Telehealth: Future growth depends on overcoming four hurdles
For years, advocates of digital health have touted the potential of video visits, phone calls, emails, text messages, and smartphone apps to provide more convenient and accessible care than in-person visits to brick-and-mortar hospitals and clinics.
As recently as February 2020, however, virtual visits still represented fewer than 1 in 250 health care visits, according to FAIR Health, a research organization that looks at commercial health insurance claims. (Virtual visits are a specific type of digital health encounter in which a physician sees a patient electronically.)
That changed virtually overnight as COVID-19 spread across the United States. With stay-at-home orders in place, and with hospitals limiting in-person care to emergency situations, virtual visits skyrocketed to 13% of all insurance claims in April 2020. That figure has dropped since, but virtual visits continue to make up more than 5% of health care visits, FAIR Health’s data shows.
“2020 was a transformative year for our industry. Consumer behavior has fundamentally changed in light of the pandemic,” Anmol Madan, PhD ‘10, chief data scientist for telehealth company Teladoc Health, said during a panel discussion during last month’s MIT Sloan Healthcare and BioInnovations Conference. For example, use of the Teladoc virtual visit platform for mental health visits grew 500% in the 12-month period ending in February 2021.
“Virtual care and telemedicine were considered ‘nice to have’ a few years ago. Today they're an expectation — a must-have. The virtual care experience is here to stay,” said Madan, who was joined on the panel by Jonathan Teich, MD, chief medical information officer at health care data management company InterSystems, and Christian Hicks, vice president of strategy and operations at Maven Clinic, which provides virtual care for those who are pregnant.
Across the United States, hospitals and health systems expanded their own use of digital health, both to safely treat patients in the hospital with COVID-19 and to let patients with low-acuity needs receive care from home.
Post-pandemic, digital health won’t function so much as a replacement for in-person care as a way to enhance or extend it, the panelists agreed. Follow-ups after hospital discharge, assessments of blood glucose readings, conversations with a doula, and many other types of appointments don’t necessarily require driving to a hospital or clinic, parking, and waiting to see a doctor.
Continued success means being able to support a unified care experience. “After the novelty of telemedicine wears off, and it's not the first time consumers are using it, I don't think they’re saying, ‘I want virtual care,’ or, ‘I want physical care.’” Madan said. “I think they're just saying, ‘I want health care.’”
Supporting a unified care experience will pose four key challenges to telehealth providers as well as health systems moving forward:
1. Data operability
Sharing data across hospital systems and technology products remains the largest hurdle. The average Medicare beneficiary sees seven physicians at seven different facilities — many with different electronic health record systems. Assembling a complete record of a patient’s care is “pretty nuts,” InterSystems' Teich said.
“There's many, many different ways of storing, encoding, and preserving the same data,” Teich said. “You can't make sense of a report that has three things coded this way and four things coded that way. If you're going to try and put that together, there has to be a lingua franca. We have to spend a lot of time transforming, aggregating, and normalizing the data so it makes sense.”
2. Ongoing personal connections
The second challenge is finding ways to make a personal connection with patients who use digital health, as use cases tend to be one-off visits (for acute needs like a sore throat) or care that’s not connected to a patient’s usual doctor (such as mental health).
In some cases, such as prenatal care, it’s a matter of developing an individualized care plan and walking someone through the various in-person and virtual touch points they’ll have during a pregnancy, Maven’s Hicks said. This helps to provide a more unified care experience.
In other cases, it’s better understanding what a patient needs. Through Teladoc’s acquisition of Livongo, where Madan was the chief data scientist, the company offers programs to help patients achieve clinical outcome goals — such as, for diabetics, reduced hemoglobin A1c levels — through a smartphone app. (Some hospitals and health plans choose to supplement use of the app with in-person support programs.)
“Maybe they just need to learn how to do a diabetes blood glucose check,” Madan said. “Or maybe this person is stressed out. Even though they're [there] to receive care for Type 2 diabetes, the place to engage them is actually helping them to reduce stress, because that's what's going to get them to the next stage of being able to use our product as effectively.”
3. Equitable access to virtual care
The third obstacle is ensuring that access to technology, whether it’s devices or broadband Internet, doesn’t further widen the digital divide. Hicks said Maven is exploring ways to develop products that focus more on text messages, which can use a smartphone’s built-in texting applications and require a limited amount of data.
Madan noted that users from all walks of live tend to respond positively to digital health when they use it. This includes Indigenous populations and others living in rural areas that face physician shortages and face up to a three-hour drive to see a doctor.
“Technology can connect them with the same convenience that somebody in an urban area would have. That's a huge differentiator,” Madan said. “Health care can be this equalizer in this new virtual world. That’s really, really promising in many ways for the future of health care access in our society.”
The rate at which telehealth visits are reimbursed, and the determination of which services count as “telehealth,” remain in the combined hands of state legislatures, government agencies, and insurance companies.