The COVID-19 crisis spurred exponential growth in telemedicine. With many patients stuck at home and hospitals and medical offices inundated with COVID patients, many doctors, nurses, therapists, and other providers turned to their phones and computers for virtual patient visits. The practice transformed even the most routine healthcare, and many of those changes are here to stay. But there’s uncertainty when it comes to the special measures taken to facilitate telehealth during the crisis.
In December, Congress extended telehealth flexibilities enacted during the pandemic that enabled broad sectors of the healthcare industry to serve patients remotely. The provisions had been set to expire at the end of the official COVID-19 Public Health Emergency, currently slated for May 11. Now, many telehealth service flexibilities will last until the end of 2024 before rules change. This extension provides all players in the industry with a window of opportunity to demonstrate the ongoing value of telemedicine.
From patients to providers to payers, telehealth affords tremendous efficiencies. Unfortunately, it’s not all upside: telehealth has the potential to leave many people behind. People with language barriers, those who are not technologically literate, the elderly, and populations without broadband access are among the many at risk. Proving that the most vulnerable populations won’t slip through the cracks is essential to staying ahead of the legislative and regulatory scrutiny that will shape telehealth after 2024.
Doctors and Patients
Convenience has proven the most appealing aspect of telemedicine. Doctors have clearer, more efficient schedules, while patients cut out the hassle of getting to and from the doctor’s office and long hours in the waiting room.
But telemedicine, which refers to remote clinical services, is only one subset of telehealth, which includes the flow of data between providers, training, education, and administration. All aspects of telehealth are growing fast, enabling advances such as remote monitoring for people with chronic conditions, self-diagnostics, and better collaboration among providers — but not for everyone.
During the pandemic, telehealth clearly improved access for a large swath of the population. But it also exacerbated existing health disparities tied to poverty, language, disability, and age. Another major concern is connectivity. Many rural areas, and some urban ones, lack the broadband services needed to access online medical services. Current federal infrastructure programs are working to change this, but that will take time.
All facets of the healthcare sector must work to ensure these vulnerable populations, who are often hard to reach, are not excluded from telemedicine. Breaching this great digital divide will take a concerted effort.
Insurance and Risk
Insurers have leaned into telehealth, with some already offering virtual primary care plans. They were quick to recognize the business advantages of achieving better health outcomes at lower costs — the effectiveness and efficiency of this type of care delivery. They’ve clearly seen the upside in telehealth, but those benefits all hinge on access and the tech literacy of patients. Regulators will take notice of that.
In the years ahead, as the public health emergency ends and providers continue to bill, there will be increasing scrutiny about how these services address – or exacerbate – health disparities equitably. Payers will have to be thoughtful about their own programs to ensure that they address that challenge. That could mean tech access initiatives, patient and provider training, and even providing communication devices to patients in need, among other remedies.
Insurers who simply want to mitigate a regulatory or legal risk need to be thoughtful about how they roll out these programs and how to leverage the technology in an equitable manner. For those willing to go further, there's an opportunity to step up and be an industry leader. Not only is it the right thing to do, but it can also be a brand enhancer — proof of commitment to a better solution for all.
More directly, it’s prudent preparation for the coming scrutiny. We are still emerging from the crisis, but the dust is settling and a new normal will emerge for care delivery. Regulators will see that some companies are addressing disparities in this new normal and others are exacerbating them. Medicare and Medicaid have embraced telehealth. Government spending at that scale guarantees legislators and regulators will dig deep as they set new standards.
Getting Ahead
As the healthcare sector attempts to forge an equitable path forward, it’s essential that the solutions it develops are not imposed on those at risk of exclusion but informed by those at risk. This means substantive engagement through the community leaders who best know how to reach people in need.
Where do the most vulnerable live? What are their healthcare pain points? What are the barriers to health plan enrollment, and re-enrollment? What tech support services are needed, and how can they be offered so they’ll actually be used? Stakeholders in the success of telehealth need to hear from prospective patients themselves about what strategies and tactics would be most useful.
Getting ahead of legislative and regulatory scrutiny requires thinking deeply about the best ways to empower communities before developing and rolling out further telehealth programs.
In five years, telehealth will be the most conventional way in which people receive preventive and primary care. We must establish continued access to care for everyone. We have a tremendous opportunity to get it right, but the clock is ticking.
A former U.S. Senate health policy advisor and Policy Director for the Democratic Senatorial Campaign Committee, Ben Nathanson is leader of the Healthcare Practice at Ichor Strategies.
