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Like in any ecosystem, the interplay between functions is paramount to success.
Over the past 10 years, patient and provider acceptance of telemedicine has been slowly increasing. If telemedicine was on a 20-year trajectory to full acceptance, we were halfway there when COVID-19 hit. Then, patient demand spiked and healthcare practices had to find a way to stay afloat. Mass adoption of virtual care ensued. Suddenly, we were dropped into a care modality nine years premature. McKinsey recently predicted the telemedicine industry would see a 50-175x increase in utilization leading to a $250B industry. Today, more than 80% of all U.S. consumers have used telemedicine to seek care, and over 9 million people under traditional Medicare used telemedicine in the first few months of the year. Now, as practices reopen and in-person care returns, telemedicine utilization is leveling off but not dropping. The pendulum is only slowing down, but how far will it swing? Telemedicine is here to stay and will likely make up a substantial portion of ambulatory visits post-pandemic.
Even before COVID-19, patient adoption of telemedicine was up 33% over last year at the beginning of 2020. With the resurgence of regional spikes in COVID-19 cases over the last month, telemedicine is continuing to increase in utilization. The debate around telemedicine being a permanent part of our care delivery system in this country has ended. The real question is one of tensile strength: How much can a health system or private group practice bend without breaking to accommodate new hybrid forms of care delivery driven by patient demand? As we consider telemedicine’s role in the future of healthcare delivery, three core drivers will emerge that differentiate how successful practices function in a new hybrid ecosystem. Like in any ecosystem, the interplay between these functions is paramount to success.
Prior to COVID-19, direct-to-consumer telemedicine adoption hovered in the high single digits. Since COVID-19 and reduced barriers to access, 83% of consumers now say they are comfortable with telehealth replacing some or all of their in-person care. This could be seen as a significant rise in patients’ trust in telemedicine to provide safe, quality care. It could also be interpreted as a ‘the only choice I had.’ If the latter were true, we would have seen a rapid fall in direct-to-consumer telemedicine visits over the past few weeks as medical practices opened for in-person business. We haven’t. If the question was once whether or not telemedicine would ever reach the consumer acceptance tipping point, it has been answered. Our patients have spoken. According to a recent study from Massachusetts General Hospital, 62.6% of patients said the quality of their telemedicine experience was equal to or better than an in-person visit. Clearly there is work to do in strengthening consumer confidence so that this modality can become woven into the fabric of our healthcare system.
In direct response to consumer demand, progressive practices are launching a phased approach to the new hybrid care delivery model. Longitudinal and preventive medicine are now being practiced. Emerging technologies are allowing a contactless patient experience to mitigate concerns of being in waiting rooms for those patients that truly need to be examined in-person.
Outpatient medicine responded to the pandemic in historic ways. Within one to two weeks, most practices had either launched or were planning to launch telemedicine platforms. Capacity quickly returned in the form of virtual visits. The final step is driving consumer confidence. Patients will need to believe telemedicine is safe and effective; some will need to have the option to see their own physician for chronic and longitudinal care. Patients are using telemedicine at historic rates. Clearly, they have gained some level of trust that their needs can be met via this technology, but there is work to do. The pandemic represents an opportunity to hardwire telemedicine into consumers’ list of options in the post-pandemic ecosystem and make it top of mind for care.
Medicine is a profession built on scientific theory. The default position is no change. Looking back at the last five months of COVID-19-driven telemedicine, it’s important to ask if it was safe, efficacious, and valuable. The anecdotal evidence leans toward the affirmative. In June of this year, the National Committee for Quality Assurance expanded 40 quality measures used for HEDIS and will better align with recent telehealth guidance from the Centers for Medicare & Medicaid Services and other federal and state regulators—a good sign that clinical quality will be an important driver of expanding telemedicine services.
One unexpected silver lining we’re discovering in telemedicine is insight into the social determinants of health based on a patient’s environment. Within two minutes of a visit starting, the provider has gained insight into the home environment. Potential areas of concern that could be at least partially evaluated include heating and cooling capabilities within the home, compliance with diet and cooking recommendations, in-home aid services, self-hygiene, and medication adherence, among others. These new data points will likely find a place in the patient’s chart. Work is underway to better understand social determinants of health and how best to address those at the provider level. All these learnings will need to be boiled down through outcome studies to assess the safety and efficacy of a direct-to-consumer telemedicine program.
Now that we are in a national crisis where lives and well-being depend on telemedicine, the adoption curve will not stay as shallow as it was before COVID-19. Many practice administrators and health system executives are asking: Can I afford to invest in a quality comprehensive telemedicine platform? Is this part of my overarching patient engagement strategy? In the outpatient world, sudden economic disaster caused by plummeting visit volumes drove the initial rapid adoption of telemedicine more than an attempt to meet consumer demand. Providers are hesitant to invest even more time, energy, and money into crafting a solution for tomorrow's healthcare environment when we don't have all the answers yet. As telemedicine adoption begins to level out, healthcare leaders will be forced to reckon with the future of medicine. That future, for the first time in the history of this country, will be guided by the consumer.
Concerns about self-cannibalization of in-person visits at a net-lower reimbursement rate are real. They pale in comparison, however, to a net loss of patient visits due to not offering telemedicine at all, followed by a migration out of your practice. To remain financially viable, practice administrators may need to reconsider their expense structures and how they maintain profit margins. With final rules on reimbursement not yet in place, it will be difficult to invest in a strategy for lowering expenses to match a payment structure not yet proposed. The consequences of delaying the decision to offer adjunctive, high-quality telemedicine services could be disastrous. Patients are in flux now and rethinking what on-demand and primary care mean to them. Suddenly, it makes sense to wrap your telemedicine experience in strategies to attract business with patient engagement tactics both pre- and post-visit. Factors like contactless experience, mobile check-in, and digital registration all become critical, and investing in consumer engagement become incontestable.
Where we go from here is limited only by our imagination. But make no mistake: It will be based on technology. Wherever we go, we will be guided by our patients. But it is our responsibility to seek out ways in which technology can facilitate healthy outcomes. Engaging patients and building and maintaining trust is paramount to any new care delivery modality. As Steve Jobs once said, “Our job is to figure out what [customers are] going to want before they do.” The same is true in healthcare. Consumer input is important, but they’re limited by what they’ve seen and experienced. Physician leaders, practice administrators, health IT innovators — we’re all on the other side, and it’s up to us, not consumers, to drive new modalities of care. We can’t afford not to.
Rob Rohatsch, MD, is Chief Medical Officer of Solv Health, a leading digital health company focused on transforming the consumer experience to deliver access to high quality, same-day healthcare that is simple, fast, and effortless. Learn more at solvhealth.com.