“Digitization is finally coming to healthcare.” For years, we have been hearing some version of this phrase.
Yet, the vast majority of us will still pick up the phone to make our next doctor’s appointment, go to the visit in-person (likely needing to take precious time off work) and then wait several weeks for a bill to arrive by mail.
Why the disconnect? Any health system leader knows this needs to change, so why is it so hard to make progress on our telehealth agenda? Given the complexity of the health system, lack of meaningful consumer empowerment and the maze of mixed financial incentives, it should be no surprise that change has been slow. Given the glacial pace of progress, it would be easy to dismiss healthcare’s digital transformation. Yet change is coming.
We are at an inflection point in telehealth. It took Teladoc, the country’s largest telehealth company, 10 years to conduct its first one million visits; it now does that many in a period of months. The Centers for Medicare and Medicaid Services (CMS), states and commercial payers are rapidly removing barriers to telehealth reimbursement, which is hastening adoption.
Offering virtual care services to consumers used to be a “nice-to-have,” but it is now a “must-have” in order to enable high-quality, patient-centered care and keep up with new market entrants. In a world where access to expertise and care are less tied to physical presence and where information exchange allows for greater coordination, telehealth services hold great promise for improving quality outcomes, access to services and efficiency in our healthcare delivery system.
We are also moving into the “post-pilot” period. A single physician practice or department-based program is no longer enough. Developing virtual care capabilities requires a systemwide strategy that gets woven into the operations of every health system.
The first step for health system leaders is to identify the unique value proposition that telehealth can offer their system. For example, a community hospital in rural Texas is going to have a very different clinical, financial and operating model than an academic medical center in Houston. So, each health system is going to need to deploy different telehealth capabilities and services. The rural community hospital can realize real benefits from deploying a tele-critical care program to retain patients who would have otherwise been transferred, and the hospital will see improved outcomes in the process. The academic medical center would benefit from using telehealth as a platform for enhancing clinical integration with its affiliated network hospital partners.
As healthcare financing moves toward more value-based payment models, telehealth strategies can promote efficient and effective venues for care that simultaneously enhance the patient experience and quality outcomes. Even in the fee-for-service world, telehealth can help health systems more efficiently deploy expertise and resources to optimize existing capacity. Telehealth support for care that can be delivered at a community level can free up high-acuity bed capacity for regional centers.
Based on our work with several health systems over the past few years in developing and launching systemwide telehealth efforts, we have made the following observations about what makes a successful telehealth program:
1. Each health system exists in a unique market with various financial incentives, physician structures, technology capabilities and clinical priorities. It is essential to be explicit from the very beginning of one’s telehealth journey about what problems you are trying to solve.
2. There is no substitute for leadership commitment and accountability. The health systems with the most successful telehealth programs also have the most committed CEOs and senior leadership who have placed clear accountability with a single executive who is responsible for systemwide telehealth efforts.
3. The surest way to have a smaller-than-desired telehealth program is to give it smaller-than-desired resources. We have observed a direct correlation between a program’s level of resourcing and the success of that program in terms of virtual visit volume and return on investment or ROI. In addition, the level of resources should be proportional to the size of your system. A single hospital may have a well-resourced telehealth program for $2 million to $3 million per year, whereas a 10-hospital system should be investing several times that amount.
4. Focus is critical. Scaling one or two telehealth programs across a system will bring disproportionate value than launching 10 different pilot programs using different technologies and across different clinical domains. Clinical and administrative leadership should drive this prioritization, and once they determine prioritized programs, leadership should commit to supporting them and be willing to say no to others.
Health systems that do not aggressively invest in and build out their virtual care capabilities will be at a strategic disadvantage in the future. Traditional boundaries of geographic competition will continue to fall away in a world in which world-class medicine will increasingly be available on consumers’ cell phones. Considering these lessons learned, figuring out what works for your system, ensuring leadership commitment and accountability, allocating appropriate resources and maintaining focus can aid health system leaders in accelerating the development and deployment of their telehealth efforts.
Ben Chu, M.D., is a senior advisor, and Jared Augenstein, is a senior manager, at Manatt Health.