3 tactics to launch high performing specialty telehealth programs in primary care clinics

To understand how stakeholders' objectives for telehealth align, overlap, or even conflict, Advisory Board researchers recently conducted 117 interviews with leaders from various organizations, including hospitals and health systems, physician groups, health plans, life sciences companies, telehealth vendors, and digital health firms.

Our cross-industry research is ongoing, but here is a first look at the major issues confronting four stakeholder groups—and the emerging opportunities for each group to make lasting change to maximize the value of telehealth:

How 4 progressive organizations are structuring their telehealth programs

• Hospitals and health systems;
  
  
• Physicians;
  
  
• Payers; and

• Health care industry ecosystem.

Hospitals and health systems

Analysis by Jordan Angers

Reimbursement overshadows hospitals' and systems' objectives for telehealth, but many continue to push for broader utilization to meet consumer interest.

Reimbursement typically dictates the scope of telehealth services that systems can provide, rather than being an outcome of a set of services that systems want to provide. This reality reinforces a longstanding perception among provider organizations that reimbursement is something that happens to them, rather than being a process that they can inflect. Hospitals and health systems want to make the most of telehealth's versatility, but many hesitate to make ambitious investments because the pre-Covid state of reimbursement was so limited and the future state of reimbursement is still so uncertain.

At the same time, hospitals and systems recognize that telehealth offers significant value for patients. Consumers are more interested than ever in using telehealth visits for a host of care scenarios and convenience factors, adding a new dimension to the competitive landscape. A truly patient-centric approach to care delivery will make use of telehealth as a tool to eliminate barriers to and hassles of receiving care.

The emerging opportunity: Hospitals and health systems should capture as much data as possible about their use of telehealth. The recent surge in telehealth utilization generates more insight than ever about which patients and providers are using it, for what needs, and how that utilization impacts downstream interactions and outcomes. Such data is essential for both systems and payers in making decisions about appropriate care, clinical best practice, future investment, and reimbursement.

Physicians

Analysis by Prianca Pai

Physicians need streamlined telehealth workflows and greater telehealth fluency—but they can't lose sight of what patients need from a virtual experience.

How Covid-19 will impact telehealth

Telehealth utilization has declined from its lockdown peak in April, with many physicians and patients reverting to the familiarity of in-person visits instead of continuing to adopt telehealth where appropriate. Physician leaders consistently point to two primary challenges to sustaining the hard-won momentum of telehealth adoption:

1. Making virtual visit workflows easier for physicians. The patchwork solutions that were necessary to virtualize care for many practices and physicians blew up traditional care team communication, complicated scheduling for physicians and patients, and led to a proliferation of platforms, often requiring a physician to simultaneously work in the EHR, the video platform, and a chat function to coordinate with the care team.

   Physician leaders don't want telehealth technology to become the next the EHR, a necessary part of care delivery that contributes significantly to physician burnout. Their focus is on optimizing workflow for efficiency and clinician ease of use, with an ideal end-state that allows clinicians to flex effectively from virtual to in-person as needed. 

2. Addressing clinician skepticism and lack of familiarity. Many physicians believe that telehealth is not "good medicine," and they lack the confidence in and mastery of telehealth to prove otherwise to themselves, their peers, and their patients.
   
   Clinical leaders looking to cement telehealth adoption are doing more than simply training physicians to use the platform well. They are clearly articulating the problems that telehealth can help physicians solve, rather than approaching telehealth itself as a problem that physicians need to solve. This value proposition for telehealth often includes better work-life balance for clinicians, reduced overhead costs, etc. They are also investing in training on how to have good  webside manner, how to conduct physical and neurological exams virtually, and how to leverage virtual care to improve patient experience.  

The emerging opportunity: Efforts to improve clinicians' experience of telehealth can't come at the expense of patient experience. Virtual visits during the pandemic have high patient satisfaction scores, but simply offering virtual visits doesn't necessarily make for a positive patient experience. Make the experience more comfortable for patients. Respect their time. Reimagine what the physician-patient partnership can look like virtually. Use the rest of 2020 to capitalize on existing relationships with patients, before competition for their loyalty becomes even more intense.   

Payers

Analysis by Tabiya Ahmed

Payers want to find a workable "middle ground" for reimbursement, but they have been disappointed in siloed vendor and local-provider solutions.

Health plans struggle to set telehealth payment rates that will satisfy providers, purchasers, and plan ROI—while also incentivizing appropriate use. Payers have historically generated value from telehealth services, especially substitute office visits, through a reduced unit cost of care. The resulting reimbursement rate is usually unacceptable to providers, who want to be reimbursed at parity with in-person visits. Some providers recently have indicated their willingness to receive payment for virtual care at 80% to 90% of in-person rate; they are often offered about 70% of in-person rate. These payers recognize that they are in competition with fully virtualized vendors like Amwell or Doctor on Demand, which may receive only half the reimbursement of a community provider.

Toolkit: Learn how to advance favorable telehealth policies in your state

Covid-19 has revealed the weaknesses of deploying either vendor-supplied or local provider solutions in isolation. Third-party telehealth vendors excel in providing a narrow set of acute services at scale and with 24/7 access, for an affordable per member per month (PMPM) rate. However, vendors are often unable to coordinate smooth transitions to follow-up tests, procedures, or referrals, or share structured patient care data with local providers. That said, as local community providers have rapidly shifted volumes to virtual care, vendor solutions have been essential in keeping up with the surging demand for virtual visits through flexible staffing and continuous off-hours coverage. Vendors also more readily integrate a member's specific health plan product information.

The emerging opportunity: Plans should not overlook the potential benefits of better utilization management and steerage that partnership with community providers can enable. Plans increasingly will have to balance control over platforms with user convenience, both of which will require collaboration with local providers to identify the scope of services, barriers for integration in the plan, and the appropriate contractual and financial incentives for providers and patients to shift behavior.  

Health care industry ecosystem

Analysis by Daphney Gaston

Telehealth could revolutionize patient access. It could also make health disparities worse.

Older patients, patients of color, and patients from low socioeconomic backgrounds face four critical barriers to accessing telehealth:  

1. Financial barriers, including the costs of internet access, smartphones, and medical devices, prevent patients from accessing telehealth and other digital health modalities.
   
   
2. Lack of broadband access affects 19 million Americans. Access is even worse in rural areas, where nearly one-fourth of the population lacks access.
3. 
   
4. Digital literacy is low for about 16% of American adults, meaning they have difficulty understanding how to use web browsers, search engines, email, text, wiki, blogs, etc. to access and communicate information, according to data from the Department of Education's National Center for Education Statistics.
   
   
5. General inaccessibility, because of visual and auditory impairments or language barriers, prevents some patients from using telehealth effectively. Telehealth services marketed today are inaccessible for older patients with visual and auditory impairments, and patients who require translation services because they are not native English speakers.

The emerging opportunity: Deploy telehealth to facilitate provider-to-provider interactions that support underserved communities. The lack of consumer broadband access in rural America makes any strategy focused solely on patient-to-provider interactions untenable—at least until a long-term broadband access solution is in place. But providing support and upskilling opportunities to rural practitioners via telehealth consultations enables them to provide better care, improves patient access to specialists, and reduces transportation burdens.