Telehealth and virtual care have great potential to improve the outcomes and the savings for health and human service systems, but adoption is low—approximately 44% of hospital executives say their organizations are not offering services via telemedicine (see 44% Of Hospital Executives Say Their Organizations Don’t Offer Telemedicine). And, a recent study of Medicare psychiatrists found only five percent are providing telehealth services (see About 5% Of Medicare Psychiatrists Provide Telemental Health Services). On the flip side, consumer utilization is very low. A recent claims analysis of commercial health insurance and Medicare Advantage claims (see Health Plan Telemedicine Visit Volume Increased 52% Per Year Between 2005 & 2017) found telehealth visit utilization of 6.57 visits per year per 1,000 members. If you assume two telehealth visits per year per member, this puts consumer utilization at a third of one percent of the insured population.
The number shouldn’t be that low. A large part of today’s consumer base (read: millennials) say they want telehealth—60% of millennials (or 49 million consumers) support the use of telehealth in place of in-office visits (see Salesforce Survey: Millennials Want Telehealth And Mobile Apps). And, many payers are on board—Medicaid fee-for-service programs in 49 states and the District of Columbia provide coverage and reimbursement for some type of live video telemental health service (see Medicaid Programs In 49 States & D.C. Reimburse For Telemental Health); Medicare is preparing to cover virtual check ins (brief communication technology-based services), and remote evaluation of “store and forward” recorded video (see Medicare To Cover Virtual Health Check-Ins); and the Medicare Advantage Value-Based Insurance Design (VBID) model will now allow participating Medicare Advantage plans to offer telehealth services if an in-person option remains (see Medicare Advantage Plans Allowed To Expand Access To Telehealth In 2020 Plan Year).
Finally, the savings are too large to ignore. The Rural Broadband Association found that the potential savings for telehealth are huge—with $4.3 billion in annual savings for the field as a whole (see Report: Telehealth Care Drives Significant Cost Savings, But Barriers Remain). Telehealth can also save hospitals in rural parts of the country an average of $81,000 annually, while saving consumers $24,000 in travel costs and $17,000 in lost wages (see For Telehealth, The ROI Is Where You Plan For It). So, why is adoption still so low? Our team discussed this issue and four market realities emerged—reimbursement complication, consumer resistance, provider organization workflow, and clinical culture.
Complicated reimbursement—The rules for reimbursement are complicated. There are many payers for telehealth; 4,000 health plans, 1,000 ACOs, county governments, jails and prisons, and much more. All with different rules for eligibility, reimbursement, prior authorization, and credentialing. Medicare fee-for-service rules for telehealth reimbursement is complicated, including regulations for defining distant sites and originating sites, and drawing geographic and modality limitations (see Beginner’s Guide To Telehealth Reimbursement In 2018). At the state level, even though we are seeing more coverage for telehealth and an easing of the cross-state telehealth regulations, reimbursement and services varies widely by state (see A Virtual Health Update).
Consumer resistance—This is changing, but there are consumer concerns. Privacy, security, and quality of care top the list (see Barriers to Telemedicine are Falling. Why Aren’t More Patients Engaging?). The good news? While some consumers do not want to use telehealth because of privacy (80%) and data security (76%) concerns, 75% of consumers who have yet to try telehealth, want to try it (see Patient Interest in Adopting Telemedicine: IndustryView).
Provider organization workflow—Our team has seen firsthand the workflow challenges to integrating telehealth (and any other virtual health model) into existing clinical service systems. The functions for consumer appointments need to be centralized; consumer eligibility and health plan reimbursement rules need to be confirmed while the consumer is asking for an appointment; schedules for clinical professionals need to be online and open for scheduling, along with their health plan credentials. Customer service representatives need the ability to give unscheduled time or time for canceled appointments to consumers; and new policies and procedures need to be written. Addressing these workflow issues is an essential step to moving the hybrid virtual/face-to-face service system.
Clinical culture—There are very few fields where the integration of technology into consumer services hasn’t changed the field. Just ask book sellers, travel agents, radio disk jockeys, bank tellers, realtors … I could go on and one. In health and human services, virtual health changes the relationship between clinical professionals and consumers. It’s not better or worse, just different. Virtual health changes the work lives of clinical professionals. And it is not surprising that many clinical professionals are not wild about the changes. No one likes to have their cheese moved (to paraphrase the book). There are many studies of clinical professionals concerns about telehealth—citing medical error and concerns and privacy considerations (see What Can Health Systems Do To Encourage Physicians To Embrace Virtual Care?), but our team has seen the change in the day-to-day work life as a big impediment.
While these factors are impediments to teleheath adoption at scale, I don’t think this resistance will prevent the change to a hybrid model of service delivery. Our coverage in the OPEN MINDS News Wire has shown this expanding market in real time, with a sample of our most recent coverage including:
- Humana Expands Availability Of Fitbit Platform
- Integrated Behavioral Health Selects Arcadian For TeleEAP Services
- Five California Counties Approved To Launch Virtual Therapies Under Mental Health Service Act
- Beacon Health Options Adds MDLIVE Behavioral Health Professionals To Its Provider Network
- American Academy Of Pediatrics Selects SnapMD As Telehealth Technology Partner
- Netsmart & American Well Create A Virtual Health Community
- Maryland Creating Telehealth Service For Treatment Of Opioid Addiction
- Walgreens & Veterans Administration Create Care Coordination Partnership
- Polk County Florida Launches New Telemental Health Program For Low-Income Uninsured Residents
- Mozzaz & Centerstone Launch ‘ZERO Suicide’ Digital Consumer Engagement Platform
For executives of health and human service organizations, the only question is when will the train arrive. I’m reminded of the quote by President Dwight D. Eisenhower—”Neither a wise man nor a brave man lies down on the tracks of history to wait for the train of the future to run over him.”
To get your strategy in line with the future, join our team in a month at The 2019 OPEN MINDS Strategy & Innovation Institute. At the opening of the summit, we’ll release the results of our annual innovation survey (to see last year’s survey results, see The 2018 OPEN MINDS National Innovation Survey: Innovation Adoption Among Specialty Provider Organizations). And, for even more join me on June 6 in New Orleans, Louisiana for The 2019 OPEN MINDS Consumer Engagement Technologies Summit, featuring Andrea Auxier, Ph.D., Senior Vice President, Product Development, New Directions; Chris Thompson, Chief Operating Officer, Monarch; Davis Park, Executive Director, Front Porch Center for Innovation & Wellbeing; Larry Smith, Chief Operating Officer, Grand Lake Mental Health Center; and Neal A. Bowen, Ph.D., Chief Mental Health Officer, Hidalgo Medical Services.