Covid-19 has transformed the traditional doctor’s office visit as we know it, moving it away from physical offices by adding online connections. That doesn’t mean virtual care is the sole future of health care. Instead, I hope it will become part of a new balance that embraces the potential of anywhere care.
To get there, the United States will need two things: the technology to shift a greater proportion of care to the home combined with more intense collaboration among all health care stakeholders, from health systems and health plans to patients, providers, innovators, and the government.
Exceptional telehealth is more than a one-time virtual interaction. It’s part of a tightly choreographed network of care that meets patients’ health needs in timely, personalized, and creative ways that align more closely with their preferences. When done right, telehealth augments traditional care and enables a more holistic experience that purposely combines digital and in-person services.
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Beyond improving the patient experience, telehealth overcomes barriers to care, from access to specialists — many of whom have newly embraced telehealth during the pandemic — to transportation challenges that keep people from needed services such as behavioral health.
But without strong collaboration by multiple stakeholders, telehealth will be unable to move from single-visit transactions to a robust suite of virtual care services that evolve and improve in-person care. Unless we can make telehealth a more integrated part of the health care experience, the U.S. will be left with its current predicament — a health care system that is too expensive for consumers to afford or for the nation to sustain.
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Consider this: When telehealth is used as part of treatment for individuals with chronic conditions, the cost of care can improve by 2% to 3%. While that might sound small, it’s anything but small when you consider that 6 in 10 people in America have one or more chronic diseases and about 90% of the nation’s $3.5 trillion spent each year on health care is for those with chronic and mental health conditions. Imagine the potential efficiencies if health care’s key stakeholders can thoughtfully unleash digital care to become a core channel for care management and delivery.
This is happening in pockets. Over the past few months, we’ve seen momentum on the regulatory front, most recently in early August via an executive order by President Trump that aims to permanently expand telehealth benefits for Medicare recipients beyond the public health emergency declaration linked to the pandemic. I applaud this progress, but more must be done to build on the momentum that telehealth has accumulated during the pandemic. As a collective entity, health systems, health plans, patients, providers, innovators, and the government must focus on several objectives.
Clarity on policies around payment parity
As Covid-19 began to sweep across the United States, the Centers for Medicare & Medicaid Services (CMS) allowed providers to bill for telehealth visits at the same rate as in-person visits, and many commercial providers followed suit. These changes removed many pre-existing restrictions — including those on the type of visit and the location of care — that had prevented providers from understanding and effectively adopting the use of telehealth with their patients.
The effect was near immediate. My company, Amwell, experienced a rapid uptick in telehealth visits beginning in mid-March, which peaked at approximately 40,000 visits per day. Doctors delivering care through Amwell Medical Group hit a daily visit volume that was 240% above had otherwise been projected under a non-Covid environment. And our hospital clients’ providers were delivering virtual care at 2,000% above what we otherwise would have expected, not to mention onboarding thousands of new doctors onto the platform and into the world of virtual care delivery.
Payment parity has broadened telehealth’s reach during this time of need. For the first time, providers are getting paid for their services at the same rates whether they see a patient online or in person, motivating them to use telehealth to help their patients get the care they need. Across specialties, telehealth is now being broadly and proactively offered to patients as a new way to safely carry out a visit. While this may feel somewhat overwhelming and new to some clinicians, it feels like a godsend to many patients, including those who require frequent care for chronic conditions or belong to more demographics that are more vulnerable to Covid-19.
Some worry that payment parity could lead to fraud and abuse of health care services. This may be true, but bad actors will try to cheat any system, as we have seen over and over again. As another care setting, telehealth will be no different. That said, I believe that the inherent digital audit trail of telehealth, and providers’ ability to understand proper billing and coding for telehealth services, will make it easier for insurance companies to gain clarity on what care has occurred and what care should be reimbursed in the new virtual landscape, helping keep fraud at bay.
Greater clarity around how and where virtual care will be used in the future is essential. The uncertainty over telehealth policy and reimbursement after the Covid-19 emergency has faded is waylaying its adoption by a meaningful cohort of physicians, even those who used it and became its fans.
Support and protect providers
People typically think about virtual care in the context of what it can do for patients. During the coronavirus pandemic, many providers are seeing what it can do for them as well. In addition to helping maintain work/life balance, telehealth offers providers a much-needed lifeline during the pandemic, giving them a safe way to see, triage, and care for patients — both those infected with the virus that causes Covid-19 and those with non-Covid-19 health issues.
Before the emergence of Covid-19, each state required every doctor who treated one or more patients living in the state to hold a medical license issued by that state. To respond to the increased demand for care via telehealth due to Covid-19, the removal of state licensure restrictions allowed physicians to practice across state lines, which played a major role in allowing telehealth to step in as a national “load balancer” of medical services. For the first time in history, the nation could beam in specialists from where they were available to where they were needed most.
For example, 48% of acute care hospitals do not have intensivists on staff, especially critical care physicians who are trained to operate ventilators. The lack of intensivists — and more broadly, a labor shortage of emergency medicine providers — has been a major hurdle facing hospitals treating critically ill Covid-19 patients. Using telehealth, however, a surgical nurse could be virtually assisted by an intensivist in another hospital to assist in things like evaluating a patient, guiding an intubation, or learning to use unfamiliar clinical tools.
As the government considers lifting emergency declarations, it’s likely that restrictive requirements for licensing will be reinstated at the state and federal levels. As the pandemic progresses, such a move would leave many providers without support, forced to deal with an influx in demand for health care without the help of a nation of experts available instantly via video or other telehealth platform. This could leave patients with challenging conditions to be cared for by the clinicians who might not have all the skills their patients need.
Telehealth isn’t just video conferencing. It’s a powerful national distribution system for health care. Regulators should take notice: We can use telehealth to democratize the availability of health care around the country.
Keeping step with progress
It is more than possible that the advances telehealth has provided during the Covid-19 pandemic will evaporate once the state of emergency is lifted and the “old norm” is blindly reapplied. I hope this harm won’t be inflicted on us. Telehealth has finally come into its own, and integrating it into the new choreography of health care will let Americans experience more modern, more satisfying, and more equitable care.
Let’s keep moving forward, not retreat.
Roy Schoenberg, a physician, is the president and CEO of Amwell, a telehealth company.
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