COVID-19 pushed telehealth to see numbers in a matter of weeks that it would have otherwise taken years to achieve. Before the pandemic struck, the number of customers for telemedicine grew 52% annually from 2005-17. As local governments responded to COVID-19 and shelter-in-place orders swept the U.S., Teledoc, the leading telemedicine company, grew its visits by 92% in under two months. According to a Fair Health analysis, May 2020 experienced a 5,600% increase in telehealth volumes compared to May 2019.
At Ancore Health, we’ve been discussing the changing healthcare landscape with our medical group, health system, and health plan clients and have heard mixed predictions about the future of telehealth. Even since March, groups we have talked to have had a wide variation in “stickiness” of telemedicine based on payer mix and physician culture. Some anticipate telehealth to replace a significant number of traditional visits, while others believe that a post-COVID environment will result in a return to limited pre-COVID telemedicine figures.
To discern whether telehealth will continue to grow or will plateau, we are closely monitoring a few key factors, including platform and diagnostic technology, provider training and incentives, and reimbursement.
Will diagnostic technology be able to serve the patients who need it?
The jury is still out on who can solve key issues like supporting patients who need assistance engaging a virtual platform and performing simple medical diagnostic tests. Can patients be provided with tools to accurately assess blood pressure, collect basic samples for lab work as well as transfer data securely to the EMR for a provider to interpret?
These must be addressed in a scalable and cost-effective way virtually if telehealth is going to continue on its growth path. Teladoc’s $18.5M acquisition of Livongo highlights not only how some companies are attempting to overcoming this hurdle but how far they’re willing to go (by how much they’re willing to pay) to overcome it.
Will providers’ behaviors change to support telehealth?
A second key factor is enhanced provider training and evaluation of incentives.
Providers have had years of face-to-face interaction, and most historical training has been for in-person visits. Many of us who’ve transitioned to Zoom or another video conferencing system can attest to the awkwardness of navigating technological hiccups and performing our regular duties via screen. Medical groups will need to quickly train their providers to deliver virtual care and a positive patient experience.
Large telemedicine companies will certainly have a leg up on provider training compared to a regional medical group.
Beyond training, many medical groups have their providers on wRVU compensation plans. For telehealth to stay on the growth course, similar credit will need to be given for both in-person and virtual care. If providers don’t receive equal incentives, they will most assuredly drive their patients to the physical clinic.
Is equal telehealth reimbursement here to stay?
Lastly, and perhaps most importantly, what will the future of reimbursement look like for telemedicine?
For telehealth to become a significant format for care, providers will have to be reimbursed similarly for virtual care and in-person visits. The recent executive order indicates Medicare’s reimbursement commitment to telehealth, but whether or not commercial health plans will follow suit remains unclear. We do know some commercial health plans (mine included) are incentivizing patients toward virtual care with lower co-pays for those visits.
In considering how reimbursement will ultimately play out, commercial health plans are certainly analyzing several metrics, and providers need to be considering these questions as well:
- Assuming a continued adoption of telehealth, what does the workforce of the future look like?
- If 30-40% of office visits go virtual, do providers need smaller staff to check-in and room patients?
- Will schedulers need to be retrained to screen patients for appropriateness of virtual vs. in-person care?
- If fewer patients are physically in a provider’s office, can office space and subsequently lease expenses be reduced?
Telemedicine’s function has provided an invaluable service during the COVID-19 pandemic, alleviating many of the stressors that accompany traveling to a provider’s office. We are hopeful and confident the industry can take steps forward in this direction, and many companies are placing their bets on a future with more virtual care.