Since COVID-19’s requirement for social distancing, the pandemic has taught us all to pivot by minimizing exposure to other people. This change led to a boom in the field of telemedicine.
From brick-and-mortar medical care to simply “clicking” on a screen, patients have never-before-seen online access to healthcare professionals, medications, and lab requests. Accessibility through web portals was crucial during the pandemic. Doctors who initially closed shop were able to continue seeing patients through an increase in telemedicine visits, while patients continued their medical care through more convenient video consults.
In the last week of March 2020, there was a 154% increase in telehealth visits compared to the same period in 2019. The spike behind this was assessed to be related to pandemic-related telehealth policy changes and public health guidance.1 State licensing laws were more accommodating for telehealth as the need for medical care, whether primary and specialized, skyrocketed. Physicians from various states saw patients across the country.2 As a result, telehealth claim lines grew by 3,060 percent nationwide between October 2019 to October 2020.3 From 2019 to 2020, consumer interest in telehealth grew from 11% to 76%, with high levels of satisfaction rate in 74% of telehealth users, and 76 percent stating that they were highly or moderately likely to use telehealth in the future.4
Will telehealth growth and adoption continue post-pandemic?
New Reimbursement Trends Favor Telemedicine
In 2020, the Centers for Medicare & Medicaid Services (CMS) has permanently expanded their telehealth services, such that 80 new services will be covered in the Medicare telehealth list4, a stark contrast to previous years where physicians had a harder time billing telemedicine consults.
For private payers, a FAIR Health analysis revealed that in 32 billion privately billed medical and dental claim records from more than 60 contributors had a 3000% increase in telehealth claims from November 2019 to November 2020, increasing the contribution of telehealth healthcare expenditure from 0.20% to 6.01%.5
Some new telehealth claims are remote patient monitoring, allowing a healthcare provider to gather data over time through a device or the patient’s input. While not a clinical interpersonal encounter (as the healthcare provider is not always looking at the patient’s data), remote patient monitoring alerts a healthcare provider on when the patient needs a consult or a medication adjustment.6
Increased Patient Reach, Better Patient Outcomes
Because patients now go online to study their healthcare options, giving telemedicine access allows for a virtual “front door” for the patients to assess whether they need to be in the clinic or hospital in person or not. Requesting for outpatient care or urgent care can be simplified, while long-term care can be assisted with connectible wearable devices, allowing for new ways to engage patients.
Long-term applications for telehealth include the management of diabetes, hypertension, pregnancy, nutrition, and mental health. Remote patient monitoring is expected to expand through wearable devices as Bluetooth-enabled and WiFi-enabled blood pressure monitors, electrocardiograms, glucose monitors, pulse oximeters, and fetal doppler monitors give more comprehensive clinical data.
Data goes both ways. Since COVID, the information blocking ban has been a game changer7 for patients, allowing lab results to be sent straight to patient portals without needing to wait for a prolonged period of time. Electronic medical records help patients to access their labs with a click and learn more about their condition in real time – allowing patients to learn more about their own situation and ask their doctors to clarify what the laboratory results mean.
Developing the Shift to Value-based Care
More than social distancing, telehealth offers a unique value proposition of enhancing continuity of care from in-person visits. With healthcare being more accessible to patients means that better preventive and curative interventions would lead to better healthcare outcomes. What does this mean for healthcare payers?
“Many health systems note that investment is dependent on the systems’ at-risk population and connected to population health/value-based care.”8 A healthier insured population with lower healthcare expenditures will enable a more sustainable insurance system. Value-based care is a new perspective and opportunity for healthcare institutions to aim for, and to partner with, along with healthcare financers.
The evidence is sound – studies on preventive long-term care may bring a significant reduction in healthcare costs as well as a better quality of life. A study on food interventions for diabetes led to at least a 40% decrease in the risk of death or serious complications, with HbA1c levels dropping an average of 2.1 percentage points for those attending a Diabetes Self-Management Class. HbA1c levels of those under medication also dropped an average of 0.5 to 1.2 percentage points. These outcomes translate to a whopping 80% drop in costs for patients – going from 240,000 USD per member to 48,000 USD per member per year.9 These interventions are made possible through telemedicine.
In the hospital, telemedicine interventions in progressive care units can significantly reduce mortality and length of stay without incurring a substantial cost.10
With great fiscal results as well as improvement in patient outcomes, it becomes a reason to provide profitable and sought-after long-term care. Telemedicine enables timely and low-cost access to care, leading to better patient compliance, and therefore, improved clinical outcomes. Better clinical outcomes can mean more trust from patients and payers alike.
Defining a health institution’s clinical outcome goals for their priority populations are the very backbone of value-based care. These goals should involve identifying which patients take the bulk of their morbidity and mortality cases, and which of these cases can be prevented through telemedicine. Developing an online and in-person preventive, screening, and long-term care program can become one of the offerings of the healthcare institution that insurers may collaborate on and incentivize. Healthcare institutions and providers will make more if they keep their patients healthy, and telemedicine is one of the ways to do it.11
Workflow Improvement and Data Interoperability
As hospitals, urgent care clinics, and private practices become digitized in varying stages, interoperability becomes far more crucial. Data is passed on from one healthcare professional to the another, and the smooth integration of digital interventions into clinical practices and workflows are crucial in reducing delays and errors.
Zoom has aided many a telehealth consult in the form of Zoom for Healthcare. However, it cannot facilitate the entire telemedicine patient-provider experience, such as writing notes of the clinical encounter, writing prescriptions, requesting labs, and scheduling follow-ups. When a patient is late to a Zoom meeting, another patient cannot move forward up the queue. A more seamless system can improve critical workflows.
Electronic Medical Records (EMR) integrated in telemedicine can significantly reduce problems with data transferring. Previously, EMRs were designed to achieve video conferencing, clinical documentation, patient communications, and billing, but may need various other clinical tools that may or may not be interoperable. Because telehealth applications may use incompatible databases, lack of interoperability remains a huge barrier to efficient telehealth usage. A full-scale yet modifiable telehealth platform that can integrate various functions, such as VSee, can be designed with clinical operations in mind.
The direction of telehealth innovation involves the application of workflow logic to quickly and efficiently deliver care throughout the entire preclinical, clinical, and post-clinical encounter. Critical features such as transferring, putting patients on hold, scheduling for various providers who collaborate on a patient’s care, as well as device streaming for remote medical exams are some key features that can help a practice look seamless online. Adding blood pressure data, electrocardiogram data, and imaging may require a high level of interoperability across various devices, but once integrated, can save a lot of time. Signing consent, calendars, and patient transfers to the front desk may help improve workflow. As they say, time is money.
Telemedicine Valuation
The gold rush of new players utilizing telemedicine reveals the potential economic value of telehealth solutions, ranging from broad-based to specialized, personalized care. Primary care telemedicine has been on the rise, as well as specialized long-term care (for example, fertility care, family medicine, and geriatrics) utilize digital interventions to enable constant collaboration with the patients and their family members. Niche markets could be reached through a mixture of digital marketing and seamless online services.
Roman (getroman.com), for example, tailored its services to men’s healthcare online, providing male-specific care. Niche healthcare is a lot more accessible through the creation of websites that cater to the very specific needs of their target market and pivot accordingly. Another telemedicine company called Ro (ro.co) that brands itself as “The Patient Company” is connecting healthcare professionals and pharmacists for seamless prescription and delivery of medications, reaching up to 6 million digital healthcare visits on their platform. In March 2021, it is valued at $ 5B.12 GoodRx Care, another telemedicine company, has two revenue models – membership-based and fee-for-service – for its telemedicine application. It recently acquired HeyDoctor as part of its telemedicine portfolio.13 At the last quarter of 2020, GoodRx earned $133.3M in net income14 and is valued at $ 18 B.15 Home laboratory testing companies like Everlywell (valued at $2.9 B) are also on the rise, mediated by telehealth platforms with health tracking features.16
Regulations and Data Security Issues in Telehealth
Will regulations stop the sudden growth of these new telehealth companies? The Health Insurance Portability and Accountability Act (HIPAA) compliance will always be at the forefront of telehealth regulations, but additional tools may be used in ensuring that data is seen only by those who are meant to see them. Multi-factor authentication, identity verification, and other cybersecurity measures should become a priority for telehealth companies as data breaches become more complex.
While safety measures are in place, there are also more regulations favorable to telehealth, such as cross-state licensing, allowing healthcare providers to bring their practice nationwide.17
The Future of Telehealth
Will the healthcare market ever fully revert to favoring brick-and-mortar healthcare? Or will telehealth be an irrefutable step forward, like the businesses that have pivoted to permanent work-from-home arrangements? It remains to be seen, but it is worth a shot.
Brian Koffman, MDCM of the CLL Society said in February 2021, “We are not going back to business as normal… COVID-19 has served as a catalyst to a safer, more efficient, and more patient-centric experience through increased telehealth options.”5
Judging by the increased demand from both the consumers (soaring from 11% to 76% interested in using telehealth in a span of a year) and healthcare professionals (increasing their number of telehealth visits by 50 to 175x compared to before COVID), telehealth is here to stay.4
References:
- Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic – United States, January–March 2020. Centers for Disease Control and Prevention. Published October 30, 2020. Accessed July 1, 2021.
- U.S. States and Territories Modifying Requirements for Telehealth in Response to COVID-19. Published June 23, 2021. Accessed June 15, 2021.
- Carlos I. Telehealth claim lines jump 3,000% in 1 year. Becker’s Hospital Review. Accessed July 1, 2021.
- Gilbert G, Harris A, Rost J. Telehealth: A quarter-trillion dollar post-COVID-19 reality? Published May 2020. Accessed June 15, 2021.
- Telehealth Is Poised for a Post–COVID-19 Future. OncLive. Accessed July 1, 2021.
- State Telehealth Policies Remote Patient Monitoring. CCHP. Accessed July 1, 2021.
- Landi H. Why experts say the information blocking ban will be game changing for patients. FierceHealthcare. Published March 31, 2021. Accessed July 1, 2021.
- From Population Health to Platform-as-a-Service: Charting the Future of RPM. Accessed July 1, 2021.
- Feinberg AT, Hess A, Passaretti M, Coolbaugh S, Lee TH. Prescribing Food as a Specialty Drug. NEJM Catalyst. Accessed July 1, 2021.
- Armaignac DL, Saxena A, Rubens M, et al. Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System. Crit Care Med. 2018;46(5):728-735. doi:10.1097/CCM.0000000000002994
- Meola A. How and why the value based payment (pay for performance) model is trending in the healthcare industry. Business Insider. Published February 26, 2021. Accessed July 1, 2021.
- Ro raises $500M, bringing its D2C virtual care business to a $5B valuation. MobiHealthNews. Published March 23, 2021. Accessed July 1, 2021.
- Landi H. GoodRx acquires telemedicine company HeyDoctor to add virtual healthcare services. FierceHealthcare. Published September 27, 2019. Accessed July 1, 2021.
- Good Rx Q4 2020 Letter to Shareholders. GoodRx. Published March 11, 2021. Accessed July 1, 2021.
- Nishant N. GoodRx shares jump 40% in Nasdaq debut after $1 billion IPO. Reuters. Published September 23, 2020. Accessed July 1, 2021.
- Roof K. Everlywell Valued at $2.9 Billion With PWNHealth Deal. Bloomberg.com. Accessed July 1, 2021.
- Robezniek A. Cross-state licensing process now live in 30 states. American Medical Association. Published April 26, 2021. Accessed July 1, 2021.
