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Telehealth’s Missing Link: In the Rush to Implement Virtual Care, What Did CMS Leave Out?

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By RAY COSTANTINI, MD

Imagine three months from now when the predicted ‘second wave’ of COVID-19 is expected to resurge and we’re still without a vaccine. Telehealth has become the entry-point to care, widely adopted by patients both young and old. Now, when an elderly diabetic patient wakes up in the middle of the night with a dull ache on her left side and back, she doesn’t ignore the symptom, like she may have during the first COVID outbreak. Instead, she logs online to her local hospital’s website from a cell phone and accesses a simple questionnaire to report her health history and presenting symptoms. The whole process takes just a couple of minutes and she immediately hears back from her health provider with the suggestion to schedule an in-person appointment for further testing to rule out any kidney issues. 

This patient doesn’t become one of the nearly 50% of Americans who delayed care during the initial COVID pandemic. She was able to access care without having to download an application or wait to schedule a virtual appointment during normal business hours. She receives virtual asynchronous care on-demand, coordinated to sync with her electronic health record. The next day, she receives a follow-up call from her primary care doctor to ensure her symptoms were alleviated with the over-the-counter pain medication she was prescribed. 

I applaud the article written by Paul Grundy, MD, and Ken Terry, “Primary Care Practices Need Help to Survive the COVID-19 Pandemic,” in which they called on Congress to make health policy decisions that will provide immediate financial relief for primary care practices. We must mitigate the real risk we face: the highly possible shutdown of our healthcare system. Amid the coronavirus pandemic, the U.S. healthcare system has taken an enormous financial hit and primary care practices have been especially affected and are struggling to survive. As the authors point out, telehealth has taken the spotlight to fill the acute need for an influx of patients needing to access care under social distancing practices. Telehealth can increase access to care, relieve provider burden, reduce costs to systems, and improve patient outcomes. However, this is only possible with on-demand telehealth, or asynchronous care. 

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Will the Public Health Emergency Policy Changes for Telehealth & Remote Monitoring Stick?

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By JESSICA DaMASSA, WTF HEALTH

With about one month left on the existing 90-day Public Health Emergency that’s eased regulations and improved reimbursement to help make telehealth, remote monitoring, and other virtual care services easier for providers to implement and patients to use, health tech companies across the US are wondering what it will take to make these changes permanent. One of digital health’s few ‘DC Insiders,’ Livongo Health’s VP of Government Affairs, Leslie Krigstein, gets us up-to-speed on what’s happening on Capitol Hill and what we can expect moving forward. What changes will (literally) require an Act of Congress? And what can be handled by HHS and CMS? From codes and co-pays to e-visits and licensing, Leslie breaks it down and tells us whether or not we can continue to expect a ‘health tech-friendly’ agenda in Washington DC.

Long-Term Telehealth Expansion Should Be Planned Intelligently

By KEN TERRY

Telehealth has been a lifeline for many doctors and patients during the pandemic, and the decisions of CMS and many private payers to cover telehealth visits—in some cases, at full parity with in-person visits–has helped physician practices stave off bankruptcy. Assuming that these policies remain in effect after the pandemic, I agree with the commentators who assert that telemedicine will become a much larger part of healthcare.

Nevertheless, what that means is still far from clear. To begin with, telehealth visits may be adequate for some purposes but not for others. Historically, the technology has been used mostly for diagnosing and treating minor acute problems. Physicians were generally reluctant to take on more complex cases or treat chronic conditions without seeing patients in person.

Pre-pandemic, most telehealth encounters took place between patients and doctors who had never treated them before, using services such as Teladoc, American Well and Doctor on Demand that usually didn’t communicate with the patients’ personal doctors. Some larger physician groups had begun to use the technology with their own patients; but even in those groups, certain doctors were often assigned to conduct virtual visits with patients who were not necessarily their own.

Clearly, the latter barrier has been broken down, with nearly half of U.S. physicians in an April survey saying they were using telemedicine in patient care. While it’s unclear what kinds of cases these doctors are diagnosing and treating, it’s likely that the scope of practice for telehealth has been expanded to include some chronic disease care.

The main barrier to this expansion is that, in telehealth encounters, physicians don’t necessarily have the data they need to make sound medical decisions. To manage hypertension, for instance, the physician needs to be able to measure a patient’s blood pressure. If the patient has a digital blood pressure cuff at home, that data can be transmitted to a physician’s office; in fact, a smartphone app could show the trend of the patient’s hypertension over time. Right now, however, only a small fraction of patients have this kind of remote monitoring equipment.

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Omada Health’s Acquisition of Physera: Sean Duffy & Dan Rubinstein on ‘The Deal’ & What’s Next

By JESSICA DaMASSA, WTF HEALTH

Omada Health put to use part of their recent $57M funding round to acquire Physera, a musculoskeletal care company that uses telehealth and digital interventions to deliver ‘virtual physical therapy’ to those suffering from back, knee, and neck pain. How does the acquisition fit into Omada’s growth strategy? WTF Health’s Jessica DaMassa chats with both Omada Health’s CEO, Sean Duffy, and Dan Rubinstein, CEO of Physera, about the acquisition, the IPO buzz that continues to swirl around Omada, and whether or not the opportunity that COVID-19 has created for digital care will be lasting as we move forward.

Healthcare Starts to Zoom Along

By KIM BELLARD

A year ago, if you’d used or even heard about Zoom, you were probably in the tech industry.  Today, if you haven’t used Zoom, your friends or colleagues must not like you very much.  COVID-19 has made most of us homebound most of the time, and video services like Zoom are helping make that more bearable.

And, thankfully, healthcare is finally paying attention.

Zoom was founded in 2011, poking along under the radar for several years, overshadowed by competitors like Skype or WebEx.  For the entire month of May 2013 it only had a million meeting participants.  Even by December 2019 it could boast “only” 10 million daily users.

Then — boom — COVID-19 hits and people start staying at home.  Daily users skyrocketed to 200 million in March and as many as 300 million in April (well, not quite).  Daily downloads went from 56,000 in January 2020 to over 2 million in April.  Zoom is now used by businesses and families alike, drawn by its simplicity and ease of use.  

By all rights, we should be using WebEx for business video calls and Skype for personal ones.  Both had been around longer, offered credible services, and still exist.  But both were acquired along the way, WebEx by Cisco, and Skype ultimately by Microsoft.  As with its acquisition of Nokia, once acquired Microsoft didn’t quite seem to know what to do with it.  Each left openings that Zoom plunged through when the pandemic hit.

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Pandemic State of Mind: Data from Behavioral Telehealth Startup Reveals How We’re Feeling

By JESSICA DaMASSA, WTF HEALTH

“The mental health system was completely broken before COVID. The supply-demand imbalance was wildly upside down. Now, that’s just all exacerbated.”

On-demand mental health startup Ginger has watched usage of their app climb 130% over the last 4-week period. The conversations people are having with clinicians are growing more intense (there’s an internal metric for that) and amid all of this the late-stage startup has re-run its ‘Workforce Attitudes’ survey to find out what’s really going on with the mental health of the employee populations it serves.

CEO Russell Glass dives into some of the findings of that report, which are pretty revealing in terms of understanding how we as a population are dealing with our stress around COVID-19 when we’re seeking professional help with it. Nearly 70% of respondents confessed this was the most stressful period of their career — five times more stressful than the financial crash of 2008 — and there are some surprising differences with how this is all unfolding across gender lines, especially with working from home.

With inbound interest from employers up 4X over the past month, we get Russ’s input on whether or not the demand for telehealth will sustain once the crisis is over and if the temporary regulatory and reimbursement changes will become permanent. Says Russ: “This is like a great experiment of the efficacy of telehealth versus non-telehealth.”

Australia Healthcare Market: Telehealth, Digital Health Expected to Boom Post-Covid19 | WTF Health

By JESSICA DaMASSA, WTF HEALTH

As healthcare systems around the world grapple with the coronavirus, ‘virtual-first healthcare’ is fast becoming the global response of private and public healthcare systems alike. In Australia, the federal government recently committed to investing $500M to built out its country’s ‘virtual-first’ healthcare infrastructure, so we caught up with Louise Schaper, CEO of the Australasian Institute of Digital Health (AIDH), to find out what that means for telehealth, remote monitoring, and digital health companies looking to capitalize on the market opportunity in Australia.

With a population of 25 million people (roughly the number of people in Florida) and a set of newly-minted reimbursement codes that makes telehealth available to all of them via the government-funded public healthcare system, the appetite for investing in new health tech solutions has grown ravenous.

Says Louise, “Anyone who has solutions that are already market-tested and approved, I’d actually expand your networks globally now. There’s not a section of the globe that hasn’t been impacted by [covid19] and we’re all needing to work out how to deliver healthcare differently.”

As in other parts of the world, the government codes reimbursing telehealth and other virtual-first services are temporary (Australia’s are set to expire September 30, 2020), but organizations like the AIDH, the Australian Medical Association, and others are advocating for their permanence and are optimistic.

The prevailing sentiment is that, like in the US, the benefits of virtual care to healthcare consumers and clinicians are going to be difficult for the government to ignore. Add to that the potential of linking virtual care to the Aussie government’s AUD$2 billion dollar build of its MyHealthRecord system — a centralized, cloud-based EMR that holds the healthcare data of 90% of all Australians — and the prospect grows even more appealing.

Join us as we talk through the basics of the Australian healthcare system and get an insider’s look at the demand for digital health, remote monitoring, and telehealth Down Under.

Will the Covid-Induced Telemedicine Scramble Change Primary Care Forever?

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By HANS DUVEFELT, MD

After my posts on telemedicine were published recently, (this one on Manly Wellness before the pandemic and this one after it erupted, on A Country Doctor Writes, then reblogged on The Health Care Blog, KevinMD and many others), I have been asked about my views on telemedicine’s role in the future of primary care.

Things have changed quickly, and a bit chaotically, and there is a lot of experimentation happening right now in practices I work or speak with.

Before thinking about telemedicine in Primary Care, we need to agree on some sort of definition of primary care, because there are so many functions and services we lump together under that term.

Minor Illnesses

Many people think of primary care mostly as treating minor, episodic illnesses like colds, rashes, minor sprains and the like. This is an area that has attracted a lot of interest because it is easy money for the providers, since the visits tend to be quick and straightforward and such televisits are also attractive for the insurance companies if they can keep insured patients out of the emergency room. With the technical limitations of video quality and objective data such as heart rate and rhythm, I think this is an absolute growth area for telemedicine. However, with all the other forms but mostly here, fragmentation of care could become a complicated problem. To put it bluntly, if we still expect a medical professional or a health care organization to keep an eye on reports from various sources, such as hospital specialists, walk-in clinics or independent telemedicine providers, they are going to want to get paid for it.

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InTouch Health’s CEO on B2B Telehealth Demand & Post-Covid Virtual Care Market | WTF Health

By JESSICA DaMASSA, WTF HEALTH

“I never anticipated — and no one did — the level of uptake and the level of scale.”

It says a lot that Joe DeVivo, CEO of Intouch Health, who’s worked with hospitals and health systems on standing up B2B-focused telehealth programs for years (and whose company was acquired by Teladoc Health for $600-million dollars in January) is surprised about the uptake of virtual care during the COVID-19 pandemic.

“Historically, I look at virtual care as a bell curve,” says Joe. “On one side of that small tail of the bell curve are the virtual care companies. Teladoc dominates that space for D2C. There’s millions of consultations a year, and we’re seeing a subset of that. On the opposite side of the bell curve is high-acuity, and what InTouch has been doing for critical care.”

“This crisis, and the changes in reimbursement, have opened up the middle of that bell curve. The core, everyday transaction of healthcare is now being impacted by virtual care. And the big question that everyone has is, “is this going to stick? Is this a crisis management tool and we’re going to go back to the ways of the past, or is that genie out of the bottle?”

We put Joe on-the-spot with his own question, find out what he thinks it will take to enable the permanent shift to virtual care at-scale, and dig in on how demand for telehealth within hospitals has changed as a result of the pandemic, where its not only being used to expand access to specialists, but has also been adapted into a PPE-hack to help frontline hospital workers distance themselves from infected patients.

And what of working with Teladoc? While waiting for the paperwork to finalize (all on-schedule for the end of Q2 as originally announced), the two have organized a co-selling agreement to be able to “hit the market fast” and bring their “hospital-to-home” end-to-end virtual care offering to those who need it now.

Health in 2 Point 00, Episode 116 | Telehealth $$, Layoffs and Rock Health’s Q1 fundraising report

Today on Health in 2 Point 00, Jess and I run through a lot of telehealth investments including Doctor Anywhere raising $27 million, 98point6 raising $43 million, Tyto Care raising $50 million, SilverCloud Health raising $16 million, SteadyMD raising $6 million, and Aktiia raising $6 million. In addition, there’s a company called Air Doctor which matches people when they’re traveling to doctors on the ground which raised $7.8 million despite the inauspicious timing. On the flip side, there have been a slew of layoffs in the space, and Jess and I give our $.02 on Rock Health’s Q1 fundraising report which was just released. Don’t miss our tag-team interview of Livongo’s Glen Tullman, and check out these episodes in podcast form on Spotify and iTunes. —Matthew Holt

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