provider organizations today operate in a fundamentally different manner than first-generation virtual care programs and in-person health care practices. In fact, studies have shown that the overall cost of care when delivered via a virtual provider organization can be lower than that delivered by in-person providers.

My company, Doctor On Demand, is so bullish that a virtual-first model can reduce costs while improving outcomes that we’re betting money on it. Working with our partners, we’re standing up virtual-first health plans and sharing the financial risk of caring for patients in those programs with plan partners in 2021. In a shifting model where providers are paid for improving health vs. visit volume, the cost-related criticism will no longer hold water.

Telehealth as a vehicle for care will undoubtedly continue after the pandemic. But if we’re to help move health care delivery forward — not just our niche of the market — it’s on us to push the boundaries of what it means to provide quality and lower-cost care.

Hill Ferguson is the CEO of Doctor on Demand, a telehealth provider.

Source: STAT