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Blog Post

Hit or miss: Looking back on our 2020 telehealth estimations

By Jordan Angers

June 15, 2022

    Advisory Board has published a lot of telehealth research over the past couple of years. Because of the rapid changes across the industry—especially the rapid roll-out and adoption of telehealth—we've had to learn to check our assumptions. One question we've revisited is that of telehealth utilization.

    In the fall of 2020, our team created a tool to estimate visit volumes that could shift to telehealth. More recently, we analyzed telehealth volumes from a Medicare fee-for-service (FFS) claims dataset. In comparing the two, it's easy to see what we got right and what we got wrong about the future of telehealth.

    We predicted what volumes could shift to telehealth

    We created the Virtual Shift Estimator to help leaders plan for the future in the middle of uncertainty. Health care experienced rapid adoption of telehealth in just a few weeks, but leaders questioned how telehealth would and should be used as the world entered the "new normal."

    We had data on how telehealth was being used at the peak of the pandemic, but that data described a period when many in-person practices were closed. Utilization data from before the pandemic was too minimal to draw any real conclusions.

    There were also a lot of unknowns:

    • How long will the pandemic last?
    • When will vaccines be available to the public?
    • How will consumers preferences for virtual and in-person care change?
    • How will payers reimburse for telehealth?
    • Will other health care leaders continue to invest in telehealth?

    Knowing that we had little data, we created the Virtual Shift Estimator to predict the volumes that could shift to virtual. Again, "could" is the important word here. The goal with the tool was not to tell leaders how many video visits they should be doing, but to help them understand what was possible with telehealth.

    We focused on the variation between specialties to remind leaders that planning for telehealth meant thinking about how to use telehealth, not how much telehealth. Results by specialty are below.

    image

    New data and new information paints clearer picture of telehealth

    Since we published the Virtual Shift Estimator, we've gotten answers to a lot of the questions we had two years ago. Now we know that patients like telehealth and will continue to demand it as an option. We know that payers will continue to reimburse for telehealth—even if it's not at parity, it will be higher than pre-pandemic rates. And we know that leaders will continue to invest in improving and expanding telehealth as they face competition from new entrants in the market.

    We also gained access to more comprehensive data on video visit utilization. In February 2022, we investigated video visit volumes before, during, and following the Covid-19 lockdown. We found that video visits are here to stay as a meaningful proportion of physician visits—especially for service lines that lend themselves to virtual modalities, like psychiatry.

    image

    What we got right and wrong in our estimations

    Now that we can see where video visit utilization has leveled out after the peak of the pandemic, how did we do?

    What we got right:

    • There's a wide variation in video visits adoption among specialties. In our predictions, we talked a lot about the importance of recognizing this variation instead of creating one overall goal for telehealth utilization. The recent claims data confirms the variation among specialties. This is an encouraging sign that leaders are using telehealth where it makes sense to use it instead of using it for the sake of implementing more telehealth.
    • Tele-behavioral health utilization remains at peak levels. We predicted that up to 88% of behavioral health could be done virtually and since then, we've seen that tele-behavioral utilization has remained constant near peak levels of utilization.
    • Patient preference dictates the future of telehealth. We included an option to factor in patient preference in our original estimates. It's now become very clear that patient preferences for when and how they use telehealth push health care leaders to invest in expanded telehealth capabilities, push providers into offering telehealth as an accessible option for care, and push employers to demand this capability of plans and providers for their employees.

    What we got wrong:

    • The overall shift to telehealth is lower than what we predicted. We said that 26% of volumes could shift to virtual. In reality, we've seen 10%-15% of volumes shift to virtual. This suggests that there's still untapped potential to do more visits virtually.
    • We underestimated the adaptive challenges clinicians would face in sustaining widespread use of telehealth. Adaptive challenges are the challenges related to a person's identity and stem from the feelings of loss as a result of change. Physicians often have trouble verbalizing the adaptive challenges they're facing—loss of autonomy, reluctance to change, and fear of the breakdown of the patient-physician relationship. Adaptive challenges are difficult to identify, and even harder to solve, meaning that some physicians remain resistant to long-term use of telehealth.
    • We conflated "telehealth" with "video visits". In our earlier research, we often talked about "telehealth volumes" in our original predictions. But we were really talking about video visits. Since then, we've recognized that telehealth is so much than just video visits—it's a wide range of modalities and use cases, including remote patient monitoring and asynchronous capabilities.

    Where will telehealth go from here?

    The story of telehealth isn't over. We're still learning about telehealth as perceptions continue to change and the industry right-sizes utilization. Just as leaders were flexible and agile during the pandemic, leaders will need to keep exercising that strength in order to adapt to the changing world.

    Overcoming clinician telehealth hesitancy

    imageClinicians are critical to telehealth’s long-term success. Yet, many clinicians still think of telehealth as a Covid-era tool. There are many technical challenges to telehealth. But even when these technical challenges are addressed, there are remaining barriers to getting clinicians to change their practice. Many see telehealth as a threat to their identity, autonomy, and core beliefs about their roles as care providers. These are what we call “adaptive challenges.”

    This webinar features a panel discussion to learn how physician leaders have made progress in overcoming these adaptive challenges and encouraging sustained telehealth adoption.

    Download now

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