Healthcare organizations that planned to dip their toe in the telehealth waters ‘some time this year’ found themselves accelerating plans faster than ever imagined. The social distancing requirements of the pandemic made these types of capabilities a requirement for doing business.

But, is telehealth really here to stay? For the decade I have spent in health technology, telehealth promised to revolutionize healthcare as we know it.  Until recently it has not.

Why?  A 2016 review in Journal of Telemedicine and Telecare sited several key barriers to adoption of telehealth: 

• Technically challenged staff
• Resistance to change
• Cost
• Reimbursement
• Age and education of patients

However, the COVID-19 pandemic has proven to be a turning point for telehealth, with consumer use up from 11% in 2019 to 46% in 2020.

Why is This Time Different?

There are several key reasons this time is truly different:

Reason #1: Removal of regulatory restrictions: 

While not sited in the 2016 review as a top barrier to adoption, removal of regulatory restrictions during the pandemic has certainly made use easier. According to a study from McKinsey, Centers for Medicare & Medicaid Services (CMS) has temporarily approved 80 new services and lifted other restrictions to enable use of telehealth.  

Reason #2: Less resistance to change:  

As might be expected in a crisis like this pandemic, both providers and consumers are more adaptable to technology. Technology solutions can protect them from COVID-19 infection.  

The same McKinsey study found 57% of providers view telehealth more favorably than before COVID-19. 76% of consumers are interested in using it going forward.  COVID-19 posed a bigger risk in both consumer and provider minds than learning to use a new technology. Many jumped on board in the last 3 months.

Reason #3: We better understand how it works: 

Because of COVID-19, both consumers and providers are getting to try out telehealth and models of care that leverage technology. It is becoming less of a mystery and more mainstream.  

Most people think of Teledoc and some form of virtual urgent care instead of going to an ER or urgent care center.  But McKinsey describe 4 additional models of virtual care:

• Virtual office visits: These are generally visits with a provider with whom the consumer already has a relationship, such as in primary care, behavioral health, and specialty care.  In the near future, this may be part of a multi-channel model that has mix of telehealth, in person visits, remote monitoring, and digital coaching and therapeutics.

• Near-virtual office visits: This structure combines virtual access to physician consults with ‘near home’ sites for testing and immunizations like worksite and retail clinics.

• Virtual home health: Using virtual visits, remote monitoring, and digital patient engagement tools, this model enables some services to be delivered remotely, such as physical therapy, patient education, and speech therapy.  This would then be complimented by in-person home visits.

• Tech-enabled home medication administration: Infusible and injectable drugs administered at home and monitored through telehealth.

Reason #4: Oh, right, MONEY: 

During the COVID-19 crisis, major insurers and CMS have supported reimbursement for telehealth with no co-payment required by the consumer.  With providers confident about reimbursement, and consumers confident about coverage, adoption sped up.

So, Is Telehealth Here to Stay?

Many people, including consumers and providers, hope that it is.

The College of Healthcare Information Management Executives (CHIME), and the American Telemedicine Association (ATA) have both reached out to regulators. They are encouraging long-term strategy and investment in telehealth.

CHIME is calling for the expansion of telehealth during COVID-19 emergency be made permanent.  CHIME points out that telehealth has helped avoid exposure during the pandemic, and saved on PPE.  They also believe consumers will demand continued access to telehealth, and providers will expect it.

ATA sent a letter to Congress pointing out that demand for telehealth will not end with COVID-19. Congress should find ways to ensure continued access to remote care for patients and providers.  

ATA recommends incorporating telehealth into the National Health Security strategy. It proved valuable in the COVID-19 emergency.

According to Fierce Healthcare, high level individuals at UnitedHealth and the Department of Health and Human Services made statements that there is no going back to a pre-COVID world of telehealth.

Following the money, McKinsey projects telehealth growing from a $3B business in 2019, to one with $250B potential in 2020.  

They arrived at that number by looking at claims data. They believe 20% of ER visits and 24% of office and outpatient visits could be done virtually, with another 9% done near-virtually.  

With the additions of virtual home health services and shifting more of outpatient to home care, McKinsey believes virtual care is a $250B opportunity. That means 20% of all office, outpatient, and home health spend across Medicare, Medicaid, and commercial insurance.

What is Next with Telehealth?

Assuming regulators keep up with consumer demand for continued telehealth access, challenges still remain.

McKinsey points out providers expressed concerns around security, workflow integration, effectiveness compared to in-person, and reimbursement.

Many providers are also unsure of how to manage a workflow of in-person visits with telehealth.  In addition, reimbursement for telehealth services post-COVID is still up in the air.

With several payers pushing for discounts on telehealth services compared to in-person, providers are turning to value-based arrangements. They can offer a suite of in-person and remote services without worrying about reimbursement.

As time rolls on, we will likely see telehealth move from simple virtual visits to integrating additional technologies. These technologies will allow patients to do more self-monitoring, and automate sending information back to providers.

In closing…

The reality is the removal of regulatory barriers and expansion of payment gave providers a nudge towards adoption telehealth.  But consumer demand gave the final shove needed to take telehealth mainstream.

Will consumers be willing to go back to how things were before COVID?  My guess is no.

It is not like anyone says, ‘Yippee!  I have a doctor’s appointment tomorrow! I get to sit in the waiting room for an hour to see the doctor for 15 minutes!’ Now people have experience seeing providers from the comfort of their home. Moving forward, they will not settle for anything less.