Telehealth 101: A Brief Introduction
Even if you’ve been living under a rock for the past 15 months, chances are still good that word somehow made its way to you about the explosion of telehealth during the pandemic. And despite working in healthcare for a few years now and considering myself relatively “up to speed” on trends in the industry, I knew surprisingly little. When I stepped into my manager position over Benefis Health System’s REACH Telehealth Network, I had to learn fast.
Telehealth is indeed a dynamic part of healthcare that has undergone both tremendous growth and change since the onset of COVID-19. In many ways, hopefully, healthcare won’t be the same because of it. In others, the jury is still out.
Here’s a brief primer on telehealth to bring you up to speed on a few of the fundamentals:
Telehealth v. Telemedicine v. Virtual Care
Telehealth is typically used as a broad term meant to encompass all aspects of remote healthcare, which can be both clinical and non-clinical. Videoconferencing, transmission of still images, remote monitoring, continuing medical education, and video visits, among many others, all fall under the umbrella of “telehealth”.
Telemedicine, on the other hand, refers to the delivery of medical treatment through a telecommunications platform; think of it as a subset of telehealth. Platforms include live video, audio, or instant messaging.
Virtual care is yet a third term that is commonly used. It is an expansive phrase that covers all the ways healthcare providers interact with their patients remotely. The term may or may not encompass patient care, but instead refers to “all the ways patients and doctors can use digital tools to communicate in real-time.” (Source: InTouch Health)
Important Terminology
- Asynchronous / Synchronous
o Asynchronous telemedicine refers to the forms of telemedicine that take place over a period of time. The most common example is known as store-and-forward, where clinical patient data (x-rays, photos, labs, medical assessments, documentation, etc.) that is acquired and stored in a secure database or the cloud is then forwarded to a clinician (typically a specialist) at a separate site for a clinical evaluation. Another example is e-visits, where a patient submits a medical concern using a web or app-based platform and a provider securely relays medical advice and/or care via prescribing medication or other treatment options.
o Synchronous telemedicine refers to telemedicine that is real-time, interactive, two-way communication via video or phone consult between a provider and a patient.
- Direct to Consumer
o Also known as D2C, this concept is just as it sounds…the patient going directly to a provider for their visit and may be facilitated through your doctor’s office, a company offering services on-demand, or some other delivery system. This is not a novelty, but it is new to traditional Medicare patients (due to the Public Health Emergency waivers) who had previously always had to be in an originating site location in order to conduct a telemedicine visit and have it paid for.
- Originating Site
o Location of the patient at the time the virtual visit takes place. For traditional Medicare beneficiaries, this is the location the patient must go to in order to receive covered telemedicine services. As it applies to Medicare, originating sites can be located in either:^
- A county outside a Metropolitan Statistical Area (MSA)
- A rural Health Professional Shortage Area (HPSA) in a rural census tract
^These, and a number of other requirements for Medicare patients, have been waived due to the Public Health Emergency declaration by the Department of Health & Human Services.
- Distant Site
o This refers to the site at which the provider delivering the service is located at the time they are providing the virtual visit.
- Parity
o Coverage parity means that if a medical service is covered as an in-person service, it must also be covered as a telemedicine service. Coverage parity provisions vary by state (it does not exist federally for CMS, which maintains a limited list of telemedicine services it covers) and has always been applicable only to those services which are appropriate to be provided via telemedicine.
o Payment parity refers to the idea that a telemedicine service will receive the same reimbursement as when the same service is provided in-person. Few states provide full payment parity and a handful more provide it for a specific set of services.
- Remote Patient Monitoring
o Also known as RPM, this refers to technology and programs that track patient health data from someone outside of the hospital or clinic and send that data to a platform (typically the EHR) where it can be monitored or viewed in real-time. This technology could be in the form of Bluetooth-enabled smartwatches or heart monitors and may send data such as vital signs, weight, blood pressure, blood sugar, etc.
A Few of the Big Players
There is now an ample amount of companies providing telehealth services and offering a variety of different platforms/capabilities. Venture capital is on the move in telehealth in a big way, making the competition for patients and their dollars fierce. Companies are partnering with existing health systems and provider organizations, while also going direct to consumer. There are, of course, many players in the field, but here are a few worth knowing:
o Formerly known as American Well, this is one of the largest telehealth platforms and providers in the market. In September 2020, they attracted $742 million in a highly successful IPO. The company has 4,000+ providers in its medical group and has total physician usage of the platform of more than 62,000 providers.
o The largest telehealth provider in the country, Teladoc raised $157 million in its 2015 IPO and has been considered the market leader ever since. The company has a growing international presence and last year completed an $18.5 billion dollar of Livongo, a leader in digital diabetes monitoring and chronic disease management.
o Founded in 2009, MDLIVE provides 24/7/365 mobile access to a board-certified physician for non-emergent medical conditions, providing a convenient alternative to urgent care or the ER for many common conditions. Consumers can access services through an individual membership or as a benefit through their employer or health plan (if offered).
o A handheld exam kit and app that lets you perform guided medical exams with a healthcare provider, anytime, anywhere. Large health systems across the country are creating partnerships with TytoCare left and right.
o Ever the disruptor, Amazon has moved into the telehealth space by providing virtual visits. The company recently announced that it would be expanding its app-based services to its employees and other companies across the United States, beginning this summer.
Though telehealth is the hot topic right now in the industry, including within the chambers of almost every state legislature, it’s staying power has yet to be determined. Overall, telehealth visits have declined since the height of the pandemic. While I haven’t heard from anyone expecting telehealth to completely replace a large chunk of in-person visits in the future, it remains to be seen how complimentary virtual visits will actually become. Predictions aside, this is an exciting side of the business to be in right now.
Strategy and Digital Health Leader
3 年Great overview!