What’s in Store for Telehealth?

One of the more pleasant surprises in the health care industry’s response to the COVID-19 crisis — if there are such things as pleasant surprises — has been the near-universal embrace of telehealth services by all stakeholders. Insurers have waived copays for many types of virtual visits. Providers have dramatically expanded virtual care options. State governments have lifted restrictions on who can practice as well as how much they can bill for. Vendors have vastly expanded services to meet demand. Vendors, providers, and insurers have all rolled out logic-based symptom-checker apps.

For a market segment that has all too often been defined by starts and starts, recent weeks have offered validation of telehealth’s value proposition. Telehealth has helped to keep low-acuity patients away from brick-and-mortar health care facilities, thereby reserving bed spaces for patients with COVID-19 (and others with high-risk conditions). Within the hospital, telehealth has also allowed health care professionals to reduce their physical touchpoints with patients with COVID-19, thereby reducing their own risk of contacting the virus.

If telehealth can prove its worth in a crisis, it stands to reason, then why not once the crisis subsides? As I heard from one executive in a conversation related to my last role, his health systems’s 5-year trajectory for encouraging digital health engagement was truncated to 3 weeks because of COVID-19 — and, he added, “the pendulum will not swing back.”

Many have expressed optimism that these circumstances will, once and for all, encourage the industry to adopt telehealth as a viable alternative to in-person care (in the right scenarios) and to dismantle the various technology, reimbursement, and regulatory barriers that have hindered adoption (and, some would further argue, have defied common sense). The so-called “digital front door to care,” it seems, is now open for business.

This may be the case, and I am optimistic that telehealth can address some of health care’s challenges. Few would disagree that the industry desperately needs more options for readily accessible low-acuity care that diverts patients from the ER. Urgent care is one option, sure, but if patients can receive care without leaving home or the office at all, then their lives (and their care journey) face even less disruption. What’s not to like?

However, health care’s recent history of rapid technology adoption suggests that immediately embracing telehealth could end up doing more harm than good. Meaningful use was unnecessarily painful for many health systems, as they simply layered electronic health records on top of analog workflows for gathering information and delivering care. More than a decade later, health systems are still struggling to optimize workflows, and most would admit that they feel like they’re stuck with EHR software that hasn’t done what they hoped it would do.

Telehealth presents the same danger. Yes, telehealth adoption in response to COVID-19 has been organic, whereas EHR adoption was mandated — but the same impact of rapidly scaling telehealth is nonetheless possible. If health systems simply bolt virtual visits onto existing clinical workflows that emphasize in-person care delivery, diagnosis, and treatment, the end result won’t be pretty. It doesn’t take much imagination to see a patient dialing into a virtual visit, only to be told that the best option for care is to come to the office. That’s costly, inconvenient, inefficient, and frustrating for the patient and the health system.

On top of the concern that telehealth could be meaningful use all over again, I see two additional and related challenges.

1. Many hospitals and health systems, hit hard by the financial double whammy of costly COVID-19 treatments and cancelled high-revenue elective procedures, will be a fraction of what they once were, if they remain open at all. Getting people in the door will be mission-critical for survival. Offering virtual visits at a fraction of the (reimbursable) cost, especially if it requires additional investment in technology infrastructure, will not be — even though it presents the opportunity for downstream patient retention for future services.
2. Patients have a lot of options for telehealth. There are “traditional” health care providers but also health plans, employers, retail clinics, direct-to-consumer apps, third-party conveners, and various combinations thereof. If any of those offerings are better, stronger, or faster than what a health system can do, then that system is going to lose its low-acuity patients. If that happens, then the post-COVID hospital could then look a lot like the mid-COVID hospital. It will be filled solely with very sick patients and very overburdened staff, it will further exacerbate the gap between those who are ill and those who are well, and it will leave hospitals with far fewer opportunities to attract new patients and capture downstream revenue.

Telehealth in the United States clearly has momentum right now. It’s bringing value to patients, providers, and payers in ways that had been imagined but not realized until the COVID-19 crisis hit. But building on that momentum will require very careful thought. History tells us that implementing technology for the sake of implementing technology does not serve health care well. The industry would be wise to remember this lesson.