Since the beginning of the coronavirus and COVID-19 pandemic, hospitals and other health care providers have urged people with symptoms to use telemedicine first to connect with a doctor.
That direction has led to a surge in the number of people using telemedicine, many for the first time. Given that surge, the pandemic could very well trigger a permanent change that transitions virtual doctor visits from a niche, low-use service to a commonplace practice with a wider role within the health care continuum.
“It gives telehealth the exposure that it’s needed for some time, because it’s out there and it’s been underutilized. It just hasn’t been utilized like organizations hoped,” said Jerry Konal, senior director of health and benefits at the Southfield office of Willis Towers Watson. “This is definitely an opportunity for the telehealth movement to demonstrate the value they offer the health care delivery system. It’s most unfortunate that it takes a crisis to create awareness.”
The underutilization up until now came despite most employers having a telemedicine benefit built into their employee health coverage.
Konal hopes that as individuals learn more about telemedicine, how it works and the lower cost, and that once the present public health crisis ends, “telehealth will remain a relevant and useful resource.” Research shows that consumers who have used telemedicine tend to keep using it when they need to see a doctor, he said.
Key to the future is how well the platforms do for first-time users during the COVID-19 crisis, which could lead to increased wait times for a virtual visit with a doctor and frustrate some people, Konal said.
“My hope is, because it really is very cost-effective, that for all those basic needs beyond this crisis, people will consider it and I really do think it will have staying power,” he said. “I think at this juncture it will highly depend … all on their experience.”
Telemedicine has been billed as a convenient and lower cost way for patients to see a doctor for primary care visits and minor ailments. Of late, telemedicine has become a tool for some care providers to monitor a patient’s condition at home, as well as expanded into virtual visits for behavioral health services.
During the COVID-19 pandemic, Grand Rapids-based Pine Rest Christian Mental Health Services has moved all outpatient visits to a telemedicine platform developed over the last two to three years as part of an overall strategy to improve access to behavioral health, CEO Mark Eastburg said.
The telemedicine platform enabled Pine Rest to close outpatient clinics to curb the spread of the coronavirus, while continuing to provide care to patients.
“Digital provides a really nice solution to that,” Eastburg said. “We recognize that we have so many people that rely on us for care and continuing care. We just can’t say, ‘Well, we’re going to take a couple months off in continuing your treatment.’ We’re really fortunate we could pivot so quickly.”
Pine Rest has about 250 clinicians trained in telemedicine visits and plans to reopen the outpatient clinics “once we get through this,” he said. Eastburg expects Pine Rest by this week to serve 5,500 patients weekly through the telemedicine platform. He sees the potential for telemedicine to take on a greater role in providing care.
“Like everyone else, we’re asking the question: What will the long-term implications of this be in terms of if you have people doing their work in a different way for a month or two? Does that give you new insights into how you can do that work into the future?” he said. “We’re obviously still learning about that (and) it could prompt us to rethink how we deliver in the future, but at the end of the day, people still value face-to-face contact and that will continue.”
The pandemic and need for social distancing has heightened the public consciousness of telemedicine and driven volumes to far greater heights.
During the crisis, care providers say their telemedicine platforms have been useful both for them and their patients, providing a potential lasting effect for the technology.
“This is really an opportunity for virtual to step up from a system perspective,” said Jared Cowan, manager of virtual health at Spectrum Health, which has experienced a significant increase in virtual patient visits. “Not only is this the moment for virtual to shine, but (we’ll see) long-term adoption and it’s here to stay from a provider perspective, a patient perspective, and really from a system perspective.”
The Grand Rapids-based health system’s Spectrum Health Now telemedicine platform recorded what Cowan calls “expedited growth” over the last five weeks or so. Through last week, Spectrum Health Now had seen a 111-percent increase in virtual visits over February, he said.
Spectrum Health Now started offering free virtual screenings for COVID-19 on March 6. By March 23, as the pandemic deepened in Michigan, Spectrum Health Now completed more than 13,000 virtual screenings by doctors, physicians assistants or nurse practitioners, Cowan said.
Likewise, Blue Cross Blue Shield of Michigan’s telemedicine service, Blue Cross Online Visits, grew 70 percent in a week in early March over the same period a year earlier, and more recently recorded a 300-percent increase in another week.
Janet Fava, Blue Cross Blue Shield of Michigan’s vice president of market solutions development, expects the present crisis to accelerate utilization rates even beyond the triple-digit year-over-year growth recorded since 2017 for Blue Cross Online Visits.
Satisfaction scores for the service, offered through the Boston, Mass.-based platform AmWell, short for American Well Co., are “very high,” Fava said.
“I think people have been hesitant to use it previously, but the people who do use it absolutely love it, and they’ll go back and use it again,” she said. “Once people use this technology and once they recognize and understand the convenience of it as well, that’s part of what we think will accelerate this growth.”
Teladoc Health Inc., a Purchase, N.Y.-based telemedicine platform, reported March 13 that its virtual visits grew 50 percent from the prior week to more than 100,000. In one day, Teladoc hosted 15,000 virtual visits, the company said.
‘Ton of interest’
As the public health crisis took hold, health insurers, Medicare and Medicaid waived out-of-pocket costs for a virtual visit to ensure finances did not prevent a person with symptoms from having an initial screening. The move also allowed people to avoid going to their doctor’s office, an urgent care center or hospital ER, all of which were expected to see a surge in patients with COVID-19 symptoms.
Priority Health has provided access to telemedicine to most members with zero copays. Amid the COVID-19 pandemic, Priority Health on March 20 waived copays to telemedicine service until April 30 across all product lines: commercial, individual, Medicare and Medicaid policies.
A few days earlier, Blue Cross Blue Shield of Michigan said it was providing telemedicine visits at no cost at least through April 30 for enrollees feeling symptoms.
The COVID-19 pandemic has increased the interest and use of telemedicine beyond patients.
Doctors who have never before used the service to connect with patients virtually are now increasingly wanting to connect. Blue Cross Blue Shield is working quickly to get those providers onboard with virtual visits, Fava said.
“We have a ton of interest from our providers right now to get the capabilities in order to deliver telemedicine,” she said. “This health emergency is really going to change the face of how care gets delivered for a lot of members now.”
In recent weeks, Spectrum Health added more than 900 affiliated primary care doctors and specialists to its platform, Cowan said. At any given time, the health system has 80 to 85 care providers staffing the 24-hour Spectrum Health Now service, he said.
One element bringing more doctors into telemedicine has been changes in reimbursements by health insurers and Medicare, said Tim Pletcher, executive director of the Michigan Health Information Network, which provides connectivity between care providers to exchange data electronically.
Doctors have invested for years in electronic health records systems and technology for sharing data entry, “so that whole stack of infrastructure is now in place” and better reimbursements for telemedicine are “just the thing that tips it over the hump,” Pletcher said.
“What’s been holding a lot of people back is the money hasn’t been there. You were sort of treated by the payer system as somehow that was less, so they paid less. Now that’s really being changed,” Pletcher said. “The value proposition has come completely around for the doctors now.”
Another driver could come from data showing many patients began canceling office visits “en masse” amid the COVID-19 pandemic’s move into Michigan, said Chris Bailey, director of national engagement and consumer health strategy for MHIN.
Those cancellations left doctors “just standing around doing nothing,” Bailey said. Telemedicine can fill that void, particularly for patients with chronic illnesses who need ongoing care to manage or maintain their conditions, he said.
“What we’re seeing as a result is providers are doing whatever they can to keep those visits,” he said. “That’s a big dynamic that’s going to have a shift forever in how patients access health care.”
As the utilization rate for telemedicine grows, there’s a need “for the telehealth space to coordinate better with the in-person space so we more optimally use the two together” to share data more effectively, Pletcher said.
That includes better connection with national platforms where a doctor in one state sees patients in another state virtually without access to their electronic medical records or connectivity to their local care network.
“We really don’t want to get a call for somebody from another state over telehealth, and they go, ‘Yeah, we see that you’re sick, go to the emergency department’ without being able to have the medical information flow to the emergency department,” Pletcher said.
EDITOR’S NOTE: This story was updated from its original version.