COVID-19 and Telehealth: Accelerating the Virtualization of HealthcareThe COVID-19 pandemic has had—and will continue to have for the foreseeable future—a profound impact on the way healthcare is delivered and consumed.
Telehealth is a segment of the industry significantly impacted by the pandemic. Understanding the current landscape and available technology will assist in informed decision-making now and for future practice and purchase decisions.
Telehealth: Definition and Market Landscape
The term “telehealth” simply refers to the use of digital means and technology to access and/or deliver healthcare services remotely. This concept has manifested itself in many technological innovations that are used today. A few of the more prevalent examples include:
- Interactive Telehealth – remote consultations between patients and providers such as Nurse Advice Lines
- Remote Monitoring and Testing – diagnostic monitoring and testing services performed remotely; remote monitoring is commonly used in association with chronic diseases
- Telemedicine Carts – video-enabled mobile carts that allow physicians to remotely evaluate and interact with patients from a remote location
- Teleradiology – remote evaluation of radiographic images for the purpose of diagnosis
- Telesurgery – surgery performed by a surgeon via robotics, performed from a remote location
Other examples include Telepharmacy and Teledentistry.
Also noteworthy are other examples of non-medical support services that are trending in the virtual direction. The transition from in-person language interpreters to video remote interpreters is one such example.
The number of suppliers and amount of spend for telehealth services prior to the coronavirus pandemic was already significant, with more than 40 prominent suppliers delivering telehealth services across the nation and many more start-ups and smaller suppliers emerging into the market.
Based on aggregated spend data from hospitals across the country, the average U.S. health system spent approximately $750 per bed per year for telehealth services last year. This leads to an expectation that a 1,000-bed health system could spend approximately $750,000 per year on outsourced telehealth services alone. This number does not include the network infrastructure or support required to operate the programs.
Poised for Growth: Strategies, Barriers
The telehealth industry has been steadily growing for several years; two contributing factors are increased convenience and decreased cost. For some patients, it is simply more convenient to receive care via virtual methods. For providers, telehealth allows them to provide care at a lower cost and increase access to care and competency. However, prior to COVID-19, acceptance has been reluctant and fragmented (Smith et al., 2020).
One important barrier to the uptake of telehealth is the unwillingness of clinicians to accept it. Because clinicians historically do not receive training regarding telehealth, they find it disruptive, complex, and foreign. For clinicians to accept it, they must perceive it as “effective, safe and normal.” (Smith et al., 2020).
Another barrier to telehealth is the willingness of the patient population to use and trust this method of healthcare delivery. “A recent survey demonstrated that patients are willing to use telehealth, but barriers still exist, namely: (1) At a time of need, many people revert to what they are used to doing and the way in which they previously interacted with the health care system. (2) Patients would prefer that they see their own provider through telehealth versus someone with whom they do not have a previously established relationship. (3) Patients may be unaware that they have telehealth as an option and do not know how to access it.” (Portnoy, et al., 2020).
To overcome these barriers, health plans, employers, hospital systems, and media outlets should work to assure people that telehealth is a safe and effective alternative under the current circumstances, make them aware that a telehealth benefit exists with instructions on how it can be accessed, and help them understand how it works (Portnoy, et al., 2020).
As consumers of healthcare become more comfortable with technology, the demand has been steadily growing, even prior to COVID-19. Telehealth has been viewed as a somewhat novel concept in the past — but during the COVID-19 pandemic, that perception is shifting from novelty to necessity. Healthcare cannot be delivered in the traditional sense. Telehealth, a viable and safer alternative, is a means of reducing the risk of cross-contamination and exposure associated wth close contact (Smith et al., 2020). Changing regulations necessitated by COVID-19 have expedited this growth, and in addition to providing an alternative to reduced access to care, have removed many historic barriers commonly associated with delivery of telehealth services. Telehealth has the potential to be of tremendous help during the COVID-19 pandemic by permitting mildly ill patients to get the supportive care they need while minimizing their and the healthcare providers’ exposure to other acute illnesses. At this time, “the Centers for Medicare & Medicaid Services and most commercial health plans have largely waived co-pays for telehealth visits as a means to encourage utilization in this time of need.” (Portnoy, et al., 2020).
The historic growth can be quantified by an evaluation of the changes in the supplier base and spend for many prominent hospitals and health systems in recent years. From 2017 to 2019, there were observed increases from 25% to 36% in the number of telehealth suppliers utilized by a given health system and 105% to 165% in subsequent spend with those suppliers.
While it is difficult to predict the future, especially during a crisis, there are a few likely hypotheses:
- The telehealth industry will rapidly expand in terms of competitive suppliers, dollar value, and applications of technology.
- Consumers will become more comfortable with telehealth services, thus increasing demand further.
- Lawmakers will have a renewed focus on telehealth with the goal of increasing access to telehealth services while maintaining patient confidentiality.
- In healthcare, anything that can become virtual will become virtual — examples include video remote interpreting, inventory and asset management, and administrative work.
- IT security will become increasingly important as the healthcare delivery system becomes even more heavily reliant on interconnected networks.
The telehealth industry is positioned and poised for radical growth and innovation that will be spurred by the COVID-19 pandemic. As this segment of technology expands, it is our obligation to closely monitor and understand the emerging solutions and their implications. Education of healthcare providers delivering care and the patients who would be accessing telehealth is imperative for the comfort of the end users and for successful implementation. As always, it is highly important to choose telehealth supplier partners wisely and keep the patients’ best interest in mind during this time of crisis and beyond.
Smith, Anthony C, Thomas, Emma, Snoswell, Centaine. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). Journal of Telemedicine and Telecare. March 20, 2020. https://journals.sagepub.com/doi/10.1177/1357633X20916567
Portnoy, J, Waller, M, Elliott, T. Telemedicine in the Era of COVID-19. The Journal of Allergy and Clinical Immunology: In Practice. March 24, 2020. https://doi.org/10.1016/j.jaip.2020.03.008
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