By Christopher Kerns and Amanda Berra of the Advisory Board
Note: This blog post is a segment of an article that was originally published on June 15, 2020 by the Advisory Board.
With telehealth reimbursement finally seeing reimbursement parity with in-person visits during the public health emergency, providers of all stripes have begun investing heavily in a variety of platforms. Here, John League—who leads the Advisory Board’s ongoing global research on healthcare technology—discusses the future of telehealth reimbursement, the technical needs that still need to be met, and how remote technology is poised to remake primary care.
1. Prior to Covid-19, telehealth adoption had been lagging.
For many years, telehealth has not lived up to its billing:
2. Adoption is now through the roof.
However, the pandemic completely altered the story of telehealth, with the use of virtual care and messaging skyrocketing.
The federal government played a major role here, working with regulatory bodies and payers to drop historical payment and privacy-related barriers. Between that and consumer behavior changes due to quarantine, statistics now tell a drastic before-and-after story:
Providers have kept the momentum going by quickly transforming the delivery system. For example, NYU Langone Health recently added 1,300 physicians and other care providers to deliver care through its telehealth platform.
And based on anecdotal evidence, while telehealth use appears to decline as a Covid-19 surge passes, rates in those places are still considerably higher than before the pandemic.
3. When people try telehealth, they like it.
Pre-pandemic research consistently said when people try telehealth, they tend to like it—and that positive experience has continued in the Covid-19 context.
4. It's not whether temporary accelerants like deregulation and improved reimbursement will stick around—it's which parts.
The telehealth spotlight was on CMS Administrator Seema Verma last week, as she provided comments that served as preliminary indicators of CMS' position on ongoing payment and regulation for telehealth.
Advisory Board drew three tentative conclusions from reading between the lines of Verma's statements:
5. Don't push telehealth overall—identify and push the best clinical use cases.
Medical groups and health systems often ask Advisory Board's telehealth research team, "What should my total proportion of virtual visits be?" John said, "I understand the desire to have a goal. To make plans and build platforms and design incentives for physicians to get a certain volume—that all makes sense. But I think that focusing on a single top-down number is misplaced."
Instead, providers should take a step back and look critically at which interactions in a care pathway—and which patients in the broader population—most need telehealth.
Interactions that require hands-on care, or in-person counseling, should not default to virtual—but other types of interactions, such as pre- or post-op visits and receiving routine lab results, possibly should. Each different provider type will have a different mix of opportunities.
And when it comes to specific patient populations, providers should look at seniors as a focus area for supporting telehealth adoption:
However, research shows that seniors still have consistently lower utilization of telehealth compared with other patient groups. "Providers must find ways to encourage older patients to embrace telehealth for the right kind of interactions. Doing that will create a tailwind for telehealth adoption generally," John said.
6. Take steps to close patient access gaps.
Not all patients are benefitting from telehealth. A comprehensive telehealth strategy should prioritize overcoming barriers, especially for underserved populations. Disadvantaged populations are using telehealth less than the U.S. population overall, likely due to lower access to health care generally, as well as to lack of devices, technology, and digital literacy. Millions of Americans lack access to high-speed internet [FCC study, Microsoft study].
To combat access barriers, providers can:
All telehealth stakeholders should also advocate for long-term change: More funding for equipment, connectivity, and reimbursement parity (where it makes sense clinically).
7. Don't reinvent the wheel—take advantage of lessons learned the hard way.
One upside of telehealth's long, slow adoption to this point? A wealth of lessons learned about the pitfalls and best practices for boosting the odds of telehealth success. Don't reinvent the wheel—learn from the experience and insight available through existing and upcoming research.
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