The ability to offer telehealth services not only addresses a critical need at this time, it also signals to your members that you are their partner in health care and will provide support through a strenuous time.
The ongoing response to the COVID-19 crisis has the health care industry scrambling as hospitals, urgent care centers, and emergency departments quickly become overwhelmed with symptomatic patients. As people all across the globe are being encouraged to practice social distancing and health care providers look for ways to limit the number of non-urgent patients they see, the market demand for telehealth and virtual care is surging to expand access to care while mitigating the risk of spreading the virus with in-person encounters.
Prior to the current COVID-19 Public Health Emergency, there was a trend of increased adoption of telehealth services. On April 16, 2019, in a Final Rule notification, the Centers for Medicare & Medicaid Services (CMS) greatly expanded its acceptance of the use of telehealth services and opened the door for telehealth services to be used for risk adjustment purposes. And, in response to the Public Health Emergency, health care regulatory bodies and technology innovators have kicked into high gear to overcome barriers to the adoption and expansion of telehealth services to provide care to ambulatory patients without contributing to viral transmission.
On March 10, CMS released a memorandum on the Health Plan Management System pertaining to COVID-19 and the use of telehealth. Guidance was augmented on March 17, under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act, whereby CMS conveyed expanded authorization for the use of telehealth and encouraged its application where possible. These changes by CMS have significantly expanded the applicability of telehealth applications at a time of high demand and importance.
What is telehealth?
With so much talk about telehealth services right now, it’s necessary to take a step back and examine exactly what telehealth encompasses. In short, telehealth is the use of communication technologies and digital information to access healthcare services remotely. Avalere identifies and defines four telehealth services—live videoconferencing (a virtual health visit), store and forward, remote patient monitoring, and mobile health.
Benefits of telehealth
Telehealth is a white glove service that improves access to care and cost efficiencies while still delivering quality care. It extends the reach of health care to geographic areas with limited providers and health service facilities and improves access when there a shortage of providers. During times where consumer demand surges, such as during today’s current coronavirus pandemic, telehealth has the potential to provide care to millions of people in a safe setting. It also allows providers to see more patients than with in-home assessments and reduces unnecessary hospital admissions.
For health plans, telehealth can help establish and maintain member loyalty and improve member retention. Right now, many patients are concerned about face-to-face interactions with their health care provider, and for many more, going into a doctor’s office is inadvisable because of pre-existing conditions and an increased risk of complications from COVID-19. The ability to offer telehealth services not only addresses a critical need at this time, it also signals to your members that you are their partner in health care and will provide support through a strenuous time.
Telehealth is very similar to in-home assessments, a proven care delivery venue. Both are valuable for the evaluation and documentation of medical conditions, allowing gaps in quality and documentation to be addressed. In both cases, providers use member-specific analytics and automated tools to optimize quality of care and documentation. Analytically driven tools deliver member-specific gaps to be addressed and closed as appropriate. Limitations with point-of-care testing in a virtual health visit are becoming fewer as new ways of collecting information or specimens are used. For instance, a provider cannot take a patient’s blood pressure in a virtual setting, however, a patient can use a remote blood pressure monitoring device and share the result directly with the provider. Additionally, equivalent closure rates for documentation gaps are anticipated for telehealth visits and in-person visits.
Telehealth services provide care similar in value to in-person visits, while reducing stresses on patients with busy schedules and childcare or transportation needs. With in-home assessments, providers are traveling from patient to patient, but with virtual health visits, providers can see more patients in a day since travel time is eliminated. Not only does this optimize a provider’s use of time but increases patient satisfaction as more appointments will be available and patients can be seen sooner.
How telehealth services are expanding
As seen in Medicare Advantage with the $8.3 billion emergency response funding bill passed by Congress to temporarily increase access to telehealth, we expect other markets to follow suit and telehealth services to grow rapidly as nationwide we work to contain the COVID-19 pandemic. States are encouraged to waive Medicaid restrictions to expand access to telehealth. Increased use of telehealth services will reduce exposure to the coronavirus, slowing the spread of the virus and keeping the most vulnerable patients safe, without compromising access to care.
The U.S. telehealth market is expected to reach revenues of more than $13 billion by 2023, growing at a compound annual growth rate (CAGR) of approximately 27 percent during 2017-2023. Driven by the need to decrease the cost of care and increase patient access to clinicians, the U.S. telehealth-addressable market is estimated to be more than $30 billion currently. With an increased focus on telehealth due to COVID-19, it’s likely that we will see accelerated growth and more telehealth service providers enter the market in 2020 as healthcare evolves in response to the pandemic.
When to use telehealth services
One-third of all doctor, urgent care, and ER visits are either unnecessary or could be handled safely and effectively over the phone or by video. Furthermore, hospitals are becoming overwhelmed with patients diagnosed with coronavirus, creating a shortage of hospital beds and medical equipment. People who are feeling ill are encouraged to consult with a provider using telehealth services to get the required care they need without burdening medical facilities and freeing up providers on the front line to care for those who have contracted COVID-19. Many conditions, even chronic conditions, can be managed in a virtual setting safely and effectively.
Virtual health provides high-quality care while mitigating the cost of traditional in-person visits. And as the nation is battling the COVID-19 pandemic, telehealth services are just as critical to the health care system as medical facilities—telehealth has the capacity to deliver care to millions of people from the safety of their own home, assisting in the containment of the virus and freeing emergency medical personnel and resources for those who need them most. After the coronavirus curve flattens and social distancing becomes a thing of the past, telehealth services are expected to remain a key modality in a transformed healthcare industry.
About the author 
Paige Kilian, M.D., serves as chief medical officer (CMO) for Inovalon. For over a decade, she has led a team of more than 20 clinical personnel who bring the latest best practices and evidence-based clinical standards to Inovalon’s products and services. Dr. Kilian is highly involved in the clinical design, implementation, execution, and improvement of Inovalon’s portfolio of health care data analytics solutions, clinical data review tools, and clinical data integrity and quality oversight programs. In addition, Dr. Kilian is responsible for clinical training and oversight of Inovalon’s internal clinical personnel, as well as partners and vendors.
Prior to joining Inovalon, Dr. Kilian was in clinical practice with Johns Hopkins Community Physicians, where she served as medical director with responsibilities including patient care, clinical training of medical students and residents, and clinical oversight of a multispecialty practice. Dr. Kilian graduated summa cum laude from Washington and Lee University and received her medical degree from Tufts University School of Medicine. She completed her residency in Internal Medicine at Johns Hopkins.