How Telehealth Will Continue its Evolution Beyond Pandemic Response

It has been nearly two years since telehealth's meteoric rise in popularity. Though it is clear that telehealth is here to stay, its role in care delivery will continue to evolve beyond being a tool to address the social distancing constraints brought on by the COVID-19 pandemic.

Even amid the public health emergency, telehealth has seen fluctuations in use. This year, about 26 percent of organizations, including acute, ambulatory and post-acute care facilities, reported that more than a quarter of their patients had used telehealth as compared with the 32 percent of organizations that reported the same in 2020, according to the CHIME Digital Health Most Wired survey.

Another recent report by FAIR Health shows that though telehealth use is continuing to grow, it is far lower than growth seen in March 2020. 

This indicates that though telehealth will remain a key part of the care continuum, providers are still in the process of figuring out how best to integrate it with other types of care delivery.

"I think of virtual care and virtual visits as a channel in a multichannel strategy," said Gurpreet Singh, health services sector leader at PriceWaterhouseCoopers, in a phone interview. "What I mean by that is, think of it less as an on-or-off replacement of therapies that can't be handled in person, but rather a channel or a tool in the portfolio of options that the health system or even physicians have."

Health system leaders and industry experts that spoke with mHealthIntelligence believe that moving forward, telehealth will be used in a targeted fashion, that is, to treat certain conditions and for certain types of patients, and its continued use will be supported by an evolving virtual-first reimbursement landscape.

Targeted use cases for telehealth

Health systems expect telehealth to make up about 25 percent of patient visits in the next five years, according to Singh.

"Their reasoning for that is that they've started to realize that many specific therapies can be handled in a virtual setting," he said. "Obviously some tertiary and quaternary care can't. But what we're finding is that there are many more opportunities to use a virtual modality. And as a result, that 25 percent number is likely to stay solid."

One of the arenas in which telehealth has made a huge impact — and will continue to be used extensively — is mental healthcare.

Telehealth utilization for mental health increased nationally from 58.8 percent in August to 61.2 percent in September, the latest FAIR Health data shows.

"There is no doubt in anyone's mind that this has been the area which has seen the biggest jump in usage compareds to pre-pandemic rates," said Oleg Bestsennyy, a partner at McKinsey, in a phone interview.

Not only does telemental healthcare ensure access to those who live in areas of the country with few mental health providers, but it also reduces the stigma around seeking mental healthcare as it enables people to participate in visits from their own homes.

For Sioux Falls, South Dakota-based Sanford Health, one of the largest rural health systems in the country, telehealth had been invaluable as a mode of mental healthcare delivery.

"Unfortunately for us, and I think throughout the nation, especially in rural parts of the country, there is a critical shortage of mental health providers," said Jeremy Cauwels, MD, Sanford Health's chief physician, in a phone interview. "I think [telehealth] is a way that we [can] provide access to mental health that is far superior and far faster than the way that we could in rural populations."

The health system relied on telemedicine, for example, when a suicidal teenager in Northern Minnesota needed to be seen by an adolescent psychiatrist.

"The difficulty was that the nearest adolescent psychiatrist was more than a two-hour drive, making the overall trip probably a full day off for mom, if they were going to be able to get the child in [for an appointment]," he said.

The health system was able to connect the teen with an adolescent psychiatrist in under two hours through telemedicine.

Another clinical area in which telehealth can ease burdens is follow-up care.

Sanford Health has general surgeons who are conducting their postoperative visits via a phone or a camera-enabled web device. What would have been a two-hour drive to and from the hospital for a 10-minute appointment is instantly made more convenient for both provider and patient, Cauwels said.

Research backs the notion that using telehealth for follow-up care is a popular alternative to in-person appointments.

Finally, there is the role telehealth will play in the remote patient monitoring (RPM) arena.

RPM, together with telehealth, has the potential to disrupt chronic care management. For example, consider an endocrinologist or primary care provider who is treating diabetic patients and can receive data from a connected diabetes solution, said PwC's Singh.

When the patients do come in for a face-to-face appointment their physicians already have a longitudinal view of their A1C levels, glucose levels, the insulin dosages that they've taken, and so on, resulting in richer provider-patient conversations.

"The potential for better outcomes, the potential for better evidence is very high," Singh said. "And I think that there's a great opportunity there."

New reimbursement models

As the use of telehealth evolves, so will the reimbursement models surrounding the care modality.

Already, we have seen the emergence of virtual-first health plans, a trend that will likely continue, according to McKinsey's Bestsennyy.

"The purpose of the plan is for any interaction with a provider or with the health system, for that interaction to initiate digitally," he said.

These health plans are designed for the hybrid care delivery model, which includes both virtual and in-person care, that is expected to continue. After the digital initiation of care, there may be a need for in-person visits, and the health plan covers both.

"When it makes sense, it's a physical location appointment, and when it makes sense, it's a virtual appointment," Bestsennyy said.

Numerous payers — from insurance giants like Cigna to startups like Oscar Health — have made virtual services a priority, launching new products to meet the care needs of the moment.

How providers should prepare

The virtual-first new normal is here, and providers need to get on board (if they haven't already).

One way to do so is to understand that the new normal is not just about the technology — it's about the patient's entire healthcare journey.

"Designing the virtual patient journey that intersects and interacts with the physical patient journey is really important," PwC's Singh said. "And so many are employing new chief experience officers or chief digital officers that really understand, or can decompose the journey, and better understand where the moments that matter exist."

Another major issue facing health systems currently is workforce planning. Even with virtual care options, staffing is hurdle for several facilities. The "great resignation" phenomenon has hit healthcare hard, with a high percentage of providers reporting burnout and a desire to leave their workplace. 

Thus, it is important for providers to have a fluid demand and supply planning capability.

"This is more analytics, right? It's basically trying to get ahead of where these surges might occur," Singh said. "Some are trying to predict when the demand flows are going to change and result how that might affect your supply, if you will, of nurses, the staff that you need, and the staff that's required in both [in-person and virtual settings]."

Sanford Health is already taking steps to meet the growing demands of virtual care. The health system recently received $350 million to build a virtual care center.

"It's a place for us to centralize and really focus on this type of care," Cauwels said. "Making sure we have a very patient-friendly, easy way for [patients] to receive the digital care that they need."

Further, the center will offer training to physicians on their 'webside manner,' that is bedside manner for the digital age.

"Not only do they have to be good sitting next to somebody's hospital bed," he said. "But they also have to communicate with the people across the airways, really bring some life and being dynamic, to those conversations."

Looking ahead, it will be important for providers to ask themselves how much and where they will invest to grow telehealth as a "driver of their differentiation," McKinsey's Bestsennyy said.

"How do you create those hybrid models? How do you invest purposefully and strategically in the creation of those hybrid models that meet people where it's best for the person and drives the best quality of care? How do they invest into applications of telehealth combining that with applications of remote patient monitoring, potentially as an example, to deliver better care," he said. "And how do they use this as an opportunity to make a big step forward in terms of creating innovative models that completely redefine how they practice medicine today?"