Optimizing telemedicine during COVID-19: The value of an integrated approach

In light of the COVID-19 crisis, nearly every provider in the country needs to provide remote patient visits. However, to realize the full potential of telemedicine, we need to be able to pull in data from all the sources where it resides and incorporate AI-based tools to help providers focus on what is most important for the patient during the ‘visit.’

But most telehealth solutions are not fully integrated with other patient data sources, making it difficult for providers to incorporate the full wealth of data they may need. Nor do they have the ability to automate care gap assessment and care plan generation. As telehealth becomes a larger part of our national healthcare fabric, these will become more critical omissions.

COVID-19 changes are fueling demand for telemedicine

A just-released survey of U.S. consumers by Sage Growth Partners and Black Book Market Research found that 64% of respondents were more likely to use telehealth since the crisis started and 69% want their provider to offer more telehealth visits even after it’s over. More than one third would even switch their provider to get telehealth.

The loosening of CMS telemedicine requirements will make responding to this demand easier than ever for providers and apply to 85 new services, including ED visits and discharge visits. Under a 1135 waiver to expand telehealth reimbursement effective March 6, 2020, Medicare will pay for office, hospital, and other visits delivered virtually by physicians and other healthcare providers to patients’ homes. The HHS Office of Inspector General (OIG) is also allowing providers to reduce or waive virtual visit cost-sharing in federal healthcare programs. Many commercial insurers are following suit.  

Telemedicine can replace some lost revenue and care

Telemedicine may help to replace some lost revenue amid shifting care needs. Many healthcare entities that are operating on thin margins are hemorrhaging revenue due to the cancellation of many office visits and 80% or more of elective procedures. Independent physician practices may be hit especially hard; for these practices, telehealth provides an opportunity to recoup some of this lost revenue. And hospitals losing more-lucrative surgical volumes may lose additional dollars even with the added volume of COVID-19 cases. One analysis suggests many will lose over $1,000 per COVID-19 patient despite additional federal assistance.

During the current COVID-19 crisis, providers can use telemedicine to serve a critical triage function to help determine if those who suspect they have a medical problem need to be seen in person. Telemedicine can also enable patients to consult with a provider about a medical issue from the safety and convenience of home. It can allow providers to read patient expressions and body language, and visualize health issues much the way they might in an office visit. It can also allow a better feedback loop between the patient and his or her physician than other modalities such as phone or text.

Defining telemedicine

The relaxation of regulations is a great first step to expanding the use of telemedicine. The next step is to better define what we mean by telemedicine. The terms ‘telemedicine’ and ‘telehealth’ are often used loosely and not accurately. Many use them interchangeably with ‘televideo.’ Instead, telemedicine solutions should be more broadly considered as enabling multi-modal communications between providers and patients, including standard phone calls, web audio calls, web video calls, and secure instant messaging.

The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services has a good definition of telehealth:

“The use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”

Optimal telemedicine: Beyond episodic visits

In our view, the HRSA’s phrase “support and promote long-distance clinical health care” hints at the appropriate use of telemedicine. We should consider the lessons learned from value-based care — that optimal care is coordinated and longitudinal rather than episodic care delivered only after someone is sick.

Ideally, telemedicine isn’t just a virtual visit delivered by a physician who has very limited information on the patient they’re seeing, but part of a well-integrated, well-oiled care ecosystem. The best type of telemedicine facilitates coordinated care in the way that a physician who knows the patient well would — leveraging patient medical records and other inputs to provide coordinated longitudinal care across the care continuum and various care locations.

Telemedicine should be part of an integrated care management solution

Yet, while the telemedicine market is crowded with hundreds of vendors, the majority of telemedicine solutions don’t fully integrate with the EHR or a population health management (PHM) platform. That means that many providers are not getting the breadth and depth of clinical data they need at the point of delivering care, and in essence, are often treating patients in a vacuum – and nearly as if they were back in the days of paper-based records.

Many telemedicine platforms don’t integrate with the EHR or care management platform, which means that they likely can’t provide the comprehensive patient information providers need to take optimal, coordinated care of their patients. Like too much of healthcare, telemedicine care is often fragmented and based on limited, imperfect knowledge. It is too often episodic rather than part of an orchestrated longitudinal care plan.

What can a more integrated telemedicine solution deliver to providers and healthcare orgs? There are numerous benefits:

  • Identify care gaps — such as A1C tests, health screenings, annual wellness visits and other preventive health measures; these can keep patients healthy while providing revenue for cash-strapped providers once the threat of COVID-19 has subsided
  • Assess risk — determine health risks using a variety of layered, AI-enhanced risk stratification models
  • Make smarter patient care decisions – get insights by incorporating social determinants of health, HIE and claims data along with other data sources to get a complete picture of each patient  

COVID-19 has brought the telemedicine genie out of the bottle and it’s unlikely ever to go back in. While predicting what’s going to happen a month from now—let alone a year from now—is harder than ever, the simple fact is that the more patients and providers are exposed to the convenience of telemedicine, the more likely they are to use it again. But healthcare organizations shouldn’t lose sight of an important fact: not all telemedicine is equal. Solutions that are able to intelligently integrate EHR and a wealth of other data are going to provide far greater benefits for their patients and themselves in the longer term.

About Mansoor Khan
Dr. Khan is a veteran software company CEO with broad experience in identifying market needs, building a team to answer those needs and establishing brand name excellence. He is currently the CEO of Persivia Inc., which he co-founded in 2015. Prior to Persivia Dr. Khan was the CEO of Alere Analytics, formerly DiagnosisOne, which he co-founded in 2004. Persivia currently provides care management, population health, and quality management software and services to over 250 hospitals, over 4500 physicians in outpatient settings, touching 20M patients.