How can telemedicine evolve in the post-Covid era

The 1918 Spanish Flu changed America and the world in ways both big and small — including one pandemic-inspired innovation still visible today. During that outbreak, “The Fresh Air Movement” was born, and with it the cast-iron steam radiator, which made it easier for apartment dwellers to keep windows open and room temperatures up. And while the Spanish Flu is long gone, cast iron radiators remain a feature of home design worldwide over 100 years later.

Covid-19 has already changed American homes, making workspaces with clean video-call backdrops (despite screaming children just out of frame) a necessity – especially for physicians. In less than a year, telemedicine went from a convenient but infrequently used method popular with younger Americans for lower-stakes needs to an essential form of treatment: the number of telemedicine encounters in 2020 increased between 50-175x across the country.

Analyses suggest durable changes – up to $250 billion of current US healthcare spend could move to virtual care – because studies find that telemedicine has enduring popularity among both clinicians and patients. Helpfully, CMS has announced that payment parity for telehealth will continue beyond the end of the pandemic — a clear reflection of the widespread belief that telemedicine will endure.

Telemedicine is here to stay; what comes next?
My expectation suggests two durable changes: (1) telemedicine will transition from stand-alone ‘vertical’ to permanently integrated option for local practices, and (2) across a much broader range of specialties, practices will offer video consultations with a variety of payment models, including direct pay/subscription, retaining and expanding on hybrid care delivery approaches. These changes will not replace the idea of a brick-and-mortar health care practice, but instead supplement them and create new ways to attract and care for patients.

Pre-pandemic, most use of telehealth involved patients engaging with clinicians they would never see in person, and likely never follow-up with again. But Covid lockdowns changed that: both clinicians and patients found that many use cases sustained remote patient care via video quite well, and for a much broader set of use cases than previously attempted. Specialties have experimented broadly beyond urgent care visits for new and existing patients, for example using video for medication adjustments, taking a detailed history for a new patient at a specialist practice, conducting pre- and post-surgical consults, and initiating physical therapy protocols.

In the post-Covid ‘Roaring 2020s,” how patients will discover a practice and join a panel are likely to shift, as will their expectations for payment. Options for contacting a clinician, how to pay for their care, and what a patient encounters when they arrive at an office, will all matter more than ever. Two things will become more important: (A) virtual introductory options to recruit new patients; (B) and direct pay options.

For Americans looking to see a new doctor for the first time, an unfamiliar crowded waiting room will be more uncomfortable given disease risk. While existing patients familiar with a practice will return for in-person visits, new patients are more likely to be skeptical of the value of in-person care if they are unfamiliar with the office and don’t know how long and where they will be asked to wait. To that end, virtual visits will become an important recruiting tool. Rather than insisting on a first visit occurring in office, one effect of the pandemic will be an expectation that a first encounter can happen via video. For instances where a virtual visit is not practical to initiate care, a detailed video office tour will be a differentiator, helping patients understand what to expect when they arrive. Practices should also highlight office ventilation and mask-wearing policies to demonstrate they are learning from the lessons of the pandemic and providing safe, comfortable environments.

Despite mass vaccination, inconsistent insurance coverage and varying ability to pay are enduring challenges.

While President Biden has re-opened insurance exchanges, marketplace shoppers still struggle with affordability. The Administration’s Covid relief bill increases subsidies for premiums making the purchase of an ACA-compliant plan more accessible, but most plans also come with high deductibles to use them — this year, bronze plans have a median annual deductible of $6,992, and silver plan deductibles rose to $4,879.

Payment models will also vary — while CMS will cover telehealth visits at parity in 2021 and beyond, commercial insurers and self-insured employers may not. The variety in benefit designs and copay and deductible levels ensures that reimbursement and ability to pay will vary extensively for commercially insured patients.

Based on these trends, expect many practices to experiment with direct-to-patient care models, including discrete fees for introductory video consults and/or subscription offerings for video and asynchronous (e.g. text or chat) access to the practice. I anticipate these hybrid models will grow and expand, particularly as deductibles, copays, and other patient responsibility components continue to increase and practices compete more directly with practices that directly target these growing patient segments.

Telemedicine will not revolutionize health care on its own, but the experience of millions of Americans during the pandemic assures us that it will become a permanent fixture of the health care ecosystem – one likely to account for a growing share of revenue in our $4 trillion health care economy. These changes are largely positive for clinicians and patients, and will lead to both improved access to the health care system and new ways for clinicians to generate revenue. For Americans who have grown accustomed to the convenience of remote care, but want a durable relationship with a medical practice, the efforts of practices across the country to integrate telehealth will ensure that continues to be a reality.

Photo: elenabs, Getty Images

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