Bricks and Clicks: Telehealth and Hybrid Models of Care

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The COVID-19 pandemic has catalyzed the growth of hybrid care delivery models, highlighting the need for clinical guidance and stakeholder agility.

This is the second installment in a series on changes in telemedicine, following Avalere’s initial exploration of telehealth policies during the COVID-19 Public Health Emergency (PHE). A future Insight will focus on the evidence to date—and the evidence still needed—for quality and clinical outcomes in telehealth. 

The COVID-19 pandemic necessitated rapidly enhanced access to telehealth services and has changed how stakeholders such as patients, providers, healthcare systems, and manufacturers think about innovative ways to furnish healthcare services and coordinate care. For certain patient populations, the rapid increase in telehealth availability addressed a need that predated the pandemic. For those living in rural areas, those with transportation challenges, or those with other barriers to receiving in-person care, telehealth provides access that would not otherwise be available to them or would require significant effort and hardship. This is particularly true for care from specialty care providers. For example, only 3% of oncologists practice in rural areas.

In the first year of the COVID-19 pandemic, over 45 million Medicare Fee-for-Service visits were conducted via telehealth, representing over 44% of Medicare beneficiaries. Between March and August 2020, 13% of outpatient visits were conducted via telehealth. But in 2021, this number dropped to only 5%. Additionally, a Zoom survey found that nearly two-thirds of patients who used virtual care during COVID-19 would prefer being given both in-person and virtual care options going forward.

As the healthcare system adjusts to an endemic COVID-19 landscape, it is critical to consider how stakeholders can remain agile in adapting to these patient preferences through hybrid in-person/virtual models of care. The swift rise in telehealth utilization was reflected in growing significant private equity investment in telehealth and the rise of third-party organizations that furnished telehealth services for specific therapeutic areas, such as mental health or primary care. Now some organizations that were originally telehealth only have begun opening brick-and-mortar clinics, while other traditional health systems and private organizations that provide in-person care have begun contracting with third-party telehealth providers.

Optimizing Telehealth Utilization

This bricks-and-clicks model provides both in-person and remote care to patients. Clinicians typically make care decisions based on the clinical situation, quality outcomes, value, and patient preference, though in the case of selecting in-person vs. remote care, it is currently more of an art than a science. As providers and payers adjust to this hybrid delivery model, the selection of telehealth vs. in-person care is often driven by the organization’s capabilities and provider preferences.

Professional societies have recognized the need for guidance among their constituents. In July 2021, the American Society of Clinical Oncology published six standards and practice recommendations for telehealth in oncology, which range from patient selection to virtual participation in oncology clinical trials. The American Telehealth Association has also released statements and materials, noting its support for legislation that improves telehealth services across the healthcare ecosystem. Still, a significant need remains for additional research and studies on optimal care pathways—including quality outcomes, safety, and comparative effectiveness—across all therapeutic areas and conditions. Other specialty societies and professional associations have an opportunity to conduct research and develop guidelines on integrating telehealth into practice for their respective specialties.

Physicians cited clarity on reimbursement and integration into electronic health records as some remaining barriers for seamless telehealth adoption. Further, the end of the PHE could roll back many flexible telehealth policies that allowed expanded provider eligibility and audio-only services, and lifted geographic and site restrictions, among others. Organizations developing telehealth guidelines will have to account for the ways that additional regulations to make telehealth accessible and feasible may impact their recommendations.

Future Opportunities in Telehealth

While challenges to optimal adoption remain, determining the appropriate utilization of telehealth for the right patients at the right points in the care journey could reduce total cost of care—providing a major opportunity for organizations engaged in value-based payment models. This could be from lower costs of delivering services via telehealth that would have previously been in person, from diverting patients from more costly care settings, or from prevention of downstream complications by increasing patient/provider touchpoints earlier in their care journeys. This is particularly true for older populations, who adopted telehealth much more than was originally expected. Utilization trends among older populations observed before and after 2020 support continued usage of telehealth. Before COVID-19, fewer than 1% of Medicare beneficiaries utilized telehealth; during the first year of the pandemic, however, usage rates rocketed to nearly 40%. This is encouraging for hybrid delivery models that aim to keep older populations out of high-cost care settings.

Many health systems have piloted or are considering hybrid models of care that allow patients to receive both in-person and remote care. One of Mayo Clinic’s Hybrid Care Hotel goals was to efficiently deliver care while reducing costs, travel time, and hospital bed usage; evaluations found that the model produced positive experiences and encouraged strong recoveries for patients. Other studies have found increasing proliferation of hybrid models across both primary and specialty care settings and for the need to incorporate other digital health therapeutics into these encounters to improve patient outcomes and performance.

Implementation of an optimal hybrid model may look different across health systems and presents significant opportunity for innovative collaborations. As these models are implemented, it will be critical to consistently evaluate their impact on access, cost, and quality of care. Organizations can leverage Avalere’s industry-leading expertise in US healthcare policy, regulatory and reimbursement pathways, and market dynamics to develop strategies for navigating the telehealth landscape. Connect with us to learn more.

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