By JULIA HU
Though it will be impossible to overstate the devastation that the COVID-19 pandemic is leaving in its wake, we can also acknowledge that it has pushed humanity to creatively adapt to our new, socially-distanced reality—necessity is the mother of invention, as they say. Telehealth is not a new invention, but the necessity of keeping people physically apart, especially those particularly vulnerable to COVID, has suddenly put virtual health care at the center of our delivery system.
Patients and providers quickly pivoted to at-home care as in-person visits were limited for safety, and use of telehealth spiked early in the outbreak. One survey of over 500,000 clinicians showed that by April—only about two weeks after the first stay-at-home orders were issued in the U.S.—14 percent of their usual number of pre-pandemic visits were being conducted via telemedicine. For many, that involved using unfamiliar technology and a big shift in procedures for providers. Congress recognized the need to support providers through this transition and allocated $500 million for waiving restrictions on Medicare telehealth coverage as part of the emergency funding bill that passed in March.
But, as restrictions have begun to lift and hospitals and medical offices are beginning to reopen for non-emergent care, we have seen the use of telemedicine start to taper off. The same 500,000 clinicians were surveyed in June, revealing that telemedicine was used for only 8 percent of the usual pre-pandemic number of visits. Providing quality, virtual health care won’t be as easy as flipping a switch, but we currently have an unprecedented opportunity to carry forward the best version of virtual care and create a more holistic health care system. As we work toward that goal, there are three components our virtual care system needs in order to be sustainable, feasible, and manageable for both patients and providers.
Patients and providers need a range of services to be available virtually.
When people talk about virtual care and COVID-19, they are most often referring to a telemedicine experience where a patient interacts with a provider through some type of video conferencing. Those visits are extremely useful for conducting certain types of appointments, including dermatological exams, triaging symptoms to determine best next care steps, and counseling or therapy appointments.
But, not every virtual care interaction needs to include a video visit with a provider. Asking physicians to keep up a full schedule of virtual visits as they simultaneously work to safely reopen their in-person practices is unreasonable. Physicians are already experiencing some of the highest rates of burnout of any profession, and COVID-19 has only exacerbated that trend.
Some virtual care, including certain check-up visits or assessments, can be conducted telephonically, giving more flexibility to both patients and providers when video conferencing is not needed. Digital health coaching tools offer another type of virtual care that can help relieve providers from some of that burden by managing patients’ routine care needs in-between either telemedicine or in-person appointments.
This is especially true for chronic condition prevention and management, which requires 24/7 support. Digital coaching can be available at any hour, outside of a physician’s normal 9-5 schedule. It also can help manage symptoms for certain behavioral health issues related to stress or anxiety.
We need to carry forward the full suite of services that virtual care can provide. This will help physicians better manage their caseloads, give patients access to a variety of services right from their homes, and build more flexibility into our entire delivery system.
Our virtual care system should embrace Remote Patient Monitoring Tools with connected devices.
Remote Patient Monitoring (RPM) allows both patients and providers to access real-time monitoring of key biometrics, such as blood glucose for a patient with diabetes, blood pressure for someone with hypertension, or weight for someone with heart failure. RPM typically uses a connected device, such as a glucose monitor or a blood pressure cuff, that records and sends data.
RPM benefits physicians by providing them with up-to-the minute information about their patients, alerting them when biomarkers indicate potentially serious issues, and helping them manage their patient population without having to conduct telemedicine or in-person visits. Because RPM is reimbursable through Medicare, it can also help drive revenue for practices, an especially important component for those struggling financially because of reduced patient volumes due to COVID-19.
RPM also benefits patients. It helps ensure that their care is being personalized to their unique health situation, and allows for quick identification and intervention of possible acute or emergent issues. By accessing RPM data, patients can also better understand how their behaviors impact their health.
Incentive structures, including reimbursement policies, need to be aligned to support these virtual care models.
To sustain quality, virtual care beyond the pandemic, we need to align incentive structures to support its continued adoption. There is much agreement, including among Members of Congress and CMS leadership, that some of the Medicare restrictions on telehealth that were loosened to address the COVID-19 crisis should be permanently extended. Key among them are: allowing providers to provide virtual care across state lines, expanding Medicare and Medicaid reimbursement for a wider breadth of virtual services, and allowing doctors to conduct virtual visits using familiar technology, like FaceTime or over the phone.
Without the certainty that virtual care services will be adequately reimbursed, there is a risk that many physicians will abandon investment in the technology needed to provide those services. We need to act now to make sure that doesn’t happen, and that virtual care becomes an integral part of our larger delivery system moving forward.
We also have a unique opportunity in this moment to shape our future virtual care system with value-based principles in mind. Aligning incentives between quality and cost can help ensure that virtual services meet the needs of patients, while helping reduce the overall cost of care.
Virtual care will remain especially important as our country continues to face rising COVID-19 cases, giving us the window of opportunity to cement quality, virtual care as a permanent piece of the delivery system. The benefits of building a more holistic system that weaves together virtual and in-person care will extend far beyond the current pandemic. From increasing access for patients, to filling critical gaps in care, to helping providers prioritize their caseloads—virtual services can help shape a better system. But we must act now to bring that vision to life.
Julia Hu is the Founder and CEO of Lark Health.