Simplifying Healthcare: Telehealth

Isn’t it hard to remember a time where we didn’t rely on computers, smartphones, and other technologies to engage and deliver the care we need?

Back in 1993, I had my own first encounter with telehealth when pregnant with my twin daughters – believe it or not, I had a contraction monitor that we hooked up to the landline telephone! I was able to remain in my home for several weeks longer (and away from expensive hospital care) as I was “watched” by the perinatologist from afar.?Fast forward 30 years, and I have two beautiful, healthy, and kind daughters – and we have a plethora of telehealth options that assist us in accessing and engaging in healthcare.?

It’s safe to say a lot has changed for us since then and that change has continued over the past few years due to the COVID-19 pandemic, particularly as it relates to telehealth and how we build relationships with our care providers. In fact, we saw an over 4,000% increase in national telehealth claim lines between March 2019 and March 2020 due to federal policy changes, reimbursement modifications and the implementation of the Public Health Emergency (PHE).?

So, how exactly did we get to this point??

Back in 1948, the first radiological images were sent by telephone. We then had the transmission of neurological examinations in 1959, the use of closed-circuit TV for psychiatric consultations in the 60s, and the application of technology in telehealth continued to grow as new use cases evolved.

The 1980s and 90s brought the advent of the Internet and ushered in a whole new digital age; and in 2010, former President Obama proposed the “Connecting America: The National Broadband Plan” to improve internet access across the U.S. In 2016, The Health Resources and Services Administration received $16 million to bring telehealth access to rural areas around the country. The evolution of these capabilities and continued federal and state investments provided the infrastructure to spur growth in the use of telehealth resulting in expanded access and improved care for individuals across the US.

In “post-pandemic” 2023, it begs the question – where are we now, and where do we go from here with telehealth? What additional promise does it hold in improving the health of the communities where we live, work, and play?

The Telehealth Effect

Whether we were aware at the time or not, the advent of COVID three years ago created an environment where all the stars finally aligned for the widespread adoption and use of telehealth.?

Up until that point, we lacked alignment between technology capabilities, the regulatory environment, the payment environment, and the need to access care differently. These all came together simultaneously during COVID. We finally weren’t fighting the regulatory hurdles of providing telehealth services across state lines or with payers refusing to pay for services unless very specific parameters were met – and even more importantly, in-person care was no longer perceived as the only high-value care option and in many cases, was not an option due to state and federal restrictions.

Telehealth as a public health tool greatly assisted during the pandemic, particularly with continued access to care. It created additional pathways and viable treatment options when we were entirely virtual and still social distancing – even now, telehealth continues to bridge care gaps in rural communities and for those with challenges accessing transportation. Telehealth, has, and can continue, to address equity issues in our current healthcare system and can have a positive effect on the improvement of health across all populations. ?

According to a 2022 Telehealth Case Study conducted by the Southern Rural Black Women’s Initiative for Economic and Social Justice, healthcare cost savings from telehealth solutions and expanded broadband could total nearly $43 million annually due to things like avoided transportation costs and lost productivity across 10 counties in the Mississippi Delta. Imagine the potential health and economic impact these solutions can have in addressing disparities when scaled and made available across our nation.

When I think about the positive telehealth innovations in my own environment, I would point to Providence 's virtual nursing unit . By leveraging virtual models of care, Providence is maximizing the skills and capabilities across our nursing teams, allowing for more flexible career paths, the ability to practice outside of the traditional care setting and returning joy to the practice of nursing. This is a prime example of using a technological solution to address an existing burden in the healthcare system, which in this case, is frontline worker burnout and the nursing shortage.?

And I can say with full confidence this is not the only successful telehealth use-case. When executed and implemented correctly, telehealth is a powerful, equitable tool that can lead to better behavioral and physical health outcomes across many populations in the U.S. It can be used to expand specialty access to broad populations, utilize our caregiver workforce more efficiently and ensure better health care for all.

That doesn’t mean there isn’t room for improvement – there is much to continue to learn about the impacts to more effectively and efficiently utilize telehealth to address the health and healthcare needs of our nation.?We need to understand why telehealth works in some environments and not in others.?We need to continue to look for opportunities to evolve and translate our learnings across care setting, disease states and engagement efforts.?Only then will we realize the full benefit of “tele” in healthcare.?

In my March newsletter around healthcare innovation , I discussed the need for innovative solutions being developed ultimately to provide value to the patient, health system, and payer. Even if a telehealth solution is a great idea and has a positive outcome, it can be a difficult to scale if business model incentives are not aligned or appropriately financed. ?

From a regulatory perspective, telehealth will likely need continued modifications to ensure adoption and expansion is enabled and that safeguards are in place to protect patients and monitor outcomes. I believe this is especially important in the behavioral health space, where we have seen examples where the main goal is often profit, particularly off prescribing products and not the care and treatment of patients being served.?

Upcoming Changes to Telehealth

In my last newsletter , I reviewed the impact of the official ending of the PHE as declared by the Biden administration on May 11th, 2023. As one of the Medicare-covered services expanded during the pandemic, telehealth, unfortunately, was affected by the emergency ending.?

This will create additional regulatory barriers to entry and decrease access, but there are notable exceptions, including continued coverage for audio-only services, as well as for those seeking mental health and substance use assistance. I encourage each of you to check with your health plan to what telehealth services are covered, as coverage will likely vary across plans and states going forward.?

Additional Resources

As always, I think the best ways we can equip ourselves to fully embrace the rapidly changing healthcare landscape is to be knowledgeable. Check out the links below that are available for you to explore that provide information about telehealth coverage and policy changes. ??

• Telehealth: What Is It, How to Prepare, Is It Covered? (NIH)
• Telehealth policy changes after the COVID-19 public health emergency (Telehealth.HHS.gov)
• Telehealth (Medicare.gov)
• E-visits (Medicare.gov)

Looking Ahead + Final Thoughts?

The use of “tele” is not new in healthcare.

It has been woven throughout our healthcare system for decades now, but the pandemic and our “post-pandemic” era have ushered in new ways to think about and approach telehealth. Now at a crossroads, we must ask the right questions to continue shaping the best path forward. ?

How is telehealth delivered? How can we make it better? How can we ensure privacy, confidentiality, and security? What are the appropriate payment mechanisms? What are the use cases where it could bring the greatest value to healthcare and to addressing disparities in access and health?

If the last few decades have shown us anything, it’s technology can revolutionize our healthcare system – more often faster than we often can adapt.

As I see rapidly unfolding developments in areas like AI and ChatGPT taking hold, I can’t help but think we’re in the next stage of the digitization of healthcare – one that presents its own unique advantages and challenges as we’ve seen with telehealth. But more to come on that later – be on the lookout in a future newsletter issue! ??

Until next month.??

- Ruth ???

Have an idea for a future topic or questions in the world of healthcare? I’d love to hear from you!