Telehealth & Covid-19: Past, Present & Future

Over the past year, a lot has happened, is still happening and is going to happen in the Telehealth universe. At the height of the Covid-19 health crisis we’ve seen an unprecedented growth of telehealth followed by a dip in utilization as people were trying on “hybrid care”.

Now, a year into the widespread use of telehealth, it’s time to reflect on the past, present and future of telehealth.

The Past: Spring to Winter

I’m not one to dwell on the past too much except to learn from its lessons. Having lived and worked in this Telehealth Universe since the mid 2000s I had seen firsthand how progress to improve access to care to one of the most vulnerable populations was being hampered by a, in hindsight, seemingly silly Medicare rule. As the rule was lifted in the Spring of 2020, it was definitely refreshing and surprising to experience how swiftly that limitation was removed.

I’m talking of course about the limitation put on the location of the patient for a telehealth visit: they had to be located in a county designated as rural (by the “Office of Management and Budget” – not CMS) and present at a healthcare setting such as a clinic or a nursing home. Last time I checked, the total population of those counties accounted for less than 20% of the US population. Consider those who actually had access to the transportation to get to such a clinic location easily, even less people had true access.

What is to celebrate, however, how quickly congress came together to remove that hurdle – and I give credit to the numerous bills that had been introduced over the years to remove that barrier (but stalled in the house or senate) and to the creative work of the CMS Innovation team to find work-arounds to create ways to actually pay for telehealth, since they clearly saw the value (even though their hands were tied by the statute).

Over the past months many organizations, companies, and individuals have been lobbying congress to ensure that that origination limitation (which only applies to Medicare, not Medicaid or commercial insurers) stays lifted — for good. I’m very optimistic that this will be the case, but politics and political strategies with bills are not always straightforward or logical, so there is a bit of uncertainty.

Other great things we saw in the past 12 months are people pulling together and loaning or donating equipment to clinics so that clinicians could perform telehealth to keep patients and staff safe. I remember the price from the most used HD webcam going from $70 to $300 in a matter of days and saw people lending their webcams to clinicians or bringing their own from home.

Another impression that stands out for me after singing the praises of telehealth for so long is how quickly accepted, for the most part, telehealth visits were, as they became the new norm. True, not all patients liked the idea and many physicians were uneasy, but many realized that this really is a viable way to deliver and to receive care.

The Present: Spring 2021

So where are we now with Telehealth? As the vaccines are being rolled out, as (hopefully) the last waves of infections are moving through our communities, healthcare leaders are beginning to focus their attention on telehealth asking: What Now?

For the most part, those health systems who already had telehealth in place before the pandemic, have now doubled or tripled down on adoption and are beginning to make telehealth a key part of their future care delivery strategy.

Then there are those who initially saw telehealth as an interim stop-gap measure to be used only during the health emergency. Many of those leaders are now beginning to recognize that Modern Healthcare Consumers strongly prefer to receive their care virtually and that if they do not serve them, another health system, online-only clinic, or the health insurance-sponsored telehealth vendor will.

There is still a lot of anxiety, though, around the long-term viability of telehealth reimbursement. As I’ve written about before, the situation for reimbursement was already pretty good B.C. (Before Covid), though there are some nuances that affect especially the vulnerable populations.

For example it wasn’t until last June 2020 that FQHCs were allowed to serve their patients via telemedicine. This is another example of an ill-advised strategy that seemingly surmised that since FQHCs are to serve the underserved in the local region, they should not be allowed to offer “care at a distance” which could transcend their geographic area. I don’t think the people who write these policies ever lived in a rural community, on food stamps with no or unreliable access to transportation.

So in the present that uncertainty lingers and virtually everyone is also expecting that over time the reimbursement fees for telehealth will go down. But I keep my hopes up that somehow this crisis can be used to accelerate the move away from fee-for-service to value-based, outcome based care, so that the discussion whether to use the phone, video, text, or in-person becomes a moot point.

Another focus of energy I’m seeing these days is to evaluate the fit of the technologies that people started using quickly in response to Covid-19. As organizations are realizing that telehealth is here to stay they are looking at the most valuable, most useful technology that can support their clinicians and provide a good user experience for all involved.

And over the past years, many great telehealth-focused niche players have developed well-performing, well-integrated platforms that are worse checking out.

The Future

From my point of view the future for telehealth looks incredibly bright. The widespread acceptance of telehealth as a clinically viable care deliverable tool has opened the doors to a number of unique opportunities.

For one, there is now an increasing willingness by many in general to employ technology in the delivery of care. This is extending beyond video chats to using remote physiological monitoring (RPM) solutions to not only manage chronic care or prevent readmissions, but also to create a “hospital at home” solution that lowers cost and promotes healing. And over time RPM solutions will be used for niche applications, like that prenatal/postpartum monitoring startup I am currently working with, which will revolutionize how moms can receive state-of-the-art care support during and after their pregnancy.

The widespread acceptance is now also opening doors to leverage telehealth to support underserved communities, the disabled, the vulnerable, etc. One startup I’m working with is focusing on the LGBTQ community especially in rural areas. Another startup that approached me is focusing on a comprehensive healthcare service that includes telehealth for minority communities.

The Mayo Clinic, where I learned about excellent care delivery from the best, distinguishes itself by offering access to the truly best in their field. My favorite example is the small-bowel transplant surgeon that focuses on infants and toddlers. He may be one of only a handful in the world to have done 100s of those surgeries.

With the geographic barriers to care removed by technology, we will eventually have access to sub-sub-specialty care services virtually from everywhere. Another startup I worked with focuses on general men’s health, but has plans to eventually pivot to specialize in treating rare and unique conditions.

To me, Telehealth is now the rocket fuel of accelerating revolutionary access to care.

And I’d love to ride in that rocket and steer its course across the whole Telehealth Universe.