Opinion: Covid-19 and telehealth: Holding on to the gains of remote care

In January 2020, telehealth companies were proceeding with a long, slow slog toward sustainability. Four months later, Covid-19 had changed the world and Americans’ reliance on digital medicine.

Almost overnight, the specialty I’ve worked in for nearly a decade took center stage, going from a growing niche business to one with skyrocketing utilization rates. The pandemic also altered the geography of care, shifting it from doctors’ offices and hospital clinics to individuals’ homes.

The question health care policymakers, providers, and payers must now ask is: “Will the pendulum swing back to how things used to be, or has the pandemic opened the door to new ways of delivering care?”

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With Omicron and possibly other variants not yet defeated, federal and state public health emergencies won’t expire immediately, nor will some of the relaxed standards that allowed practitioners to see patients via telehealth in states where they weren’t licensed, or that reimburse providers for remote care.

But as the pandemic eases, these regulations will again be put in place. Reverting to the old ways without analyzing what’s been gained would be a big mistake.

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Telehealth made big strides during the pandemic, both from a technological standpoint and from patients’ perspectives. Telehealth use during the initial Covid-19 peak (March to April 2020) increased from less than 1% of visits to as much as 80% in places where pandemic prevalence was high, according to McKinsey, and a recent report by the U.S. Department of Health and Human Services found that Medicare telehealth utilization increased 63-fold between 2019 and 2020.

A dramatic shift was seen in access to mental health services via telehealth. This came partly because of a rise in demand due to the stress from the pandemic, but virtual visits also allowed for greater access, creating greater parity between physical and mental health care. These are practices worth keeping. This technology backbone can also enable new telehealth models.

Consider the newly public Butterfly Network, the maker of a pocket-sized, portable ultrasound that’s one of many examples of the miniaturization of medical devices. This kind of innovation means that care for individuals with more challenging medical conditions can be brought directly to their homes; an ultrasound expert can even be beamed in to guide clinicians visiting the patient. The logistics of health care at home can and will be Amazoned — by Jeff Bezos’ company or a different one. But companies solely focused on digital health care will have a major impact since they can typically move and adapt more quickly to disrupt the industry.

With improved connectivity and technology, telehealth will continue to blossom, and it will eventually seem antiquated to sit in a medical office surrounded by sniffling and coughing patients waiting for your turn to see the doctor. Access to technology, especially broadband internet access, has become a key determinant of a person’s health. Helping bridge that divide will be the federal infrastructure plan signed into law late last year; it devotes $65 billion to creating and expanding internet access in rural and other underserved areas.

Will bringing a system of health care to the home mean better outcomes and lower costs? Large, interdisciplinary, longitudinal studies don’t yet exist, but I certainly hope such research will soon be conducted. What is available, however, are the subjective opinions of both providers and patients, information that reveals important signals about the value of delivering care in the home.

For starters, patients say that who their health care providers are matters — even with telehealth. According to a 2021 report by the U.S. Department of Health and Human Services’ Office of Inspector General, 84% of seniors enrolled in Medicare received telehealth services only from a provider with whom they had an established relationship. Despite the relaxed regulations on who could provide care, patients made it clear that previous contact — and the trust presumably built up during that time — still mattered.

Despite the newness of telehealth for many people, a recent report from Moving Health Home found that 73% of adults said they were confident in the quality of clinical care they received in the home, and 66% said it should be a priority for the federal government to increase access to clinical care in the home.

As the pandemic evolves into something more endemic, breakthrough cases will continue to appear, and older people will be more vulnerable to them. It’s increasingly likely, and possibly essential, that many Medicare recipients will continue to seek out telehealth from their current doctors rather than being potentially exposed to the virus in a hospital or doctor’s office.

This trend toward virtual care goes beyond patient preferences. Providers and regulators also see opportunities for remote medicine and are eager to push harder for wider adoption of telehealth that results in resolution of reimbursement issues with government and commercial payers. Last November, Teladoc announced it was expanding access to its virtual primary care platform to many more payers and hospitals. Patients also can turn to Amazon’s Alexa, which has new health care “skills” as part of a newly announced partnership with Teladoc.

The U.S. House of Representatives is considering a bill called Cures 2.0 that would expand the telehealth footprint of Medicare and Medicaid beyond the pre-Covid rules that restricted its use for certain patients unable to commute to a nearby doctor’s office.

Many entities — patients, providers, regulators and lawmakers — are pursuing a post-Covid push for greater efficiency and better care amid the transition from fee-for-service to value-based care, with telehealth falling in the value-based care model.

Telehealth earned its stripes by proving its value during the pandemic. Its utility during “normal times” is limitless. Now is the time to push the field forward — whether it’s giving patients the health care experiences they seek, the policies of lawmakers, the influences of health care providers, or massive amounts of venture capital poured into telehealth and last-mile services — rather than moving backward.

Kevin Riddleberger is chief strategy officer and co-founder of DispatchHealth, a provider of in-home medical care.

Source: STAT