Telehealth experts see quality measurement as the vehicle for payment reform, consumer choice

Businessman video-chats with doctor on laptop
Defining telehealth quality gives insurers a way to ensure that virtual care is providing value.

New quality measurements released by the National Quality Forum on Tuesday could lay the groundwork for telehealth payment reform by giving payers a better grasp on how to define an effective program and expanding access to quality care

More broadly, the framework to measure telehealth quality will help vendors and providers adapt to a larger volume of users and allow the technology to become fully integrated with traditional care models, the co-chairs of NQF’s Telehealth Committee said during a media call on Tuesday.  

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“I think telehealth is going to grow leaps and bounds over the next five years and people in this field are going to have to figure out how to adjust the delivery of it and the expectations for it,” Marcia Ward, Ph.D., director of the Rural Telehealth Research Center at the University of Iowa, said during the call.

The committee’s other co-chair, Judd Hollander, M.D., associate dean for strategic health initiatives at Thomas Jefferson University, noted that although telehealth is likely to become more entrenched in the continuum of care, virtual consultations have unique aspects that make it impossible to compare them to an in-person visit. But, he added, telehealth needs to be able to meet the same quality demands.

For example, telehealth occasionally relies on “temporized care,” in which a provider may not be able to make a full diagnosis but can provide enough treatment for a short-term holdover until that patient can see a specialist or their primary care physician.

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Hollander—who began the session by pointing out that physicians have been doing informal virtual visits with family members “since the phone was invented”—recounted a recent telehealth visit during which he determined that a patient’s knee had not been fractured and provided him instructions on how to make a splint with some household objects. Had that patient gone to the emergency department, he would have waited hours to get x-rays and then see an orthopedist.

“I didn’t actually solve his problem, but we did save him a ton of time and money,” Hollander said.

Time, money and convenience make up a significant portion of NQF’s guidelines, particularly with the emergence of Accountable Care Organizations and the transition toward value-based payment models. But the framework also relies less on making an accurate diagnosis and more on ensuring that the encounter leads to actionable information and expands access to a broad range of rural and urban patients.

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Ultimately, the framework gives payers and providers a means of assessing program quality as consumer demand is expected to increase.

“We are hoping that payers will begin to pay for it because patients and consumers will want it,” Hollander said. “And as they are shopping for plans, they will look for plans that cater to their needs.”