As health care providers learn to leverage the full digital transformation benefits of a telehealth strategy amid the coronavirus pandemic, key findings have emerged about patient acceptance and access to care. During a recent HIMSS- and RSM US LLP-sponsored telehealth focus group, five key insights were shared by a diverse panel that included 16 organizations ranging from large integrated health systems to smaller, focused providers. Here’s what was discussed:
1. There is a widely acknowledged digital divide among patients. On the one side are the tech-savvy patients who have readily adapted to the switch to telehealth and who report high satisfaction for the convenience and safety benefits. On the other hand are patients who cannot access telehealth platforms due to a number of barriers such as limited broadband/Wi-Fi access, lack of access to a smartphone, technology that only supports English, no privacy to conduct telehealth visits and general discomfort with technology. One provider estimated that at least 15% of their patients couldn’t access telehealth.
Closing this digital divide in order to provide equity in care is an important focus for many providers, especially those who support communities with high Medicaid usage. Reducing the technology barriers to telehealth will be difficult, but not nearly as hard as overcoming the social determinants which impact health care; improvements in that area will have to be a long-term focus.
2. The explosion of telehealth visits is driving adoption of remote patient monitoring (RPM). One innovative provider analyzed data on telehealth visits and determined that they could triage those patients who could easily implement RPM based on who was already participating in text and telehealth visits with smartphones. For these patients, for example, they could simply ship out blood pressure or pulse oximeter monitoring devices and connect them through their smartphones. In order to offer equity in RPM services to the rest of their patients, providers offer a more costly option of sending out home health services to address those more technology challenged. One provider is positioning RPM as their “hospital at home” experience which has significant appeal to both the provider and the patient. RSM sees RPM as the next wave of telehealth to take off after the tele visit. RPM will first be targeted for patients with specific conditions and will become more widespread over time as technology adoption continues.
3. The jury is still out on whether or not we will be able to maintain the same level of quality using telehealth. One prediction is that it will be another two-plus years before we have enough data to evaluate the true quality of telehealth versus in-person visits. Reliable studies on the quality outcomes resulting from telehealth will be useful not only to evaluate and refine telehealth delivery, but also to further accelerate provider acceptance of telehealth.
4. Some providers are taking the path of least resistance and conducting their telehealth visits using the telephone. However, there is a concern that COVID-19 waivers for telephone reimbursement parity will be lifted and telephone visits will no longer be reimbursed or reimbursed at a much lower rate. This will lead to an increase in denials for telephone visits improperly submitted and a decrease in telehealth visits that were only able to be conducted by phone. As a result, savvy providers are reviewing the data to determine which providers and patients are conducting telephone visits today and seeking to provide an intervention to convert these to video visits before expected changes are made in the reimbursement regulations. This effort is also important to promote equity in access to telehealth and avoid exacerbating the digital divide.
5. There seems to be a recognized tradeoff between those telehealth platforms that offer the easiest and most user-friendly access versus those that provide the tightest integration with the electronic health record platform. It was noted that the EHR-based telehealth solutions enable the smoothest and most thorough documentation of the visit. Organizations that originally opened their telehealth technology options to their providers are now rethinking offering all of those options in favor of those that promote better documentation. With experience, providers are also building new templates to document telehealth visits in their EHR and learning the best methods to document in their telehealth visits. RSM’s view is that the number of telehealth solution vendors will consolidate over time and those solutions that are tightly integrated with the EHR will become more user-friendly and dominate the bolt on solutions.
The panelists were bullish about the future of telehealth with one predicting that telehealth will represent in excess of 25 to 30% of their visits in three years. However, while we have made a major leap forward with telehealth post-COVID, there is still change on the horizon for telehealth to improve to meet consumer and provider expectations.