Telehealth 3.0: Advancing from sprawl to smart, strategic growth

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Telehealth is here to stay. In 2020, virtual health solutions and stopgaps were sped into place to enable the delivery of healthcare during the COVID-19 pandemic. These solutions — which provide important benefits for patients and providers — have now become a permanent fixture in healthcare. However, as hospitals, health systems and health plans contemplate their future digital care strategies and investments, they are realizing they must pursue a more strategic and integrated approach to ensure that virtual care continues to fuel a higher quality and more seamless care experience.

To better understand the virtual care landscape, the barriers that remain and the outlook for the future, Amwell partnered with HIMSS Analytics on a survey of 100 front-line clinicians and support staff, 102 senior leaders at hospitals and health systems, and 100 health plan executives. The results were reported in Building the Future of Virtual Care: Streamlined, Scalable, Sustainable.

This article is based on the Amwell survey, research included in the report and conversations with Amwell executives Ali Hyatt, Vice President of Marketing, Jamile Mack, Sr. Account Director, Provider Solutions, and Jalpa Sheth, Account Director, Health Plan Solutions. They shared their observations and insights about the future of telehealth.

During the peak of the COVID-19 crisis, telehealth became mainstream

Prior to the pandemic, telehealth was in phase 1 — a decades-long incubation period in which telehealth users and use cases increased incrementally over decades.

But overnight, due to the COVID-19 pandemic, that slow, incremental progress turned into explosive growth, ushering in phase 2 of telehealth.

The data tells the story. In the fourth quarter of 2019, there were 1 million telehealth visits, representing just 1 percent of all healthcare visits, according to the COVID-19 Healthcare Coalition Telehealth Impact Study. Then, in the first quarter of 2020, there were 5 million telehealth visits, accounting for 5 percent of all healthcare visits. The number grew to 33 million in the second quarter of 2020, representing 37 percent of all health visits.

Throughout the early and most intense periods of the pandemic, telehealth was the only game in town. It proved to be a lifeline for many patients and providers. For many provider organizations and clinicians, the immediate focus during this time was launching and scaling telehealth solutions as quickly as possible to meet the overwhelming demand.

“Oftentimes in a matter of days, clinicians had to figure out how to see their patients,” Hyatt observed. “As a result, 2020 was understandably about speed, not strategy.”

Making telehealth a more sustainable part of care delivery

In the second half of 2020 the percentage of virtual visits has stabilized at around 22 percent of visits, below the peak in the early days of COVID-19, but still far above the level prior to the pandemic. “We’re entering a new phase of telehealth,” Hyatt said.

In Mack’s view, “As telehealth enters a new phase, healthcare leaders are reconsidering the role that it will and should play in care delivery and in their organizational strategy over the long term.” In this new phase, the emphasis has shifted from reacting amid a crisis to proactively and strategically adapting for the longer term.

Key drivers of this new phase include:

  • Patient demand for telehealth. By now, almost all patients have had a telehealth visit. During their last telehealth visit, 8 in 10 consumers had a positive experience, per a recent report from the COVID-19 Healthcare Coalition. Hyatt pointed out that 41 percent of patients said they would have chosen telehealth over an in-person visit for their most recent appointment and another 26 percent viewed telehealth as interchangeable with an in-person visit.

  • Clinicians see benefits in telehealth. Virtually every clinician has had experience with telehealth, and most have a favorable view, citing benefits of improved patient access (82 percent), increased efficiency (52 percent), improved patient experience (51 percent) and a more flexible work-life balance for themselves (43 percent).

Clinicians don’t see the use of telehealth declining. For their own practices, a majority expect telehealth to either increase or remain at its current level.

  • Use cases are diversifying. The use cases for virtual care are expanding beyond the most common initial use cases of urgent care and behavioral health to primary care, chronic care management, follow-up visits after surgery or hospital stays, specialty care and more. As telehealth use cases broaden, telehealth volume will continue to grow.

Despite telehealth’s positive momentum, challenges and barriers remain

While consumers and providers are enthusiastic about telehealth, and the benefits are clear, long-standing barriers to adoption and use remain. However, those barriers vary among clinicians, hospitals and health systems and health plans.

Despite their general acceptance of telehealth, many clinicians remain hesitant about ramping up virtual care. About half of clinicians (51 percent) continue to cite a preference for in-person visits, and some questions remain about clinical appropriateness. Also, clinicians have uncertainty around reimbursement for telehealth visits after the pandemic.

Among hospital and health system leaders, staff resources to implement virtual care is a key barrier, as is reimbursement uncertainty. For health plan leaders, barriers include a confusing telehealth member experience and lack of awareness among members about a plan’s virtual care offerings.

In addition to clinician hesitancy, reimbursement uncertainty and staffing issues, common to all stakeholders are technology challenges, which have emerged as important pain points. Two major themes are an excessive number of virtual care platforms and lack of integration and interoperability.

Excessive virtual care platform. “With urgency at a high [during the pandemic], payers, provider organizations and clinicians all turned to the quickest options available so patients could continue to get care,” Sheth said. “The result, however, was ‘platform sprawl.’” Amwell’s research found that the majority of health plans and providers are using at least three platforms/ systems for virtual or digital care — and more than one-quarter have five or more platforms. “There’s an excessive number of systems out there to support virtual care,” Hyatt said. “A lot of this was because of decentralized planning during the pandemic.”

  • Lack of integration and interoperability. These disparate virtual care platforms often don’t integrate with EHRs, aren’t integrated with an organization’s workflows and aren’t able to share data with other systems and platforms. Many clinicians say that virtual care systems and workflows are not at all or are hardly integrated with their organizations’ existing systems. The use of a number of disparate solutions is leading to a confusing and frustrating care delivery system and experience.

Stakeholders plan to increase their telehealth investments but want consolidated, integrated solutions

Telehealth is now entering its third phase (“Telehealth 3.0”), which can be defined by a shift from pandemic-fueled expediency and sprawl to consolidation, integration and purposeful central planning. During the pandemic, the rapid adoption of telehealth was about speed. Now, as organizations prepare for the future, virtual health investments and decisions require a cohesive vision and a clear strategy.

In taking a more strategic approach, the majority of hospitals and health systems (56 percent) are planning to increase their virtual care investments over the next two years. Among health plans, meanwhile, a majority of the plans that don’t yet have specific virtual care offerings (such as virtual primary care) in place today intend to add them over the next two years.

The primary factors driving telehealth investments are greater patient access, improved patient outcomes, increased patient satisfaction, lower costs and return on investment.

“It’s critical that health systems and provider organizations are able to streamline the management and support of the technology they deploy for virtual care services. When you consolidate to one system or solution it’s much more scalable. It’s less resource intensive to support, train, educate, and manage the solution and it’s easier to streamline the clinician and patient experiences, Mack said.

Key themes and focus areas for telehealth investments center on supporting increased telehealth volume, ensuring a seamless and easy-to-use experience for patients and providers, achieving greater integration and interoperability in terms of workflow and data-sharing, and equipping the organization with a scalable, sustainable enterprise-level digital infrastructure.

“The top two things health plans can do to overcome existing barriers are 1) improving member awareness by utilizing marketing strategies that are targeted, that let members know about the benefit and availability of telehealth, and 2) invest in technology where plans can integrate all their different services onto one platform, so that they can easily enable a single, centralized and seamless member experience,” said Sheth. The vast majority of hospitals and health systems want a single virtual health platform that is secure, compliant and fully integrated.

“Stakeholders broadly agree on the core elements that need to be in place: a streamlined experience for patients and providers, interoperability of platforms as well as data and a nimble, sustainable infrastructure that can support future growth,” continued Mack.

Conclusion

Telehealth is now a critical piece of the healthcare ecosystem. Telehealth 3.0 is about consolidation, integration, interoperability and purposeful planning. It is about having a single, easy-to-use, secure, integrated virtual care platform.

“Everyone is operating on multiple virtual health platforms, but what they actually want is a single integrated platform,” Hyatt said. “They want to be sure they can see the whole picture of the patient. They want everything to work together . . . this is the promise of one integrated system.”

This single integrated system is what the key players in healthcare are envisioning, investing in and actively working toward. Hyatt concluded by saying, “At Amwell, we’re helping health systems and health plans move from of platform sprawl to a future of smart, streamlined, strategic telehealth growth.”

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