Quality and Value in Telehealth: Progress and Potential

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Summary

Telehealth solutions aimed at enhancing quality, cost, and equity require greater investment in evidence generation and clinical practice guideline development.

Overview

Utilization of telehealth grew exponentially during the COVID-19 Public Health Emergency, pushing healthcare organizations to think differently about the mechanisms of delivering care. This also led to an influx of telehealth data that allowed researchers to generate evidence around telehealth’s impact on quality and value. While the evidence suggests that targeted and effective use of telehealth can reduce unnecessary and costly downstream services, improve care quality for individuals living with chronic conditions, and lower barriers to access care, the results have not been as compelling in some scenarios.

Promising Results in Patient Satisfaction and Chronic Condition Management

Several studies demonstrated that telehealth provides a quality of care that is comparable to and, in some cases, better than in-person care. A study of cancer patients receiving radiation oncology treatment observed no significant differences in patient satisfaction between patients who underwent a telemedicine consultation and those who attended an in-person office visit. Additionally, most survey respondents using telehealth said their confidence in their physician (90%) was the same or better via telehealth compared to an in-person visit. For patients with chronic diseases that require consistent treatment, telehealth can improve the quality of care by streamlining disease management. A study of individuals with type II diabetes found that remote patient monitoring combined with medication management resulted in significant improvements in glycemic control.

Bridging Geographic and Socio-economic Barriers to Equitable Care Access

Telehealth can serve as a powerful tool to advance equity by removing logistical and geographic barriers to care. For example, the travel time to see a specialist in certain geographic areas can contribute to differential health outcomes observed in rural and under-resourced communities. However, the nuances of how telehealth is delivered can have a major impact on whether those populations realize the possible gains. A study at the University of Rochester Medical Center demonstrated that vulnerable patients had the highest uptake of telehealth services and low rates of no-shows and cancellations. Conversely, a study in ophthalmic care found lower utilization of telehealth by these patients, particularly when it came to use of video visits vs. telephonic. These mixed results suggest that telehealth alone does not overcome other major systemic causes of healthcare disparities such as structural racism, cultural and linguistic non-inclusiveness, and lack of patient-centric care design.

Appropriate Telehealth Usage Promotes Healthcare Cost Reduction

Telehealth can serve as a vehicle to lower healthcare costs by reducing the need for downstream care in expensive hospital settings such as the emergency department. For example, a study investigating the City of Houston’s Emergency Medical Services telehealth initiative found that a physician videoconference consultation prior to transport reduced emergency department visits 7% over a one-year period. The reduction of unneeded healthcare utilization not only reduces patient and system costs but also improves efficiency and maximizes the number of patients caregivers can manage. Using remote consultations, specialized knowledge can be shared with locations that otherwise lack access to in-person experts, resulting in more appropriate utilization of healthcare services and higher quality comprehensive care delivery. Remote patient monitoring has also reduced costs in some cases, as in a study of patients with congestive heart failure using an implanted device that was shown to be highly cost effective.

The results of these studies indicate that telehealth could contribute to advancing equity and value. But given the variation in study results to date, more evidence is needed to determine how to optimize quality, patient-centric value, and overall cost-effectiveness, specifically to understand which clinical scenarios and populations are best suited to telehealth and to which telehealth modalities. Professional societies such as the American Society of Clinical Oncology, the American Academy of Neurology, American Academy of Pediatrics, American Medical Association, and the Alliance for Academic Internal Medicine have each released guidelines or practice resources for effective use of telehealth.

However, the disease- and specialty-specific guidance that provider and payer organizations need in order to implement high-value telehealth programs is still the exception rather than the rule. Investments in rigorous studies and real-world evidence generation by key stakeholders—including health plans, health systems participating in value-based care, patient advocacy organizations, and life sciences companies—can accelerate the development of these guidelines and ensure that telehealth’s potential is realized.

Avalere’s expertise in digital health, value-based care, and quality can help clients optimize their telehealth strategies. To learn more about the implications of telehealth for manufacturers, providers, and payers, connect with us.

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