MedCity Influencers, Payers

Why insurers should continue covering telehealth post-pandemic

Sustaining the momentum that telehealth has due to Covid starts with a commitment to building positive incentive structures that will redound to the benefit of patients, providers, and payers alike.

Before the Covid-19 pandemic arrived, the burgeoning telehealth market was on a sluggish trajectory, with low adoption rates despite advancing technology.

Experts predicted that this would change gradually over the next three to five years. More digital natives would become parents and spurn the analog experience of making trips back and forth to their children’s pediatricians’ offices, preferring to save time and reduce stress with virtual visits. Meanwhile, the on-demand, consumer-centric revolution that has disrupted a broad swath of industries would extend to healthcare, driving demand for telehealth higher.

But if a compelling set of positive incentives was supposed to convince key players in the healthcare ecosystem to embrace telehealth, reality had other plans. As the novel coronavirus outbreak spread last year, the pandemic fostered a set of negative incentives that sent usage of telehealth soaring by up to 175 times pre-pandemic levels.

Fearful of contracting the virus and facing lockdown restrictions, patients opted for digital alternatives over in-person medical appointments. Providers, meanwhile, turned to telehealth to stanch the bleeding amid plunging revenue. Insurers – both government and private payers – scrambled to support their members by providing reimbursement for digital care delivery.

As insurers plan for a post-pandemic world, now is the time to make this shift permanent. Here’s why telehealth is indispensable to the future of healthcare – and how payers can make the transition to a virtual-first model of care.

The Why

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It took a global pandemic to drive widespread adoption, but the verdict has long been in, and now it’s clearer than ever: Telehealth works.

A nationwide survey of 1,594 physicians tells the story. Three in four clinicians reported that telehealth services enabled them to provide their patients with quality care, with 60% saying that telehealth has improved their patients’ outcomes and 80% indicating that it has facilitated timely access to care. Meanwhile, 61% agreed that telehealth helped improve care delivery costs. It’s little surprise, then, that more than two-thirds of physicians plan to increase their usage of telehealth tools moving forward.

Pre-pandemic research also shows that telehealth is especially effective at driving down costs and achieving quality outcomes for patients – a true win-win.

Telehealth’s promise extends from pediatric visits to geriatric care. As senior citizens’ share of the population climbs over the coming decades, millions more people will be living with chronic conditions – and telehealth services like remote patient monitoring (RPM) will be essential to keeping up with increased healthcare demand.

Beyond providing an effective alternative to in-person care across a wide range of use cases – including urgent and primary care, chronic and complex care, and behavioral health – increased telehealth will also mean improved access to care for patients in areas facing provider shortages across different specialties.

The How

While negative incentives may have fueled last year’s telehealth surge, focusing on positive incentives for adoption will be critical to cementing telehealth’s long-term role in the future of healthcare.

Reimbursement and parity will need to be better defined and more predictable across government and private payers in order for practices to optimize their resource planning and provide effective virtual care. Mainstreaming a virtual-first plan design has the potential to unlock a new era of value-based care – provided that the telehealth solutions being implemented are designed with the entire continuum of care in mind.

Making the transition work will require advanced solutions that augment and improve upon current telemedicine approaches that rely on phone- or video-only visits. To fulfill its promise, telehealth must cover a greater depth and breadth of clinical use cases, without compromising on the quality of care. That entails a future in which clinical-grade telemedicine technology is a consumer household item that acts as consumers’ gateway to care, supports the collection of clinical exam data, and performs diagnostics. These solutions must also achieve seamless integration of each virtual engagement with patients’ electronic medical records. This will be crucial to enhancing preventive medicine, improving patient outcomes, and providing simplified, coordinated care experiences that offset some of the negative side effects of virtual care, including increased usage of additive care.

Patients stand to benefit from lower premiums, out-of-pocket costs, and co-pays – in addition to the convenience of receiving care from the comfort of their own homes. When in-person visits are necessary, providers can receive in-network referrals after an initial virtual engagement.

Although the transition to digital healthcare comes with immense promise, it will fall short of its full potential if sufficient measures aren’t taken to address the digital divide. Expanding access to virtual care in community settings will empower even non-clinically trained caregivers, case managers, and community members to deliver care to those most in need – particularly senior citizens, communities of color, and the poor.

The Covid-19 experience generated undeniable momentum behind telehealth, accelerating innovation across the healthcare system. Sustaining that momentum starts with a commitment to building positive incentive structures that will redound to the benefit of patients, providers, and payers alike.

Photo credit: Sorbetto, Getty Images

Menahem Shikhman, TytoCare’s VP Business Partnerships, has over 15 years of experience working in the Medical Device and Healthcare IT industries. Meni holds a BS in Computer Sciences from Florida Atlantic University and an MBA from the Kellogg School of Management - Northwestern University. Meni spent a decade in a variety of senior roles at Abbott Diagnostics working on their state of the art informatics offering, design and commercialization, as well as in Digital Health Product Management, R&D, and Business Development. Meni also served as the Chief Software Architect for the Abbott Informatics Division. Most recently, Meni spent several years at CareDox, serving as the Chief Product Officer designing innovative Cloud and Mobile platforms to transform pediatrics.

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