Giving Telehealth Its Due: How It Impacts Outcomes

By Matt Phillion

Despite its emergence as a more visible part of the spectrum of care during the pandemic, telehealth is still criticized in places for not delivering the same effectiveness of care as in-person visits. For many healthcare professionals, however, there is a belief that virtual care providers are poised to establish standards of care that can even exceed in-person care, while helping hospital systems raise their quality and safety by strengthening existing teams, improving patient access, and ensuring patients can receive the timely care they need.

“Telehealth is mainstream, and that’ s a good thing, but not everyone is comfortable navigating across a hybrid care model,” says Dr. Carrie Nelson, chief medical officer for KeyCare. “Some providers and office staff have trouble switching between in-person visits and telehealth to integrate it into their own practice. It’s helpful to have the extra support of a virtualist medical group entirely focused on telemedicine to offload routine things and free up brick and mortar space for care that must be delivered in person.”

There are good reasons why it’s sticking around, and much of it has to do with access. Some 80% of physicians continue to incorporate telehealth into their care post-boom, and the U.S. saw an increase from 5 million to 53 million Medicare patients receiving telehealth.

“It’s leveled off at 15% of Medicare patients having had a telehealth visit per quarter, but when you break out the data, it’s persisted at a higher rate for certain patient populations,” says Nelson. “Medicaid has found tremendous access advantages to using telehealth, but it’s not universally true. It’s that double-edged sword where some Medicaid patients don’t have access because of broadband inequities.”

Nelson also points out that telehealth has been a huge boon for patients with disabilities, as well.

“In my own practice, I knew a couple for whom going to see a doctor was a big event in their lives: they had to find a ride, hope the ride showed up, and often getting to my office early or late and then waiting for a long time after their visit for their ride to show up. These smart people figured out a solution, but I have often thought how much telehealth would have helped make their lives easier,” says Nelson.

Working within a hybrid model

Telehealth has always existed in some form, Nelson notes: calling in an antibiotic for a patient over the phone on a weekend was not uncommon in the years preceding what we now think of as telehealth. Where providers can run into challenges with modern telehealth is how to effectively build a hybrid model without losing steam.

“It can create bumps in the day some physicians have trouble navigating,” says Nelson. “And regulatory concerns exist: we’ve been given an extension of the billing wavers and ability to use telehealth while we work on getting long-term legislation in place. But there are concerns that we’ll have to go backwards, and how will we navigate that? So some providers are sitting tight before they fully embrace a telehealth model.”

Integration of information can still be a challenge for providers and organizations when it comes to telehealth as well. Many telehealth companies operate on their own platform, which can make integration of clinical information a challenge. Others are working to connect with existing systems. KeyCare is on Epic, for example, which enables the information in the patient’s history, medical conditions, allergies, medications, and such to be readily at hand to support clinical decision making during a telehealth visit and ensure anything that transpires during the visit is then reflected in that patient’s record.

“Care integration is really helpful in terms of making sure there is high quality and personalized care,” says Nelson.

Another barrier for telehealth is that double-edged blade of access. Unfortunately, those who can most benefit from telehealth access may also be those who lack broadband or face other technology hurdles that would enable them to make the most of telehealth.

“It can be an equity solution in some cases but widen disparities in other cases,” says Nelson. “We’re starting to call broadband access a super social determinant. We think of it often as a rural problem, but it can be an urban one too as access varies from neighborhood to neighborhood. It’s something we need to catch up on.”

This challenge is on the radar of the American Telemedicine Association, which has been working on developing policy recommendations to improve access for everyone.

“I remember seeing a recent photo of kids sitting outside a coffee shop using the shop’s internet to get the broadband access they needed to do their homework. What a demonstration of the significant inequity problems that exist,” says Nelson.

Shaking off existing telehealth myths

What does the industry need to do to break from this persistent belief that telehealth doesn’t provide as beneficial an experience as a brick-and-mortar appointment?

“There’s a lot of misinformation out there about the quality of telehealth, but the data is really strong, and goes back a number of years,” says Nelson. “Even prior to the pandemic researchers were studying whether quality measure performance differed between brick-and-mortar care and telehealth. There were pre-pandemic articles looking at HEDIS (Healthcare Effectiveness and Data Information Set) quality measures for those who had telehealth as part of their care versus those who did not. Those with telehealth did as well, if not better, on those HEDIS measures.”

It’s clear that some conditions benefit more greatly from the access telehealth provides, such as hypertension and diabetes.

“Thinking about those particular conditions, I know in my own practice, I might want to see a patient with high blood pressure again in two to four weeks. But then the front desk staff would have to tell the patient that I didn’t have any appointments available in that timeframe,” says Nelson. “The result was a longer interval between appointments, leading to a prolonged timeline in getting their blood pressure to goal. Those delays have real health consequences and interfere with performance on quality metrics. Such things can be easily dealt with through telehealth follow-ups, which have been shown to be at least 20% more efficient than in-office visits. And home blood pressure readings, properly done, are more accurate than in office readings.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.