COVID-19 cemented telemedicine trended into the fabric of healthcare delivery. It proved invaluable during the peak of the first wave of the pandemic – driven by necessity and fostered by an abundance of regulatory and health plan payment relaxations, waivers, and accommodations. Providers scrambled to have a tool in place, and usage skyrocketed – by 50x or more at many organizations.
Yet lurking behind every boom is a potential falloff. Telemedicine is no exception which means its future remains somewhat ambiguous. Since May telemedicine usage has tapered, as shown in the graph below.
This is not a boom-to-bust scenario, however. It is more of a boom to new baseline. Pre-COVID-19, telehealth constituted a very small percentage of overall visit volume. A recent study, Telehealth and Appointment Volume during COVID-19 from WELL Data Insights estimates that through 2020, telemedicine will remain at about 15% of overall visit volume.
Trajectory of Telemedicine
Many factors will influence the long-term trajectory of telehealth, five key ones are:
- Telemedicine relaxations and waivers: The continuation of telehealth relaxations and waivers implemented in response to the Public Health Emergency, including lifting geographic and site-of service restrictions, broadening allowed billing codes, and expanding coverage for services such as remote patient monitoring.
- Payer parity and normalizing: Most states now require private health plans to treat telemedicine services the same as they do in-person visits (parity), but “parity” is varied. Some states require insurers have coverage parity, some require payment parity and some require both. In addition, during the early months of the pandemic, many health plans waived copays and deductibles. In the past two months, some of these waivers have been eliminated – but not consistently across payers – and sometimes not consistently across a payer’s plans. Addressing these inconsistencies can increase adoption and immensely reduce the complexity and volume of rework for billing and coding staff when submitting claims.
- Consumer demand: Studies clearly show consumers appreciate the convenience of telemedicine and its safety, at times of high risk. Future demand will depend greatly on out-of-pocket cost, usability and experience. Now that they have tried it, however, 76% of Americans in a recent consumer survey now say they are interested in using telemedicine going forward.
- Physician / provider adoption: Rapid acclimation to telemedicine allowed providers to see patients, monitor high risk patients and support revenue short-term. For many providers to fully embrace telemedicine, a clear ROI and optimization of systems and workflows will be needed.
- Telemedicine vendor capabilities: In many cases the first wave of telemedicine tool adoption was driven by two requirements: low cost and fast implementation. Vendors will need to mature their products, bolster support and services and remain price-to-product competitive to support the value proposition of telemedicine.
Setting Your Telemedicine Direction
With so many forces at play, its essential providers strategically evaluate and plan an approach to telemedicine specific to their goals, patient populations and practice. To prepare you must:
- Know your market. Telemedicine adoption has not been universally consistent and likely never will be. It’s important to identify and understand the variables – including demographics, geography, weather, disease prevalence and payer mix that make up your market to fully evaluate the ROI of telehealth. For example, the WELL study found significantly higher sustained telemedicine adoption in Millennials and in Pacific states. Americans 55+ have historically been somewhat resistant to using telehealth, but a 2019 study by AmWell found 52% of seniors are willing to use telehealth particularly for prescription renewals (84%) and chronic care management (67%).
- Market to your market. It’s also important to understand your patient population’s appetite for telemedicine; you should then plan and market to your patient base accordingly. If you’re “all in” on maximizing telemedicine in your practice and you understand your patient population disease / risk mix and demographics, your communications and investments can be targeted to achieve that goal. If you determine telehealth won’t be a large-scale component of your practice, your messaging and investments will look very different.
(“other data suggests Americans 55+ are more resistant to using telemedicine (although its use is still on the rise). ” Based on the info in the survey below, change to ” Americans 55+ have historically been somewhat resistant to using telehealth, but a 2019 study by AmWell found 52% of seniors are willing to use telehealth particularly for prescription renewals (84%) and chronic care management (67%)
- Ready your staff and systems
Now’s the time to step back and evaluate / optimize your…
- Telemedicine platform: Because of the urgencies created by the pandemic, many rules and regulations that previously restricted or forbade the use of unsecure consumer technologies such as Zoom or Facetime were relaxed in the interest of expediency. Going forward, telehealth tools will most certainly need to meet all HIPAA requirements and industry best practices. Each provider will need to determine its investment in telehealth technology, based on its unique market, position on telehealth, must-have vs. desired functionality and overall long-term product roadmap.
- Coding and billing: The telemedicine coding and reimbursement landscape will continue to shift over the next several months. Ensure your coding staff stays apprised of changes, is trained accordingly and has the capacity to manage the complexity and nuances of revenue optimization.
- Patient and provider experience: Your plans for delivering a patient and provider experience that meets or exceeds the satisfaction levels of an in-person visit will be inextricably linked to and informed by your market, your patient outreach and your telehealth product. Telemedicine, and the patient and provider experience around it, is not one size fits all, but there are some consistent experiential considerations to address, including telemedicine technical support, patient scheduling, provider ergonomics and workflow.
We are at a fascinating inflection point, particularly for ambulatory care. We still operate as “high touch” but COVID-19 has shown us the value of “high tech.”
Going forward providers will need to find and maintain their unique balance of the two in their telehealth strategy. Having a holistic understanding of your market, your appetite for telehealth and your internal and system capabilities are important first steps to achieving that balance.
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