Is TeleHealth Really, Truly, Finally at a Tipping Point?

1. Is TeleHealth Really, Truly, Finally at a Tipping Point?

Changing consumer expectations, favorable federal regulation changes, new data to support its effectiveness, expanding services, and a changing view of care delivery all point to widespread adoption of telemedicine in the not-too-distant future.

In 2012, everyone seemed to be excited about the concept of telehealth, but it has been slow to take hold. Now, as we approach 2020, there appears to be a resurgence of interest. Payers, providers, innovators, and consumers are all interested in the possibilities, observed Kevin Pereau, CEO of TranscendIT Health. Pereau was the moderator for the panel discussion, “Telehealth’s Tipping Point,” at the recent HLTH 2019 conference. And his panel of experts all agreed.

Are we really at a tipping point this time?

Weighing in on the question of whether telehealth is at a tipping point, American Telemedicine Association (ATA) CEO Ann Mond Johnson cited a number of factors that seem to, indeed, place it at a pivotal moment. Expectations from consumers have changed, and today’s digital natives expect telehealth services, Mond Johnson said. Also, telehealth is moving from acute care and primary care into new areas like chronic care management, where it’s making a difference. As she noted about people’s experience with telemedicine: “Once people use it, they are wildly enthusiastic.”

Fay Rotenberg Bush, president of Firefly Health, a “virtual-first” primary care company, takes a slightly different view. She believes we still have a way to go before we see widespread adoption of telehealth and sees the first cycle of adoption around convenience and the increased access to care. But she says we still must work on delivering proactive and ongoing care, with proof of improved outcomes.

Offering another provider perspective, Peter M. Fleischut, MD, senior vice president and chief transformation officer of New York-Presbyterian, believes providers must deliver care in terms of a true consumer journey. Like Johnson, he sees expectations among today’s consumers requiring, not requesting telehealth services.

Policy helps fuel adoption

Responding to attendee questions, the panel, naturally, had to address how policy affects adoption.

Rotenberg Bush noted that there are many positives in terms of regulation. She said that there’s a push for parity between telehealth and traditionally delivered care, but that regulation changes are still lagging behind the advances in care delivery. She also noted the risks. She explained that if you incentivize for visits, you’ll recreate already existing broken processes. And if you pay the same way, you have another “over-visit-based structure.” Instead, she emphasized, what’s needed are new ways to triage people. She also sees the need to allow clinicians to see patients in states other than their own.

Mond Johnson sees regulations around reimbursement as it tries to keep up with new technology, but then, as the technology advances further, it continues to leave reimbursement policy behind. She believes national licensing is a “tough row to hoe” and isn’t likely to become widespread.

“What it comes down to is that we need to use technology to reimagine care, and policy must support this new model.”

Ann Mond Johnson, CEO of ATA

Risks still lie ahead

What are the risks of telehealth, and how can those involved mitigate those risks?

Mond Johnson underscored the risks inherent in any healthcare delivery model, including traditional face-to-face care. She further emphasized that because medicine is being practiced differently with telemedicine, it doesn’t mean the care is worse. She finished her remarks by commenting that when people can’t go to a clinic, we need to use technology to take care to the patient at home.

Dr. Fleischut addressed the opportunities for changing the care model and providing end-to-end care using telemedicine as part of the model—opportunities that outweigh the risks. He noted the need to measure care quality and safety.

For Rotenberg Bush, there’s a need for tight integration between virtual care and physical locations, and she noted that those physical places won’t or shouldn’t go away because not all care can be provided virtually. For example, patients may still need in-person follow-up care.

Reimagining Care Delivery

What’s the future of telehealth three to five years down the road? All the panelists agreed that telehealth will broaden to include more types of care delivery and more types of healthcare professionals.

Telehealth will transcend into every clinical care, believes Mond Johnson. She cited an example of her own rehab after a skiing accident. She did all the rehab virtually and had better-than-expected mobility as a result. As she put it, “The exam room of the future is home.” By taking care to patients, it’ll be easier to identify situations before they deteriorate. According to Mond Johnson, telemedicine is making it possible for people to get care where and when they need it.

She went on to note that reimbursement has improved at the federal level. She also cited two other “bright lights”: self-insured employers and the Veterans Administration (VA). She’s seen the VA craft partnerships to give access to care to those who’ve served our country. She ended by emphasizing that there are many things in telehealth to be optimistic about.

Adding on to the discussion, Rotenberg Bush said she believes there’s some care that doesn’t need to be provided by a physician, and that we need to move away from just one kind of care and break away from all the siloes. She sees other types of caregivers involved in follow-up care, for example. What’s important is to provide the most appropriate care by the most appropriate healthcare professional.

Giving the provider viewpoint, telehealth is also allowing physicians, pharmacists, and care managers, among others, to “upscale” and practice at the top of their license, noted Dr. Fleischut.

All these viewpoints stressed an underlying themes of the entire session: the reimagining of healthcare. The experts agreed that we need to stop thinking of telemedicine as a virtual model that’s identical to traditional care. Mond Johnson noted again that behavioral health delivered virtually is as good, if not better, than traditional in-person care. She stressed that technology will help us reimagine care, not just replace it. Rotenberg Bush seconded that view, noting that we need to rethink delivery of care—not only how it’s delivered but also by whom.

Perhaps it’s best sum up the entire discussion with these thoughts from Dr. Fleischut: We’ll know that telehealth has gone over the tipping point when we simply call it healthcare, when it is fundamentally the way healthcare is delivered.

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