Thursday, Apr 29, 2021

Getting one’s ducks in a row, with Post-COVID telehealth

Roy SchoenbergPresident & CEO, Amwell


There’s no denying that the pandemic profoundly altered the trajectory of virtual care. COVID-19 brought us well beyond the conversation around telehealth’s value. Yet perhaps the biggest impact of the pandemic on telehealth has been the realization of all that it can do. What was once viewed as a platform for providing ‘one-time-only’ urgent care, is now being used for scheduled primary and specialty care visits with a patient’s own provider and much more. 

Now, there exists a strong desire to make telehealth a foundation for a modern, connected care experience. The new imperative for digital connectivity translates to embedding telehealth into traditional healthcare activity so a broader range of services can be extended in ways that elevate the consumer and provider experience. This transition requires leaders to reimagine their approach to virtual care and focus on future-proofing their telehealth strategy in an evolving environment. The following areas of focus are key to prepare for.

Prepare for care without borders. During COVID-19, federal and state governments expanded telehealth by waiving or suspending regulatory barriers to telehealth, including state licensure and credentialing. As a result, medical knowledge and skills can be projected from one side of the country to the other, proving that technology knows no geographical boundaries. 

As discussions around whether to maintain relaxed licensure requirements take center stage—with a bill that would allow providers to seek two-year approval to provide telehealth in other states and draft legislation for a “Medical Excellence Zone” allowing providers to practice across state lines— it’s imperative healthcare operators ensure their telehealth infrastructure allows services to reach patients, regardless of location, seamlessly and securely. This flow of care services will happen in both directions, in and out of any region and will therefore include competitive inbound services from similar organizations not operating physically in your domain. Did anyone mention Amazon (Primary) Care play?

Moves toward specialty care without borders have already proven impactful for caring for children in rural and underserved communities. During the first months of the pandemic, when in-person visits were limited to the sickest pediatric patients, demand for telehealth rose by 2,400% at Nemours Children’s Hospital in Florida. At this hospital, telehealth gave families of all socioeconomical backgrounds regardless of location, a pathway for scheduled visits with primary care and specialty care providers. 

Prepare for telehealth to enable new care delivery models. This year hybrid approaches have emerged in various facets of our lives, from schooling to work. Perhaps nowhere can hybrid models be more impactful than in healthcare. While multiple flavors exist, hybrid care models blend physical and digital care encounters. Leading organizations like Penn State Health have already proven hybrid care approaches to be successful in achieving better clinical outcomes and higher patient satisfaction. 

Virtual primary care (VPC) is an example of an innovative hybrid care model already experiencing great traction in the market – one we fully expect to redefine healthcare in the coming years. VPC takes the best of traditional primary care, adds disease management techniques and data integration, and presents the patient with a digital-first, user-friendly experience and journey. Patients can connect with their selected PCP virtually and be referred for in-network labs, imaging and specialists as needed (some via telehealth, and some in physical locations). VPC bridges gaps in care and serves as a gateway to longstanding patient-provider relationships. 

While relationships between patients and providers are likely to strengthen because of these new care models, we should expect that the power-balance between payers and providers will be reset with the arrival of these technologies and programs. 

Prepare for telehealth to move from consumer-driven (transactional) to care-oriented (relationship-based). While it may be easier to grasp the subtleties of relationships during face-to-face interactions, telehealth has the power to enhance these connections. For this to happen, telehealth must be woven into all the different places that can sustain relationships between a patient, their doctor and their care team. From the hospital to the home and everywhere in between, telehealth must be embedded and the experience across each setting must be unified.  

Leaders can set themselves up for success by taking a holistic approach to this challenge, extending telehealth capabilities to complement and reinforce wherever care happens. If we go back to the example of VPC -- at its core, is its ability to foster ongoing, longitudinal relationships between patients and providers. It gives patients access to tools like secure messaging, enabling regular correspondences with their doctor and perhaps most importantly, allows them to see the same doctor visit after visit—whether that be for primary care, behavioral health or otherwise. 

Since most healthcare happens around long-term conditions, the arrival of longitudinal telehealth is highly impactful. 

Prepare for an ‘always on’ world of healthcare. Access to healthcare has advanced beyond the mobile phone, app or browser. As virtual care continues to evolve, we need to expand our thinking around the types of technologies that can be used to facilitate healthcare interactions. Everything from TVs to watches are now fair play, as is the addition of automated, asynchronous interactions. 

The proliferation of devices that can be used to connect patients and providers positions us well to make healthcare present not just at the time of a visit but “between visits” as well. Through a mix of technologies, we can introduce care companionship. This is especially critical for our most vulnerable patients – from individuals living with diabetes or battling cancer to those recovering at home after surgery. In these scenarios, remote devices (sensors) monitor patients’ physical and physiological activity, alerting clinicians to patterns that suggest the need for a telehealth checkup, or an ambulance. As telehealth shifts care into the home, the more we open up that technology infrastructure and allow it to “play well with such others,” the better the experience will be.

Future proofing your telehealth strategy. In many ways, the battle for the legitimacy of telehealth has been won—but that’s not to say the war is over. As an industry, we are at an inflection point. If virtual care is seen only for what it has enabled during the pandemic—an alternative to the corresponding physical visit—we will miss out on the opportunity to reimagine the distribution of, and experience people can have with healthcare when it travels over technology. By reimagining how virtual care can fundamentally enhance the patient journey, and the way medical practice needs to adapt (gulp!), healthcare organizations will be better positioned to achieve their virtual aspirations for 2021 and beyond. The time is now.


Roy Schoenberg, MD, is president and CEO, Amwell.

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