Blog Post

The 3 hardest questions about telehealth (that even industry leaders can't answer)

November 6, 2020

    Across 2020, we witnessed a huge spike in telehealth utilization, followed by an almost equally steep drop-off. Not surprisingly, telehealth has been top-of-mind for executives in almost every segment of the health care industry. Leaders ask about the value and appropriateness of telehealth, its sustainability in an already fragmented health care system, and how it should integrate into (or fundamentally disrupt) the existing care delivery infrastructure.

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    Last week, Advisory Board hosted its first ever Cross-Industry Telehealth Summit to unpack these very questions and leaders' perspectives on why advancing telehealth—as an industry—is hard. The virtual event convened 55 leaders from across the health care ecosystem, including payers, providers, technology companies, and business and association leaders. Participants represented a range of progressive organizations, like Intermountain Healthcare, Teladoc, American Telemedicine Association, UnitedHealthcare, Pfizer, JP Morgan Chase, Bind, UPMC, Merck, Bright.MD, athenahealth, and many more.

    Through a series of interactive discussions, participants explored points of tension and alignment in how industry stakeholders approach telehealth. The diversity of participants' backgrounds and roles was vast—ranging from clinical and care delivery, to innovation and product development, to analytics and population health. Those perspectives helped to surface interesting similarities, and notable differences, in how industry leaders understand the problems facing telehealth and our respective roles in solving them.

    Below we highlight the three of the most interesting questions raised in the discussion.

    3 telehealth questions that are top-of-mind for industry leaders

    1. What does 'success' for telehealth adoption actually look like?

    As participants reacted to data showing a spike in telehealth utilization, one thing became clear: there is no universal definition of success for telehealth. Utilization offers one lens for assessing how well telehealth is being adopted, but given the variety of perspectives represented at the Summit, it's not surprising that folks offered several others. One provider leader described success as "finding the right dosage of telehealth"—the key is to figure out how much care should be provided virtually for a given condition or use case. A technology leader had a different view, focused on integration: "It's about becoming fully integrated—across the institution, with other technologies and tools, with the EHR, with primary care doctors, and within the workflow of day-to-day practice." Another participant had a simpler, and more provocative view, which is that success is all about "re-utilization"; if telehealth works well enough for patients, providers, and payers that they decide to keep using it, that's success.

    Despite the range of views, one thing everyone agreed on was that more telehealth isn't inherently good, especially if access is not equitable. As one participant put it, "We keep hearing that telehealth is at a tipping point, but that's not true for the underserved." The group discussed how new technologies can actually exacerbate existing problems in our health care system, including health inequities. "It's not enough to build and implement telehealth. We need to build it to address patients with the highest need, and ensure digital literacy support" for patients, but also for providers. Otherwise, "we're just substituting services" and not necessarily improving patient care.

    2. Who should determine the right 'dosage' of telehealth?

    One of the messier questions participants asked was about how to determine the right amount of telehealth. Have we, as an industry, decided that telehealth is a good and useful innovation, and therefore patients should receive care via telehealth as long as it's safe and clinically appropriate? Or is telehealth ultimately a consumer-driven innovation, and therefore patients should decide for themselves when to use telehealth, based on their preferences?

    In some ways, it's probably both. Certain patients will always have a consumer approach to health care, and if they prefer telehealth, they will self-select into programs that provide it. At the same time, there will always be patients who defer to their doctor's recommendations, or who don't have enough information or health literacy to demand care that suits their preferences.

    That's why it's crucial to have telehealth systems that are flexible enough to not only meet individual needs, but also to adapt when needs change over time. One technology leader put it this way: "Just because you have Type 1 diabetes doesn't mean you can't get stung by a bee. A single consumer touch point doesn't define a patient, and a patient isn't defined by their disease."

    This question of who should determine the right dosage for telehealth is a big one—but it's connected to a broader challenge with health care writ large, which centers on the tension between standardization and personalization. On the one hand, it's critical to have standardized guidelines for which health interventions are most effective and appropriate in a given situation. That is the basis for evidence-based medicine, and a key lever for ensuring care is provided appropriately and equitably.

    On the other hand, in order for care to be truly patient-centered, it must be tailored to individual needs, preferences, and priorities in a given situation. Although this challenge is not unique to telehealth, it is particularly relevant given that local providers and large national telehealth vendors are both vying for the patient relationship. 

    3. Why is data a barrier for so many stakeholders?

    Data continues to be a top barrier to telehealth adoption. Industry leaders cite challenges like portability of the medical record, interoperability across technologies, and the need for standardization and aggregation across systems. But part of what makes data such a complex challenge is that stakeholders have different "jobs" they want data to perform, and each job requires a different set of information and a different set of systems.

    For example, in order for a physician to provide care via telehealth, they need the patient's medical record to be accessible at or before the point of care. For a payer to make coverage and reimbursement decisions, they need cost and utilization data for their member population. For researchers to assess the clinical impact of telehealth, they need to compare outcomes data across patients who did and did not receive care via telehealth.

    As one provider leader said, "We have to figure out, what do we want the data for? What is the goal? What is the why?" Depending on the decision a given stakeholder needs to make, the set of information they need can be completely different.

    The infrastructure they need can be completely different, too. An integral piece of this infrastructure centers on who "owns" the data. At the Summit, participants debated the benefits and drawbacks of specific stakeholder groups being the data owner—but ultimately concluded that data ownership isn't just one thing. As one participant stated, "It's not so much a matter of who owns the data, but who is managing it appropriately."

    Telehealth data (or any health care data for that matter) does not necessarily have to be owned, aggregated, managed, and accessed by the same entity. Most participants agreed that patients are the ones who own the data, but technology companies should lead efforts to aggregate and manage it, while lots of entities—provider organizations, health plans, regulators, and others—should be able to access it.

    Disaggregating the data challenge based on the "jobs" health care industry leaders need the data to perform and the components of data "ownership" that exist will help shape what questions we need to ask, who needs to be involved, and when.

    Where do we go from here?

    It's probably fair to say that "the cat's out of the bag" with telehealth—as more patients and providers are exposed to it, we can safely assume demand for it will continue, and debate about the best ways to provide it will persist. To ensure we have the right infrastructure in place to advance appropriate, equitable telehealth moving forward, it is crucial for leaders across the health care ecosystem to continue to convene, discuss, and collaborate accordingly.

    Stay tuned for additional coverage from the cross-industry telehealth summit, including our key takeaways from the day and more.

    How Covid-19 will impact telehealth

    The rapid embrace of telehealth in the wake of Covid-19 is simply astonishing. In less than one month, provider practices shifted from doing almost no virtual visits to doing only virtual visits.

    While telehealth won't be the only way to access care in the future, it will be a much more commonplace one. Read our take on telehealth's sudden pivot from "nice-to-have" to baseline expectation.

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