In the blink of an eye, telehealth has gone from nice-to-have to table stakes. Its explosive growth represents the most rapid and unexpected change in medicine in recent memory. How policymakers and payers respond to it will affect the course of our healthcare system for years to come.
This revolution was driven, of course, by the response to COVID-19. As front-line workers risked their lives to treat the pandemic's early victims, ambulatory-care providers turned to telehealth to bridge the gaps. State and federal governments cleared away long-standing restrictions on telehealth under the federal public health emergency declaration. Many employers and health plans followed suit.
Data from the Commonwealth Fund estimates that, by mid-April, 14% of all healthcare visits were conducted remotely. That has now plateaued at around 7%. Traditional (fee-for-service) Medicare, where telehealth policies were most restrictive, felt the greatest impact from the changes driven by the pandemic. The share of primary care-visits conducted remotely for this program grew from less than 1% in early March to 43.5% in July according to HHS.
Two things quickly became clear: First, telehealth will remain an important part of care delivery long after the pandemic subsides. And second, the experiment taking place before our eyes provides an incredible learning opportunity.
All this compelled the National Committee for Quality Assurance, along with the American Telemedicine Association and the Alliance for Connected Care, to convene the Taskforce on Telehealth Policy. Our objective? To make recommendations on how to consolidate the benefits of this burgeoning mode of care while ensuring that services are high-quality, safe, and fully integrated into the overall healthcare system. We brought together a group of accomplished leaders representing a broad spectrum of healthcare stakeholders—patients, health plans, health centers and systems, other providers, and telehealth platforms to help us meet this challenge.
On Sept. 15, we released our final report—the product of more than a dozen taskforce sessions, 300 public comment submissions and a virtual townhall that drew nearly 1,000 participants. It reflects a cautious optimism about how telehealth can advance our shared goals of higher quality, better outcomes, greater access and improved patient and provider experience, based in part on the promising results since March.
Highlights of our findings and recommendations include:
• Telehealth is the natural evolution of healthcare into the digital age. It is essentially a setting or modality of care, rather than a type of care.
• The ongoing move from fee-for-service to value-based arrangements in healthcare should enhance the ability to leverage telehealth's potential.
• Nearly all of the restrictions on telehealth lifted under the public health emergency – such as the limits previously in place on the type of clinicians and medical conditions authorized for telehealth services and the requirement that telehealth providers establish a previous, in-person relationship with a patient beforehand – should go away permanently. HIPAA privacy protections should be reinstated.
• States should collaborate on strategies to facilitate the practice of telehealth across state lines.
• Policymakers must address gaps in broadband access and digital literacy on both sides of the provider-patient relationship to ensure the benefits of telehealth reach all Americans.
• Early data suggests that telehealth has substituted for a good deal of in-person care during the pandemic without increasing overall costs.
It is still too soon to draw definitive conclusions on what unfettered access to telehealth means for costs, quality and outcomes. This can only happen once we return to something resembling the pre-COVID norm. We therefore urge policymakers first and foremost to closely monitor the experience and follow where emerging evidence leads.
Our report also highlights the need to align standards, guidelines and policies for telehealth with those for in-person care to avoid creating another silo of healthcare data and treatment that is not coordinated with patients' other care. Moreover, we identify several opportunities that the unique nature of telehealth services offers to catalyze the move to a more digital, integrated and patient-centric health care system.
The nation has witnessed unimaginable pain and loss at the hands of the coronavirus. Still, we have adapted and survived. In some cases, we may find our way to a better tomorrow because of these challenges. We owe it to those who have sacrificed so much in 2020 to maximize these opportunities and build a stronger, more resilient healthcare system. Expanded telehealth is a promising tool for getting there. We hope our report illuminates the path to maximizing its potential.
Margaret "Peggy" O'Kane is president of the National Committee for Quality Assurance.
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