IT Forefront

How service line leaders can prepare for telehealth's future, in 4 steps

by Mallory Kirby and Daniel Roza

America's Covid-19 epidemic drove CMS and private payers to adopt policies to rapidly scale up telehealth, but these conditions won't last forever—and service line leaders need to prepare accordingly.

Cheat sheet: 3 imperatives to leverage telehealth against Covid-19

What paved the way for telehealth's widespread adoption?

To understand how to navigate this new landscape, we must examine what made the rapid uptake of telehealth during Covid-19 such a success. Broadly speaking, three fundamental market changes converged to facilitate widespread adoption:

  • Telehealth reimbursement achieved parity (at least temporarily) with reimbursement for in-person visits;
  • Telehealth infrastructure requirements were relaxed to allow visits through easily accessible platforms, such as FaceTime and Zoom, for the duration of the public health emergency; and
  • Demand increased sharply as both patients and service lines avoided in-person contact.

These factors drove rapid telehealth implementation that, by most metrics, has been a startling success. Recent consumer surveys found patients rate the care they receive and their interactions with clinicians just as highly via telehealth as they did via in-person visits, and, according to a McKinsey study, 57% of providers view telehealth more favorably now than they did before Covid-19.

4 ways telehealth has changed—and how you can prepare for what's next

These market changes facilitated telehealth adoption, but service line leaders should not count on these ideal conditions to last forever. Once markets normalize, successfully implementing and growing telehealth programs may become a lot more challenging.

Here's what's changed in telehealth—and how you can prepare for what's next.

1. Reimbursement parity is not permanent—so how else can telehealth derive value?

Reimbursement discrepancies, historically one of the major factors stymying telehealth implementation, was rapidly mitigated when CMS decided to reimburse most virtual visits at 100% of the in-person rate. Private payers, some of whom had previously provided telehealth reimbursement parity depending on state guidelines, followed suit. For many programs, this change made telehealth financially viable for the first time and allowed them to implement it with little downside risk.

Our prediction:

Full parity for virtual visits will not last. Although we don't know yet how much reimbursement will change, most (if not all) payers expect to decrease telehealth reimbursement at some point. In the past telehealth was presented as a cost-saving alternative to in-person visits, so it will be challenging to convince payers that virtual visits now require the same financial resources as in-person visits.

Your next steps:

Service line leaders must make the case for telehealth beyond reimbursement potential. The benefits could include value-based metrics such as improved readmission rates, downstream referral volume, and patient capture or loyalty. Additionally, to cut operational costs, leaders should plan how to align telehealth staff, services, and settings to balance their footprints across physical and virtual care.

2. Payers will be less lenient to programs that have not invested in appropriate and secure telehealth infrastructure

To enable rapid implementation of telehealth, reimbursement was expanded to cover almost any platform (phone calls, FaceTime, and other non-HIPAA-compliant video chats). This was a boon for programs that had not previously invested in virtual infrastructure and platforms.

Our prediction:

To continue to receive reimbursement in the future, programs' virtual health infrastructure will likely have to adhere to a higher standard of data security and patient confidentiality. Additionally, most providers and payers question whether to sustain reimbursement for phone call visits.

Your next steps:

Programs without an established telehealth platform must evaluate and choose a platform that can grow with them as higher expectations and standards are put back in place. Make sure these decisions are made with provider and patient preferences, existing EHR functionality, and payer interoperability in mind. Invest in provider training, including not just how to use the platform, but also how to use it to deliver positive patient experiences.

3. Patients have had a taste of telehealth, and will continue to crave its convenience

With the forced shift to virtual for many appointment types, huge numbers of patients have encountered telehealth for the first time. And it turns out that patients were generally satisfied with their experiences, despite some reports of technological challenges and ongoing gaps in rural Internet access.

Our prediction:

Patients are likely going to demand continued access to telehealth, not only in the short-term as the pandemic continues to unfold, but also in the long-term as they look for more convenient options for care.

Your next steps:

Survey your patient populations for their preferences, comfort levels, and experience with telehealth, and work with your clinicians to identify the best clinical use cases for telehealth. The ideal balance of in-person and telehealth visits is contingent on patient perceptions of convenience, safety, and comfort using virtual solutions. Service lines with rural markets will have to consider the needs of those patients, who are most likely to benefit from the convenience of virtual visits but are least likely to have access to the necessary infrastructure or technology.

4. No matter what, data collection is crucial to the future of telehealth

Telehealth will be a part of the "new normal"—even if specifics around reimbursement, patient demands, and platforms remain uncertain. Despite those unknowns, it's clear that telehealth data governance will be a key part of that new normal. This presents a significant hurdle to providers, the majority of whom have not collected telehealth data in the past.

Our prediction:  

Data on the impact of telehealth on care quality and finances is crucial, both to understand internal provider performance and to inform conversations with payers about telehealth. Telehealth data will provide necessary guidance on what is and isn't working, and where there are opportunities for improvement or growth as providers continue to integrate telehealth services into standard practice.

Your next steps:

Providers should incorporate telehealth metrics into existing data collection platforms or ongoing quality improvement initiatives to ensure that telehealth data is usable and meaningful. Potential metrics to consider include number of virtual visits, downstream referrals, and ROI attributable to telehealth visits.

How Covid-19 is transforming telehealth—now and in the future

Covid-19 has transformed telehealth from a “nice-to-have” program into an essential element of care delivery. Parallel demands to limit patient travel, prevent potential exposure, and preserve clinical capacity all have telehealth as a solution.

The sudden attention from providers, payers, and consumers will also have enormous consequences for telehealth adoption in the future.

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