Telehealth experienced explosive growth during the COVID-19 pandemic. Although it does not solve all the healthcare needs, it can be equivalent to an in-person visit for certain acute and chronic conditions. Telehealth can be a large part of the healthcare of the future. It has solid potential for establishing preventive health measures to enable healthy living, prevent sickness, and encourage proactive health maintenance.
However, telehealth is experiencing significant barriers to reaching this goal. Before COVID-19, telehealth was on track to develop its technology at a good pace, but when COVID-19 hit, telehealth grew faster than it could manage. A national study revealed that telemedicine encounters increased by 766% during the first three months of the pandemic [1]. Suddenly, there was explosive demand for virtual patient care, as we were all grounded to our huts, but the infrastructure wasn’t set up for success for such explosive growth. It still isn’t. Trial and error resulted in many lessons learned and today, telehealth is still navigating past the barriers. The key is to evaluate the issues holistically. After all, telehealth is far more extensive than one may think.
Complications With Key Relationships
The key relationships within this platform are complicated by:
How physicians manage their patient populations
How the telehealth technology enables patient care and the integration of medical records with the electronic health record (EHR) or electronic medical record (EMR)
How telehealth integrates with patient care and Health Plans
And, of course, how third-party payor coverage is handled (such as, Medicaid/Medicare or private insurance).
Currently, telehealth companies are in a race to the top, but each faces challenges that they are slow to overcome due to the Grand Canyon sized knowledge gap. Some of these companies are started by tech people and some are started by doctors. One knows nothing about the actual medical end of things; the other is oblivious to the technological end of things. Yet, both struggle with payor integration as the platforms they create are fundamentally challenged for seamless integration with the health plans! Meaning they create a platform that cannot sync with the core platforms. Other platforms are built by the health plans themselves, and even these platforms lack the integration they need.
There is a need for a standardized structure to manage Telehealth that can be easily integrated with the EMR. The insanity of sending spreadsheets back and forth creates more complications and risks than solutions. Furthermore, there is a need to understand the key fundamental elements that can be built from the ground up and that knowledge is sacred.
Lessons Learned
As a Senior Manager over the Healthcare Data Effectiveness and Information Data (HEDIS) and Quality Oversight Lead for a national Managed Care Organization, I am responsible for the HEDIS audit and have observed many lessons learned by health plans and by the telehealth providers. The biggest lesson learned is that many HEDIS and patient “care gaps” can be completed via Telehealth, but the lack of proper workflows means that the right work is being done but providers are not earning the credit! Wouldn’t you want to get graded for the work you do, especially if it’s an A?! Unfortunately, most of the current telehealth work today is not reflected in the quality measurements, such as the HEDIS audit performed annually by the health plans to fulfill the National Committee of Quality Assurance (NCQA) accreditation requirements. But why? Well, the answer is simple, it’s too difficult to integrate that work into the standardized NCQA data framework that is auditable. The truth is, it’s possible but resource intensive. In other words, it’s expensive, and no one has the “budget” for it!
What is your experience with telehealth? Leave comments down below.
Reference:
[1] Shaver, J. (2022). Prim Care. 49(4): 517–530. Published online 2022 Apr 25. doi: 10.1016/j.pop.2022.04.002
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(Thanks Mariya Bobo for being our first guest blogger!)
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