February 17, 2021
At AcademyHealth’s National Health Policy Conference, experts from three nonprofit health organizations came together to share their telehealth experience and discuss opportunities to advance virtual care well into the future.
A year into the COVID-19 pandemic and despite peaks and valleys, record-high usage of virtual care services remains. We know that telehealth will now be a permanent fixture in health care delivery.
At AcademyHealth’s National Health Policy Conference this week, experts from three nonprofit health organizations came together to share their telehealth experience and discuss opportunities to advance virtual care well into the future. Speakers included Dr. Richard Isaacs, CEO and Executive Director of the Permanente Federation; Dr. Namita Ahuja, AVP of Medicare, Medical and Post-Acute Services at UPMC; and Dr. Lee Mills, Senior Vice President and Chief Medical Officer of CommunityCare.
As demand for telehealth exploded in 2020, community-based, nonprofit health organizations found themselves in a unique position to shape the evolution of virtual care. Quick to adapt to the public health crisis and change in use of health care services, Kaiser Permanente, UPMC and CommunityCare collaborated with their local provider partners and health systems to enhance telehealth networks and access while also expand virtual care options — and, in CommunityCare’s case, build an entire telehealth program from scratch.
The speakers explained how telehealth has greatly expanded services and fostered better care coordination, particularly between primary care and specialists, while acknowledging the dangers of exacerbating existing inequalities and potential for overuse.
They also laid out how policymakers can foster continued growth in a highly successful form of virtual care delivery.
Behavioral Health, Care Coordination are Telehealth Bright Spots
Telehealth usage has surged, and more consumers than ever are open to receiving care virtually; in fact, polling shows nearly half of all Americans are interested in virtual care options. Utilization over the last year has shown that telehealth is particularly effective for certain specialties and uses.
All three speakers found consumers are enthusiastically seeking and embracing behavioral health resources via telehealth. At CommunityCare, Dr. Mills noted that nearly half of all telehealth usage has been tied to behavioral health treatment. And Dr. Ahuja says UPMC members who seek behavioral health services have been more likely than those seeking physical care to continue using telehealth and less likely to return to in-person visits, due to receiving care in the privacy and comfort of their own homes. In fact, at UPMC, the drop-off rate for telehealth usage is almost 30% lower drop-off rate than telehealth usage for physical health.
The organizations also believe that telehealth has helped foster more effective care coordination. Dr. Isaacs explained that Kaiser Permanente has taken advantage of e-consults between primary care physicians (PCPs) and specialists, invested in remote monitoring and encourage more frequent communication between patients and PCPs — leading to more effective care management. Dr. Ahuja illustrated how UPMC has used remote care to help manage cases, especially inside their palliative care program.
The Dangers of the Digital Divide and Ensuring Appropriate Use
While telehealth has made it easier to deliver care, health plans acknowledge that there may be potential pitfalls as virtual care continues to grow. The speakers were quick to point out concerns that improper usage of telehealth could exacerbate existing health inequities.
Dr. Ahuja and Dr. Mills both discussed how access to reliable internet and electricity have undermined the effectiveness of telehealth in some cases. They cautioned that providers need to make sure that telehealth is a viable option for consumers before recommending it.
But both doctors also noted that, in many cases, telehealth has helped address inequities for some populations; for example, many consumers who live in rural areas have been able to access routine medical check-ups more often, thanks to the elimination of travel time.
Speakers also addressed mounting concerns about fraud or waste in telehealth services. All three plans have noted that a more global payment model helps mitigate potential overuse in their networks, explaining that value-based models reduce incentives for low-value services.. And none of the plans have found significant evidence of widespread overuse of telehealth services.
The Future of Telehealth
While the presenters were optimistic about the future of telehealth, they made one thing clear: recent gains in telehealth are fragile and could backslide if policymakers don’t take the proper steps to encourage continued growth.
They emphasized that recent flexibilities granted by the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) in light of the COVID-19 pandemic were essential to expanding virtual care options. These include waiving site of service requirements and allowing physicians to provide virtual care across state lines.
Dr. Mills explained that HHS’s decision to allow easy-to-use, everyday online tools and platforms (including Facebook and Google Meet) was essential to their ability to stand up a new telehealth program so quickly.
And Dr. Isaacs and Dr. Ahuja both noted changes that allowed Medicare patients to access care at home via telehealth allowed them to roll out virtual care tools to the most COVID at-risk populations and — more importantly — will encourage telehealth growth in other sectors.
All three indicated that, for telehealth to succeed, policymakers need to make those recent changes and flexibilities permanent — cementing current progress and ensuring continued telehealth momentum beyond the current pandemic.