The Past, Present, and Future of Telehealth

Access. This word has been both the driving force and inherent challenge of telehealth since its origin. Telehealth allows clinicians to scale delivery of healthcare services while simultaneously empowering patients in certain populations to receive the care they need, when they need it, eliminating disparities.

Resource scalability, improved outcomes, and increased access for all patient populations are the key objectives driving telehealth advancement. While the use of technology in healthcare is not new, significant events such as COVID-19 have propelled change and catalyzed hyper-innovation that otherwise would likely have taken years.

In this blog post, we explore the past, present, and future of telehealth services and examine how they have changed the healthcare industry and patient experience as a result of COVID-19.

Telehealth in the 2010’s

From 2010 to 2017, adoption and implementation of telehealth exploded. In 2010, only 35% of hospitals had implemented some aspect of a telehealth system. By 2017, 76% of hospitals had either fully or partially implemented computerized telehealth. To compound, the utilization of remote patient monitoring also grew from 43% of hospitals implementing in 2016 to over 61% of hospitals in 2017, according to the American Hospital Association, Fact Sheet: Telehealth (2019).

Although the majority of US hospitals were now connecting with patients and consulting practitioners at a distance through the use of video and other technology, the reimbursement and regulatory barriers to wide adoption remained and telehealth was vastly restricted to patients located in rural areas and in specific settings, such as a hospital or physician office.

From the healthcare consumer standpoint, the market was ripe for innovation as 66% of consumers indicated willingness to use telehealth in 2019, while only 8% of the US population had tried it. 64 million consumers also indicated that they would switch their Primary Care Providers to one who offered telehealth, according to the American Well Telehealth Index: 2019 Consumer Survey.

Telehealth Today

Telehealth connects patients to vital healthcare services via advanced audio-visual technology and includes remote patient monitoring. By increasing access to physicians and specialists, telehealth helps ensure patients receive the right care, at the right place, at the right time, which proved to be instrumental in 2020.

Telehealth use grew exponentially during the 2020 pandemic, primarily attributed to Congress, CMS, and other federal agencies waiving many restrictions previously applied to telehealth. CMS waived geographical restrictions, making telehealth services much more accessible for patients with needs that were not directly related to the urban/rural divide, in response to the COVID-19 pandemic. Nearly half (43.5%) of Medicare primary care visits were provided via telehealth in April 2020, compared with less than one percent before the public health emergency in February 2020 (0.1%). (ASPE July 2020 Issue Brief)

In addition to changes in federal regulations, 18 states have made changes to create new telemedicine legislation. With the relaxation of regulation and licensure requirements amidst COVID-19, many patients have received the critical medical care needed and report a high level of satisfaction.

Providers have also seen great benefits in adopting telehealth technology. They have reported anywhere from 50 to 75 times the number of telehealth visits during the COVID-19 pandemic than pre-pandemic. More than half of providers have also stated that they are more comfortable using it and view it more positively now than they did prior to the pandemic. To note, 57% of providers view telehealth more favorably than they did before COVID-19 and 64% are more comfortable using it, according to a McKinsey COVID-19 Physician Survey.

Regulatory and Statutory Changes

While each state regulates telehealth differently, all 50 states have some form of Medicaid reimbursement for telehealth services. In the past, Medicaid had limited reimbursement for telehealth based on geography, but that fundamental assumption to healthcare accessibility has been challenged in recent years.

Live video is the most common healthcare service delivery method for Medicaid reimbursement in the country. However, Medicaid reimbursement for telehealth services is stipulated on a variety of other factors at the state level. According to The Center for Connected Health Policy in Spring 2019:

50 states and Washington, D.C. provided reimbursement for some form of live video in Medicaid fee-for-service
Eleven state Medicaid programs reimbursed for store-and-forward.
Twenty state Medicaid programs provided reimbursement for remote patient monitoring.
Six state Medicaid programs (Alaska, Arizona, Maryland, Minnesota, Virginia, and Washington) reimbursed for all three, although certain limitations applied.

Imagineering the Patient Experience

At Keystone Healthcare, we work with our hospital partners to provide high-quality, patient-centered care to each patient. We envision a future in which patients reflect on the care that they received feeling as though they’ve had an experience that prioritized their time, connected them efficiently to an exceptional team of healthcare providers, and even re-engaged them upon discharge. Our technology will ensure they have a healthcare experience unlike any other.

The Keystone Telemedicine Team makes up a bold team of pioneer clinicians, technicians, and business leaders. Together, we have reimagined the entire patient flow to redesign and improve the patient experience, leveraging technology to bolster clinical expertise each step of the way.

Our key program areas include:

ED2Home: A direct-to-consumer platform that allows patients to virtually connect to ED providers from the comfort of their home. This program is aimed at providing a seamless transition from home into the ED when necessary.

Tele-EMS: This innovative platform connects ED providers on-demand with local EMS or Mobile Urgent Care providers. This program is aimed at using technology to triage, treat, and transport patients to the ED or to an alternate destination of care within the hospital system.

Virtual Case Management & Utilization Review: This program gives ED providers real-time access to virtual case managers. Case managers assist ED providers with their inpatient admissions and ensure documentation and status is appropriate at the time of admission from the ED.

Virtual ED Tele-Triage: This program positions a virtual provider in triage. The intention is to dramatically reduce patients leaving the department prior to being seen. Other performance metrics are also impacted, including improved patient flow, patient satisfaction, patient safety, and an increase in capacity within the ED for providers and nursing staff.

Virtual Inpatient Hospital Rounding: Virtual Inpatient Hospital Rounding would provide hospitals with the flexibility needed to manage multiple inpatient scenarios and could accommodate a variety of staffing patterns to reduce costs.

Keystone Connect: This is our artificial intelligence program that sends texts to discharged patients from any of our programs. The goal of Keystone Connect is to provide administration and program directors stratified patient satisfaction data points in real time and give them an opportunity to intervene. This customizable program does allow the option for dissatisfied patients to connect back to our Utilization Review Team.

A Promising Future

Clinicians, hospitals, healthcare systems, policy makers, and consumers of healthcare are recognizing the advantages of digital tools and the positive impact these tools have on access to care and providers.

Although there has been increased utilization throughout the pandemic, barriers and challenges remain for telehealth and it will certainly be an area of rapid evolution.

For a more detailed discussion on this topic, join our webinar to engage with Elizabeth James, MD, FACEP and Melissa King, DNP, FNP-BC, ENP-BC.