The future of telehealth has never been discussed with more fervor; between numerous IPOs, Teladoc’s proposed merger with Livongo, and rising patient awareness, it’s difficult not to get swept up in the excitement. And yet, several crucial questions still loom. The biggest: who pays?
Since the start of the Covid-19 pandemic, both federal programs and commercial insurers have temporarily stepped up coverage for telehealth visits. The idea of permanently expanding telehealth services covered under Medicare has garnered widespread support, but how private insurers will react is less clear.
Dr. Roy Schoenberg, president and CEO of Amwell, the telehealth company that went public just last week, said payments for telehealth visits have not yet reached a point where they are interchangeable with in-person care.
“I think we have the right band-aids in place for telehealth to be utilized,” he said in a discussion hosted by CB Insights Future of Health. “But if you ask a clinician … ‘can you use telehealth interchangeably with physical care and that’s not going to compromise your revenue?’ I think most clinicians will say, ‘I’m not quite sure.’”
As long as that question exists, the default will be in-person visits.
“We need to get that clarity in place before clinicians will feel comfortable that they can use their discretion on where telehealth is appropriate or not,” Schoenberg said.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Telehealth visit numbers also reflect this. While virtual visits spiked early in the pandemic — Amwell said it saw its visits jump 300% in the second quarter — they’ve since begun to flatten as offices reopen. According to data from Epic Systems, telehealth volumes peaked in mid-April, when they accounted for 69% of all visits, and have since dropped to 21% of the total.
This might sound bad, but it’s still a significant improvement from telehealth usage levels prior to the pandemic — less than .01% of total visits, by Epic’s calculations.
“I think the numbers will be higher because people are much more comfortable and familiar with telehealth,” Schoenberg said. “(But) it’s going to subside from the days where this was the only way to go.”
From his perspective, he saw two waves of telehealth adoption: a big influx of worried patients turning to telehealth for urgent care, and a second wave of provider adoption. With the latter, he sees an opportunity to change how healthcare is structured, making it easier for a clinician to check in with a patient to see how they’re tolerating their medication, or letting people age at home, at least for a bit longer than before.
“The number of clinicians that started using telehealth and never stopped is the biggest change,” Schoenberg said. “That is the turning of a corner for telehealth that will become a resounding change in the way that healthcare is going to be structured in years to come.”
Photo credit: atibodyphoto, Getty Images
