In recent years, telehealth emerged worldwide as an indispensable resource at a time when in-person visits weren’t an option. Telehealth undoubtedly provides many benefits for both patients and providers, including increased access to services, greater convenience, reduced clinical overhead costs, and deeper insights into patients’ lives. But telehealth falls short of comprehensive care for a growing subset of patients — those with significant and multiple chronic conditions.
Before we can consider telehealth as part of ongoing, longitudinal healthcare, there are major issues that need to be addressed, including integration with traditional healthcare services, and inequities among patient subgroups that arise out of economic, infrastructure, and technological barriers.
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Dr. Robert Mirsky Robert Mirsky, MD, MMM, FAAFP, has health plan experience across Medicare, Medicaid and commercial lines of business. He most recently served as CMO and VP Medical Operations for Aetna Medicare and has held several CMO leadership roles at companies like North Shore-LIJ, CareConnect Insurance Company, Tenet Health System and more. He is […]
We also need to integrate additional capabilities, such as remote patient monitoring, to get more comprehensive patient data and drive specific interventions.
Technology and healthcare as we know it today
Telehealth is a subset of the rapidly evolving field of digital health. Telehealth refers to patients’ ability to interact with physicians and therapists virtually, and also encompasses a number of remote monitoring capabilities, including pulse oximeters and blood glucose meters to treat conditions such as high blood pressure and diabetes respectively.
Historically, telehealth was primarily used to serve patients in rural populations who could not easily access healthcare facilities. Recently however, telehealth has quickly become the fastest growing modality for providing healthcare, revolutionizing how doctors and patients interact.
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Before the onset of the pandemic, the national volume of telehealth services was projected to reach 3.6 million visits. But telehealth usage surged during the pandemic as patients sought safe ways to access treatment and actual volumes exceeded 120 million visits at the height of the pandemic and through the rest of 2020.
The shortcomings of telehealth for vulnerable populations
The widespread adoption of telehealth indicates that this technology may actually exacerbate disparities in access, particularly when it comes to vulnerable populations in the U.S. including racial and ethnic minorities, non-English speakers, people with low incomes, and the elderly.
Take the population of seniors, for example. Over time, seniors who heavily rely on telehealth, may find themselves with less social interaction and be less likely to leave their homes after major life events such as losing loved ones or retiring. Primary care provided predominantly through telehealth services also limits a provider’s ability to perform physical examinations and doesn’t get seniors into interactive settings that can help combat the effects of social determinants of health, like loneliness and isolation.
To provide more comprehensive care that holistically improves health outcomes for vulnerable patient populations, care teams need to integrate digital advancements — remote monitoring devices, virtual visits, mobile health apps — with longitudinal care plans, peer support, and programs that address social determinants of health.
The future of the care team and tools they’ll use
As technology evolves, we can continue to develop innovative care models that leverage telehealth services to improve patient care. The concept of the provider needs to move well beyond the physician, to include the use of digital tools as well as a multidisciplinary care team, family, caregivers, and peer support. Telehealth that adds rather than substitutes holds the promise of more effective, equitable, and accessible patient care for even the most vulnerable populations.
The combination of digital technologies with more traditional healthcare allows care teams to unobtrusively track health states and outcomes in a way that only technology or brick-and-mortar hospitals cannot.
Take, for example, someone with congestive heart failure who has gained weight. With a digital scale and a wearable device that measures vital signs, a care provider can monitor fluctuations in oxygen and pulse to know if the patient is at risk for a congestive heart failure exacerbation, allowing for early intervention.
Additionally, by integrating peer support into comprehensive treatment plans, we can help close the growing communication gap between patients with chronic conditions and the doctors that support their care. While peer support is rarely integrated into traditional treatment plans, studies have shown that it improves clinical outcomes for a wide range of chronic mental and physical health conditions by fostering recovery and promoting empowerment.
Peer support efforts that are designed to fulfill the unique psychosocial and health needs of people with chronic health conditions, can actually have an positive impact on them, and in some cases, can lower hospitalization rates.
The more we view healthcare holistically, as an ecosystem comprising patients, physicians, caregivers, and technology, the better we will be able to improve patients’ health outcomes and overall quality of life.
Photo: elenabs, Getty Images
Robert Mirsky, MD, MMM, FAAFP, has health plan experience across Medicare, Medicaid and commercial lines of business. He most recently served as CMO and VP Medical Operations for Aetna Medicare and has held several CMO leadership roles at companies like North Shore-LIJ, CareConnect Insurance Company, Tenet Health System and more. He is currently a Better Health medical advisor.
Dr. Mirsky has practiced family medicine for 10 years and completed residency and chief residency at St. Joseph’s Medical Center in New York. He is dedicated to helping seniors age and thrive by addressing the medical, emotional and social determinants of health with a focus on mitigating isolation and loneliness through face-to-face and virtual engagement. He is a known expert in care management and disease-specific initiatives, primary care and retail health, and post-acute facility settings. Additionally, he has experience in network management, provider profiling and medical economics.
