So You Have Telehealth—Now What?

It has been more than a year since the Department of Health & Human Services (HHS) issued the COVID-9 emergency declaration and CMS relaxed rules regarding the provision of reimbursable telehealth services. After this announcement, the industry saw a rapid increase in the adoption of telehealth to safely deliver care during the pandemic. One study that looked at telehealth and office-based care utilization before and during the pandemic found that telehealth utilization increased /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230‑fold compared to the prepandemic period.

The public health emergency (PHE) is currently in effect but set to expire in mid‑July /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230/insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-2023, unless it is renewed.^[] Even if it’s not, Congress is unlikely to revert the telehealth program to its prepandemic state. Organizations such as MedPAC, which regularly advises Congress on Medicare payment policies, have recommended maintaining the expansion of telehealth beyond the PHE, with a few modifications (e.g., to control utilization, spend, and fraud). More recently, the secretary of HHS stated that the agency is “absolutely supportive” of making telehealth provisions permanent after the pandemic and emphasized the need to deliver quality and to not let telehealth increase disparities.

Now, during the second year of the PHE, it is clear that healthcare is no longer delivered primarily in brick-and-mortar locations and that patient demand for virtual care will persist. If your organization adopted telehealth over the past year and is now wondering what is next, here are the top five issues to consider going forward.

In /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230/insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230, healthcare organizations focused their efforts on quickly expanding, or adopting, the use of virtual care technologies. More than a year later, organizations that integrated virtual care into their operational strategy must optimize it to ensure patients have a consistent and coordinated experience in either virtual or in-person settings. The following four elements of a successful virtual care strategy are focused on the fundamentals and continue to be a priority at the organizational level:

• Service Lines: Virtual care is not well suited for every specialty or clinical pathway. However, elements of virtual care, such as asynchronous questionnaires, may be more widely applicable. Organizations will need to prioritize where resources should be deployed to provide the greatest benefits to patients and providers.
• Infrastructure: Inevitably, regulations that were relaxed as part of the PHE will return (e.g., use of HIPAA-compliant platforms). Anticipating the need for complying with these regulations by reviewing and implementing the requisite infrastructure to ensure privacy and security will allow providers and patients to continue using the virtual care technologies they have become accustomed to. Another imperative is the need to integrate the telehealth solutions into an organization’s IT infrastructure (e.g., EHRs, other clinical and operational platforms).
• Staffing: The introduction of virtual care visits interspersed with in-person visits has certainly affected clinic workflows and visit volume capacity. As such, it will be important to ensure that the appropriate staffing mix and related staffing ratios, along with workflow integration, are established across the patient journey to support virtual and in-person visits seamlessly and at scale.
• Revenue and Reimbursement: As regulatory policies continue to co-evolve with virtual care technologies, organizations must ensure their clinical and billing operations are set up to respond to changes to maximize reimbursement. At the same time, there is opportunity to negotiate optimal payer contracts to ensure parity between virtual and in-person visit rates.

The hospital-in-the-home model, which existed before the pandemic, was designed to allow patients to heal in the comfort of their own homes (with the assistance of remote patient monitoring [RPM] devices) and to free up hospital beds. The pandemic accelerated the need to provide expert care and engage patients in their homes to keep noninfected patients safe, and CMS responded by introducing the Hospital Without Walls initiative and then the Acute Hospital Care at Home program during /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230/insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230.^{[/insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-2023]} The latter makes it possible for approved health systems to treat more than 60 different acute conditions safely in home settings by following the program’s requirements.^{[/insights/blog/968/womens-health-5-trends-to-watch-for-in-2023]}

As the impact of the pandemic subsides, more hospitals will begin offering the hospital-in-the-home model as part of the standard of care, and patients will want the option as well. Although virtual visits are one component of this model, healthcare organizations will need to invest in additional technology and programmatic development to augment the hospital-in-the-home experience.

Many health systems and independent practices use RPM, which is an established patient care method and often focuses on managing specific diseases (e.g., glucose monitoring for patients with diabetes). Connected technology expands on RPM to include any device or service that allows the recording and sharing of information to be used to deliver patient care, including but not limited to:

• Online screening questionnaires that direct patients to the right care setting.
• Use of predictive intelligence to identify patients at risk of falls.
• Home-based sensors that allow frail patients to live more safely and independently.
• Patches that can be worn for cardiac or continuous temperature monitoring.

During the pandemic, connected technology became an important component of caring for vulnerable patients outside of a remote visit and keeping them out of the hospital, where they could contract COVID-9. Beyond the pandemic, RPM and other connected technologies will prove more important than ever, as patient convenience, population health management, and capacity management move to the forefront of healthcare organizations’ priorities.

Reimbursement will continue to be a substantial barrier to the adoption of the continuously widening breadth of these technologies. In recent years, CMS has made a significant effort to update the fee schedule that recognizes the use of virtual technologies. The CMS /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230/insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-2023 final rule includes important clarifications for the use of RPM CPT codes that were introduced last year, which will help enhance the revenue opportunity for RPM programs. As new technologies emerge, payers, especially CMS, will need to ensure reimbursement regulations keep pace with the development and utilization of new technologies.

While behavioral healthcare access has been a long-standing issue in the US, the pandemic exacerbated the need for mental health services. During the pandemic, /insights/blog/972/cms-issues-proposed-changes-to-the-ma-and-part-d-programs-for-cy-2024 in 0 adults in the US reported having symptoms of an anxiety or depressive disorder, up from in 0 in /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-202309. The pandemic’s social impact included unemployment, housing insecurity, social isolation, school closures, and delayed care. Concurrently, we witnessed unprecedented civil unrest and racism being declared a health crisis in many cities.

A silver lining of this turbulent time has been the rapid expansion of virtual care and the increase in its adoption for behavioral health services. Organizations such as Cigna reported that utilization of virtual behavioral health went up /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20237% compared to prepandemic levels and noted that utilization was consistent throughout /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230/insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-20230 despite a decline in use of virtual care for other services.^{[/insights/blog/972/cms-issues-proposed-changes-to-the-ma-and-part-d-programs-for-cy-2024]}

Despite its impact and staying power, barriers to accessing virtual behavioral healthcare are still pervasive (e.g., cost, stigma, privacy in the home, shortage of behavioral health providers, digital access and literacy). Addressing the immediate and long-term mental health impact should continue to be a top concern for our healthcare system, and its approach should continue to incorporate a virtual care strategy.

The pandemic was a catalyst for digital health transformation, but it has also revealed a digital divide that can lead to further inequities and healthcare disparities, especially for safety net and rural populations. Telehealth regulations were relaxed to provide a platform to deliver care to those who are unable to travel to a clinic. However, not everyone has access to a computer or the internet. One survey estimates that /insights/blog/968/womens-health-5-trends-to-watch-for-in-202/insights/blog/968/womens-health-5-trends-to-watch-for-in-2023/insights/blog/968/womens-health-5-trends-to-watch-for-in-2023% of American adults do not have the high-speed broadband connection needed to participate in video visits. In addition, many individuals lack the digital literacy needed to engage in digital health.

As we think about next steps for virtual care, we must develop solutions that address the barriers to accessing digital and telehealth services. But we also need to remember that improving healthcare and social determinants of health (SDOH) requires more than a high-tech solution. Without programmatic support, a solution is less likely to succeed, even when the technological infrastructure is comprehensive and accessible to all. As such, health systems should continue investing in care teams, navigators, health coaches, and other resources that are instrumental in making a transformative difference in a patient’s healthcare journey.

How will your organization advance after adopting or increasing its use of virtual technology? Necessity leads to invention, and the pandemic showed us just how much care can be delivered virtually. As your organization explores how to expand telehealth and connected technology across the continuum of care and into patients’ homes, be keenly aware of how those programs will impact all patient populations. Regulatory policy makers, payers, and providers must collaborate to adapt to changing technologies and address the growing digital divide. Health systems that want to be at the forefront of healthcare are not going to wait while the reimbursement issue is resolved.

Published July 16, 2021