The COVID-19 pandemic has accelerated the adoption of telehealth and there is a general consensus, including from White House leaders, that virtual care is here to stay.
In response to the COVID-19 pandemic, the Trump administration has opened up access to telehealth with sweeping—but temporary—changes to reimbursement policies.
"Rather than just wholesale transformation, we have experienced an acceleration around transformations that were already underway," said Ryan Smith, chief information officer, Intermountain Healthcare, during a virtual event hosted by media company Protocol.
"With telehealth expansion we have transitioned from it being a disruptive technology and care delivery model to overnight being almost a normal part of healthcare delivery," he said.
It's expected that an upcoming Medicare payment rule will include proposals outlining how the Trump administration plans to permanently expand reimbursement for telehealth services. Legislators also have taken steps to permanently open up access to telehealth services for Medicare patients.
It's understood that there are some healthcare visits that must be done in person and virtual care will not completely replace in-office care. What remains up in the air is where telehealth volume will land going forward.
So what will the future of virtual care look like in a post-pandemic healthcare industry? During several online events in the past week, healthcare leaders weighed in on what's next for the industry's digital revolution.
"Having integration between virtual care and in-office care makes each much more effective," said Kimber Lockhart, chief technology officer at tech-enabled primary care group One Medical during the event hosted by Protocol.
"I think we’ll start seeing the connection between what was largely disparate provider groups providing either virtual care or in-office care and we’ll start to see more blended models, where, depending on the needs of patients, care can move between virtual and in-person channels seamlessly," she said.
Mario Schlosser, co-founder and CEO of health insurance company Oscar Health, said patients seeking care for behavioral health issues as well as chronic conditions largely shifted to virtual services during the pandemic.
"What that shows you is that there is a big chunk of healthcare that you can virtualize and members want to see it virtualized," he said during an Axios virtual event.
"We need to make sure that this shift to digital doesn’t create more utilization, but shifts utilization that should not have otherwise happened," Schlosser said. "I think there will be a blended approach and for as much care as possible it will be virtual first and then carefully orchestrated through the rest of the system for those things that need to happen in person," he said.
"From the time you arrive to the facility to conducting the encounter to being discharged, there is so much physical touch involved everywhere. I think that entire touchless experience is a highly valuable asset to work on to enable that consumer experience to make it safer. We have technology to do that today. Unlocking that touchless experience is a huge opportunity and we’re working to enable that," said Bharat Sutariya, Cerner's chief medical officer of population health, during the Protocol event.
Intermountain's Smith said the health system is thinking through how to redesign spaces for ambulatory care to leverage touchless technologies to minimize the number of people in waiting rooms.
Acceleration of next-generation technologies
One Medical wants to use technology to direct patients to the right venue of care, whether it's virtual or in-person.
"We're working on using machine learning and other strategies to understand what patients’ needs are and route them to the right place to get care," Lockhart said.
In the next five years, healthcare will move from a transactional experience to a continuous experience where patients have an ongoing dialogue with providers, Cerner's Sutariya said.
"The technology around us, ambient technology and the Internet of Things, using that to positively impact lifestyle, create healthy behavior and take care of chronically ill, that will pick up significant momentum. We have the advantage of Big Data, machine learning and artificial intelligence to help us with that and get it right," he said.
During the pandemic, the Centers for Medicare and Medicaid Services (CMS) has established payments for telehealth visits at the same rate as in-person visits.
Schlosser, for one, does not believe that payment parity is sustainable once the emergency period is over.
"I think this is going to be the battle to come. There is a huge opportunity to bending the cost curve in this shift toward digital and virtual, without a question. If we don’t use that window then a big opportunity of bending the cost curve goes away," he said during the Axios event.
He added, "That will either mean that telemedicine will get reimbursed lower than in-person care, which would, unchecked, bankrupt a bunch of providers. Or it could mean that in the shift toward digital you also have a similar shift towards at-risk care delivery. So, providers who have been at-risk during the pandemic, their business has held up pretty well."
At the same time, health systems and hospitals have made significant investments in telehealth infrastructure during the pandemic and these organizations want to ensure a return on that investment, said Tom Leary, vice president of government affairs at the Healthcare Information and Management Systems Society (HIMSS) .
Bending the cost curve
CMS and the Congressional Budget Office (CBO) will take a hard look at how the expansion of telehealth has impacted healthcare costs, industry leaders said.
"Clearly CMS doesn’t want to increase their spend. They are going to dig into to see what the current rate is going forward and the impact on outcomes and healthcare spend," said Domenic Segalla, principal, healthcare advisory services at accounting firm Withum during a recent virtual event hosted by HIMSS.
With the shift to virtual care, larger health care systems are concerned about what to do with their large brick-and-mortar footprints, Segalla said.
"Something we’ve been hearing from CFOs is we went through outpatient expansion and now with many of these E/M level visits and the potential expansion of services that can be done virtually, what do we want to do with this large footprint or large amount of real estate that we have?," he said.
"With the shift towards virtual care, if we didn’t pause to think about the role of physical space in our strategy that would be a mistake," One Medical's Lockhart said.
"As we are evaluating how we expand, we do believe in-person care is incredibly important and isn’t going away. There are many things for which in-person care is the only way to provide the examination or care that a patient needs," she said. "On the other hand, we have discovered there are some things for which virtual care may in fact be better. There are some conversations that are best had in a situation where patients are in a comfortable setting, such as behavioral health conversations."
Telehealth is now poised to take a bigger share of the healthcare market, according to McKinsey and Company. Up to $250 billion, or 20% of all Medicare, Medicaid, and commercial outpatient, office, and home health spend could be done virtually, according to the company's analysis.
"I think we absolutely see telehealth staying," Intermountain's Smith said. "Will it continue at the current rate that it is? A lot of that depends on the continued relaxing of reimbursements and it's also going to be highly dependent on the stage of the individual health system’s maturity, especially at it relates to value-based care."
The expansion of virtual care dovetails with trends around consumerization and transparency in healthcare, he noted.
"Everything is accelerated. Those organizations that haven’t evolved their models will be in peril. Certain provider organizations will fail. We’re going to be back to broader mergers and expansions again by virtue of those not able to make that shift from fee-for-service to fee-for-value," he said.