The COVID-19 pandemic transformed telehealth by creating a sudden imperative for remote delivery of medical care to the benefit of patients and providers alike. That transformation has catapulted telehealth and its many benefits to the forefront of mainstream medicine. The challenge now: Make those benefits permanent and expand them further to improve value in care delivery.
The potential is enormous. Telehealth is not simply making it possible to communicate with a health provider online; it is enabling the delivery of sophisticated and complex medical care to remote locations.
The implications for healthcare, its quality, and cost, are profound – especially for rural hospitals and remote communities. In the last 10 years, 120 rural hospitals in America have closed, according to The Chartis Center for Rural Health. The pandemic has only accentuated this risk. And with the impending bankruptcy of the Medicare Trust Fund, telehealth is a viable option to help make care more affordable.
Telehealth changes the equation, not only making specialists available to rural hospitals but enabling patients to receive that care without being transferred to larger, more distant facilities. They can remain in their communities, surrounded by their support systems, with the local hospital retaining the revenue. That strengthens not only rural hospitals but rural economies where the hospitals are often the largest employers. And it adds an element of convenience not available before.
The care provided by telehealth, using secure video and audio technology, is also extremely sophisticated. For example, at Intermountain Healthcare, we’ve been able to assess the potential for bone marrow transplants by telehealth, eliminating the need for a potential donor to travel until the match has been confirmed. There’s no way to overstate this: Telehealth is groundbreaking medicine.
COVID-19 accelerated these advancements. Nearly half (43.5 percent) of all Medicare primary care visits were provided via telehealth in April, according to the federal government, compared with less than one percent in February (0.1 percent). At Intermountain Healthcare, our use of telehealth visits ballooned in 2020 from 7,000 in March to 63,000 in April and have stayed consistently high since. Yet the federal government’s approval of telehealth use and payment was only made on an emergency basis. It expires when the emergency ends.
We need to seize this momentum. To do so requires three steps.
First, determine on what basis telehealth will be permanently compensated by the federal government, and also by payers. On an emergency basis, the government wisely authorized the same payment as in-person visits, which enabled the rapid shift to telehealth needed during the pandemic. Telehealth can be provided more affordably than traditional medicine and it could be compensated in the long-run at a lower cost than face-to-face care. But the government, providers, and payers need to change their incentive models to benefit consumers’ health and pocketbooks.
It’s absolutely clear that we don’t want to create a fee-for-service telehealth “goldrush” with any changes. So, innovative alternatives to the fee-for-service model should be fully considered, with telehealth serving as a component of value-based care. With such care, hospitals and other care providers are paid based on the health outcomes of their patients, not on the amount of care provided, thereby emphasizing preventive care and reducing unsustainable healthcare costs. In the end, the payment level should incentivize telehealth’s use to keep people healthy for less.
Second, coordinated care should be prioritized. Telehealth’s greatest potential lies not in replacing in-person care, but in enhancing that care.
Rural hospitals, again, are a great example. Patients and caregivers benefit through rapid consultations on diagnoses, second opinions on treatments, and expert guidance with specialized procedures. And it improves care. In a study of seven of its community hospitals, Intermountain Healthcare’s tele-critical care program documented a 36.5 percent decrease in observed to expected mortality.
Third, telehealth should be authorized to enhance the services of a broader array of caregivers, including pharmacists, social workers, and others crucial to improving population health. Telehealth enhances care for widespread chronic conditions such as diabetes and hypertension, enabling a broad range of remote monitoring as well as “nudging” to increase treatment compliance. It should be fully engaged in combating the epidemics of chronic disease and helping control the spiraling costs of those conditions.
The pandemic has accelerated the telehealth revolution. We must seize the momentum and support policies that improve the health of people and our communities.
