According to research by McKinsey & Company, the adoption of telehealth was 38 times higher during the COVID-19 pandemic than it was before.[1] While most provider offices have returned to in-person appointments, many continue to offer telehealth as an option for vulnerable patients or for those who request a virtual appointment.
Now that telehealth is in place and patients have embraced it, it’s time to think of ways to use the technology to address long-standing issues in our continuum of care. Following are four areas we think telehealth can have the biggest impact once the pandemic has finally subdued.
HOME CARE
Telehealth is invaluable as a way to connect home-care patients with their clinicians from the safety of the patient’s home. Video allows clinicians to identify visual cues that might indicate a need for intervention or for the patient to be seen in an office. It can also reduce the need for trips to the physician’s office for things that can be handled virtually.
Clinicians can also use telehealth appointments to better prepare for an in-home visit. This means they can spend less time gathering information once they reach the patient’s home and more time actually treating the patient. Since appointments are more efficient, clinicians may be able to see more patients or spend more time on preparation or other office-related tasks.
Using telehealth for home-care patients also gives patients and their families peace of mind knowing that help is always at hand. It can also help enhance patient satisfaction by making clinicians more accessible.
BEHAVIORAL HEALTHCARE
The COVID-19 pandemic has highlighted many shortcomings in our healthcare system. One of those is around behavioral healthcare—specifically a lack of access. More than 51 million Americans are reported to be living with mental illness.[2] Yet, fewer than 50% receive treatment. The issue grew exponentially during the pandemic as social distancing mandates were put in place and in-person support groups stopped abruptly. Stress from social isolation, loss of income, and fear of becoming infected increased the impact on the mental health of many and that impact won’t magically go away once the pandemic has gone. The need was great prior to the pandemic, and it’s even greater now.
Now that behavioral health providers have implemented telehealth, they can use it ongoing to help ease issues of access. Patients can be assessed, triaged, diagnosed, and treated without having to come into an office. This ensures patients get the right treatment from the right provider sooner. For those without access to transportation for which to get to counseling or treatment, or for those living in areas with few behavioral health resources, telehealth helps fills that gap.
REMOTE PATIENT MONITORING
Perhaps one of the greatest opportunities for using telehealth to improve our continuum of care is remote patient monitoring. Two of the biggest areas of benefit are post-discharge care and chronic disease management.
Post-discharge care
When patients are discharged from a hospital or emergency department, they’re often given instructions to follow up with their primary care provider or a specialist. They may leave with a prescription for medication and educational information on caring for their medical condition at home. Yet a study published by the Agency for Healthcare Research and Quality (PHRQ) found that almost 20% of patients experience some type of adverse event in just the first three weeks after discharge, with the majority being preventable.[3] The top three issues found in the study were adverse drug events, hospital-acquired infections, or procedural complications. The same study found that additional “discharge hazards” came from patients being discharged while test results were pending, or that they were released needing an outpatient “diagnostic follow-up.” Telehealth can address all of these issues by giving hospitals, specialists, and primary care physicians the tools they need to remotely monitor these patients in the critical days after discharge.
Chronic disease management
Our population has become increasingly sicker. According to the CDC, 51.8% of adults in the U.S. now have at least one chronic condition and 27.2% have two or more.[4] Cardiovascular disease and diabetes are two of the most prolific diseases, both of which require regular care, monitoring, and medication adherence to avoid adverse events. Research shows that half of patients living with cardiovascular disease do not take their prescribed medications.[5]
Other studies have found that patients with diabetic foot ulcers average 14 outpatient visits and 1.5 hospitalizations each year.[6] Remote patient monitoring using telehealth and devices such as blood-pressure cuffs, at-home EKG devices, blood glucose devices, and sensory insoles allow providers to proactively identify issues in order to avoid complications and hospitalizations.
Many providers have avoided implementing programs like chronic care management (CCM) and remote patient monitoring (RPM) because they felt the effort to do so was greater than the reward. Now that telehealth processes are already in place much of that heavy lift has been removed. And new CMS reimbursement opportunities can bring considerable financial benefits for RPM as providers can receive $75,000 in additional net revenue per provider per year if at least 50% of eligible patients are enrolled. Another benefit is that care can be provided by clinicians other than the physician, which helps reduce additional time pressure on physicians.[7]
LONG TERM CARE
During the height of the COVID-19 pandemic, long-term care facilities went on lockdown. Telehealth allowed clinicians the ability to assess, triage, and provide care guidance without an in-person visit to the facility. Leveraging telehealth in this way even after the pandemic can give long-term care facilities the ability to provide more timely access to care without patients having to wait for prescheduled on-site clinician visits. In a time when staffing shortages abound, telehealth can bridge the gap and ensure long-term care facilities can continue providing consistent, high-quality care.
THE PATH FORWARD
According to a study published by the AHRQ, telehealth can deliver “as good as or better than usual care” outcomes for specific populations.[8] The evidence was centered around “remote, home monitoring for patients with chronic conditions, such as chronic obstructive pulmonary disease and congestive heart failure.” Also included were patient counseling about their chronic conditions, as well as psychotherapy for behavioral health patients.
The bottom line is that telehealth is working, processes are defined, reimbursement is in place, and patients want it. We need to seize this opportunity to make true, long-lasting improvements in the health of our populations.
[1] https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
[2] https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
[3] https://psnet.ahrq.gov/primer/readmissions-and-adverse-events-after-discharge
[4] https://www.cdc.gov/pcd/issues/2020/20_0130.htm
[5] https://www.sciencedirect.com/science/article/pii/S0735109716371765
[6] https://www.ncbi.nlm.nih.gov/books/NBK65152/
[7] https://www.acpjournals.org/doi/10.7326/M14-2677
[8] https://effectivehealthcare.ahrq.gov/products/telehealth-expansion/white-paper
