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The Impact of Telehealth on the Future Care-Delivery Landscape

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On June 11, Avalere experts explored the future of telehealth and how organizations can help shape and take advantage of its increased utilization.

The webinar featured:

  • Chad Brooker, Associate Principal, Policy
  • Nader Hawit, Senior Director, Product Management, and General Manager, Prospective Advantage™, Inovalon
  • Josh Seidman, Managing Director, Center for Healthcare Transformation
  • Danielle Showalter, Principal, Commercialization & Regulatory Strategy

The discussion focused on the following topics:

  • Current and future implications for stakeholders
  • The new flexibilities that have the best chance to remain post-pandemic
  • Historical barriers to adoption to be addressed
  • Engagement strategies to affect policy, coverage, or utilization of telehealth

The COVID-19 pandemic has presented significant challenges to the care-delivery landscape. These issues have led to delays or gaps in care and undiagnosed and undermanaged conditions. Telehealth has rapidly expanded to help meet some of these challenges. While it is not new, the recent environmental dynamics and state and federal facilitation of telehealth have led to extensive growth in how it is being used and are poised to reposition the value of telehealth. As states begin to open up and elective care resumes, all stakeholders need to consider which, if any, of these new telehealth flexibilities should and will remain and what that will mean for the care-delivery system.

Current and Future Implications for Stakeholders

COVID-19 has caused many stakeholders to rethink their operations and has led to a resurgence in telehealth to fill gaps in care. Many payers are changing their approaches to telehealth by improving reimbursement, establishing tools for patient-provider communication, and waiving cost-sharing. The urgency of the pandemic created a rapid transformation in healthcare characterized by technological and data innovation.

Despite historical hesitancy around telehealth, providers responded quickly to the emergent needs created by the pandemic. Most large health systems already had significant technological infrastructure in place, but even many small practices have evolved in a matter of weeks to integrate telehealth. Many employers are embracing this platform, especially for behavioral health. While the adoption of telehealth largely resulted from necessity, it is shifting beyond need as patients and providers become more comfortable with and start to appreciate the convenience of virtual care.

Throughout the pandemic, telehealth has been an integral tool in ensuring patients maintain access to prescription medications and other therapies. Manufacturers have pivoted thinking to also access patients in home-based settings, and Medicare responded to allow this shift in care delivery setting by expanding supervision through audiovisual services and the interpretation of who is considered “homebound.” Providers have not taken a uniform approach to telehealth, which has caused disparities across certain conditions. Patients with more complex conditions or requiring more treatment have experienced delays in drug management and changes. While telehealth has helped reduce these disparities, there is opportunity to leverage a broader variety of virtual services for improved management.

New Flexibilities That Might Remain

Telehealth has potential in many different specialties, but some services are more effective in person. Routine care management for chronic conditions is well-suited for virtual platforms, with data showing positive outcomes for those patients. Some areas require provider-patient contact, such as group care and support groups. Moving forward, stakeholders will want to consider how to incorporate telemedicine into standard in-person care. One element of telehealth that can add clinical benefit in tandem with in-person care is digital data integration. The use of wearables, digital tools, and health apps can improve access to patient information across the care continuum and help providers make better clinical decisions. While challenges like electronic medical records integration, patient usability, and provider data fatigue remain, there is an opportunity to expand the collection of real-world evidence to enhance value stories.

Last year, the Centers for Medicare and Medicaid Services (CMS) created new codes for virtual visits that increased provider flexibility. Providers have expressed their desire to continue utilizing telehealth going forward and are considering their capacity to do so in terms of payment issues and financial viability, changes in patient engagement, and privacy concerns. Another factor in telemedicine’s viability after the pandemic is payer parity and coverage for services. While many flexibilities granted by CMS during the pandemic will end, Medicare can continue to define coverage and reimbursement through rulemaking. Other flexibilities will need to be addressed through congressional action at both the state and national levels. Although it is uncertain at this time how these flexibilities will be structured in the future, stakeholders will need to think about demonstrating telehealth’s value to ensure it sticks.

Historical Barriers to Telehealth

Historically, providers have been slow to adopt telehealth. The biggest barriers have been workflow, culture, and reimbursement. We are witnessing ongoing innovation with major electronic health record players building an embedded telehealth capability, streamlining the clinical workflow, and enhancing the patient experience. Payers have also struggled with coverage decisions based on uncertain clinical benefit and concern for increased utilization without the clear ability to show savings from telehealth services. The large recent uptick in telehealth service volumes offers an opportunity for stakeholders to demonstrate value and savings through more touchpoints with patients and increased care management

In addition, telehealth is traditionally reimbursed on a fee-for-service basis but could become more rapidly adopted with provider incentivization and risk sharing. Value-based care models and practices that have adjusted clinical workflows to accommodate telehealth will likely have the easiest transition, while smaller practices or those serving disadvantaged groups may not have the capacity or financial stability to incorporate telehealth. The pandemic has created room for new delivery methods, but providers will still need to think about how to fit telehealth into their models and overall care goals.

Engagement Strategies

As providers and patients become more comfortable with telehealth, it will be important to create a care continuum that considers virtual health in the broader delivery framework. Payers are beginning to incorporate telehealth and digital connectivity into their supplemental benefits and programs for patient support on chronic condition management. Some of these tools include medication adherence, education and coaching, transportation, nutrition supplementation, and companionship apps that mitigate loneliness. Providers can also deploy remote patient monitoring to manage treatments, and digital health increasingly guides plans and clinicians in understanding gaps in care and patient health. Telehealth has also been beneficial in removing some barriers to inpatient care, such as cost, transportation, and lost productivity. Empowering these services with data enriches the patient experience and support feedback models to harder program and benefit design.

During the pandemic, many of the historical barriers are being removed as regulation around telehealth has temporarily changed. Reimbursement has increased and security and privacy restrictions have lifted. For telehealth to become properly integrated, the value proposition must continue to be shaped by engaging policymakers at the state and national levels, payers, and providers. To prove the value of telehealth going forward, sustained payer parity, provider incentivization, security compliance, and real-world evidence will be critical.

Data and real-world evidence around adherence, long-term outcomes, access to pharmaceuticals, and healthcare utilization will be important for stakeholders looking to demonstrate clinical benefit. The evolving healthcare landscape and telehealth policy will be shaped by the value proposition demonstrated to date in enabling access and quality health care.

Access the archived version of the webinar.

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