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Will virtual doctor visits support healthcare’s drive to value?

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By Jeffrey Hogan and Brian Klepper

In the early weeks of the pandemic, COVID-19’s most visible impact on day-to-day healthcare came in the industry’s near overnight embrace of virtual visits. The threat of rampant infection alarmed regulators and deeply frightened patients and clinicians. So with temporarily loosened rules, primary and specialty care practices quickly pivoted to telehealth tools, adjusting their care patterns to the new frame.

The speed and scale of the transformation was breathtaking. In the week ending April 18, almost 1.3 million Medicare members received telehealth services, compared to just 11,000 six weeks before. That was a growth of 11,718%, or almost 120-fold.

In a real and profound way, telehealth saved the day, providing an alternative to healthcare’s ossified patient visit structure. Snatched from The Locker of Little-Used Tricks, many clinicians discovered they could use virtual care to connect with and solve many problems of patients who were hiding in their homes. They got on-the-job training in the robust and often lesser known capabilities of remote visits — like specialty care coordination — as well as the technology’s clear limitations when a clinician can’t lay hands on a patient.

The sudden move to virtual visits didn’t just provide a new care pathway. It also revealed that under certain frequently occurring circumstances, telehealth can be highly effective, efficient and dramatically more convenient for patients. Deployed properly and mindful that many health issues require close, hands-on examination, virtual care is here to stay. Ryan Schmid, CEO of the highly regarded worksite clinic firm, Vera Whole Health, maintains that 80-85% of primary care visits can be appropriately handled virtually. The figure for specialty care is probably somewhat lower, but still significant.

Telehealth’s validation as a highly utilitarian clinical tool during the early months of the pandemic confirmed the need to elevate its logistical stature, integrating and optimizing it — in terms of regulation, infrastructure requirements and finance — into the larger health services ecosystem. That integration must fully appreciate virtual care’s potential and ensure that capabilities, like interoperability, are developed to support an ever-expanding and ever more useful platform.

The financing model that can best drive telehealth’s application will be critical. Ideally, providers should be incentivized through at-risk arrangements, like capitation, to manage most cost-effectively, while ensuring through data that quality remains appropriate. Almost certainly, CMS’ policies on this topic will specify an approach that the commercial sector will follow. It is not yet clear whether the major health plans organizations — e.g., United, Anthem, CIGNA, Aetna, Humana — are in favor of the value that virtual visits can deliver, and will structure payment that fosters telehealth’s ongoing growth and stability. The approaches that both public and private payers settle on are hugely important and will define virtual care’s influence for years to come.

On June 30, 340 organizations representing the full range of health care stakeholders, submitted a letter to Congress asking for permanent policy changes that will allow Americans to access telehealth services past the COVID-19 pandemic. The decisions made in the next few months about the shape of telehealth have momentous implications, particularly for the healthcare value movement. While it does not solve all problems, virtual care offers a highly flexible, low resource approach that, with many patients, can deliver a positive care experience with equal or better quality at lower cost. It represents an important arrow in health purchasers’ value quiver, moving our health system in the right direction.

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