We don’t need to run diagnostic tests to know that the healthcare system in the U.S. is gravely ill. High costs and subpar care are just the tip of the iceberg for patients today. Annual wellness checks, while well-intentioned, make it all too likely for people to wait for months at a time to ask their doctor about troubling symptoms rather than seeking more immediate attention.
When the COVID-19 pandemic led many people to avoid medical offices, doctors feared that neglected ailments could worsen. While this concern has to some extent been borne out, there was one unanticipated silver lining: a coming-of-age moment for telehealth. In the early months of the pandemic, consumer adoption of telehealth more than quadrupled from 11% to 46% as virtual visits quickly became the initial touchpoint for many primary and mental health care consultations.
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For the first time, both doctors and patients were exposed to virtual tools that enabled them to connect swifter and more often. These digital interactions weren’t a full replacement for physical visits, but rather an opportunity for check-ins, questions, and referrals to be expedited, and in-person appointments to be scheduled as needed. Easier and more convenient care has generally resulted in a positive experience for everyone involved and is now creating employee adoption and
Telehealth has a long history in specific niche scenarios such as chronic pain management, specialty telemedicine consultation and sleep disorders, but the past year has seen a rapid acceleration in its adoption as a core element of routine care. As the pandemic finally begins to wane, how can we take the experience and insights gained beyond ad hoc practices and anecdotes to inform a full reinvention of primary care?
Patients move to the center of healthcare
The expansion of telehealth comes in the context of a broad trend toward more patient-centric delivery of care. Value-based care models seek to improve quality and efficiency while reducing cost by partnering healthcare providers with community-based organizations to better reach underserved people within their own communities. Among payers, an emphasis on increasing preventive care support seeks to catch issues before they worsen, which not only improves patient outcomes but drives down costs by avoiding more serious interventions — one model projects revenue savings of up to 20%.
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Employer engagement initiatives seek to empower patients with measures to better manage their own health, such as fitness subsidies, smoking cessation programs, and mental health resources.
The team-based model aims to go even further by taking a 360-degree approach to wellness. Yet truly holistic care would have to include the Patient-Centered Medical Home model — which can only be dovetailed by telehealth.
In development for more than half a century under the leadership of groups including the American Academy of Pediatrics, the World Health Organization, the American Academy of Family Physicians and the National Academy of Medicine, the PCMH fundamentally reorients the practice of primary care delivery. Instead of the limited care that a single doctor can provide, a team-based approach proves to have more success at keeping patients healthy and helping them achieve their comprehensive wellness goals.
The PCMH model encompasses five principles:
Comprehensive care – A single primary care medical home meets most of the patient’s physical and mental health care needs, from prevention and wellness to acute and chronic care. Through this home, the patient can access the services of a complete team of care providers such as physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and care coordinators.
Patient-centered — Patients, families, and care providers develop a relationship based on a full understanding and respect for the patient’s unique needs, culture, values and preferences.
Coordinated care — The PCMH coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports.
Accessible services — The PCMH improves accessibility by complementing in-person visits with round-the-clock remote access to the care team.
Quality and safety — Evidence-based medicine and clinical decision-support tools help guide shared decision-making with patients and families, improve patient experiences and satisfaction, and support population health management.
The incorporation of telehealth practices and PCMH principles into the delivery of care can improve both costs and outcomes — a win-win for employees and their employers. More preventive, timely, and coordinated care can prevent ailments from worsening, in turn lowering the overall cost of treatment. A more personal bond and ongoing relationship between patient and provider builds trust and leads to better health outcomes.
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More appropriate use of treatments and specialist resources improves cost efficiency. A shift of many interactions from in-person to virtual settings can save all involved from wasted time, improving their productivity and satisfaction.
Better outcomes for patients — and payers
By making it easier for people to see their primary care doctor and easier for doctors to maintain an ongoing relationship with patients, telehealth provides a breakthrough from the limitations of the traditional annual wellness visit. The fragmentation in the current healthcare system has led to ample frustration among patients and providers alike. Telehealth offers an opportunity to reimagine the delivery of care in a way that emphasizes continuity of access on both sides. By providing frictionless access to clinicians who really know the patient longitudinally, we're better able to build the trust that can open communication about broader social context and barriers to care, break down taboos about mental health, increase medication adherence, and build a more collaborative experience across the continuum of care.
Instead of waiting for the next routine exam to bring up emerging symptoms, patients can set up a quick virtual consultation from the convenience of their own home to see whether a sooner office appointment is necessary. If an issue does need immediate attention, it can be caught early, before it spirals; if not, the patient gains valuable peace of mind. Small things are less likely to become big things.
Chronic conditions can be managed more effectively. Moved outside the intimidating context of a medical facility, a telehealth visit can also be more conducive to candid conversations about sensitive topics like weight loss, smoking cessation, substance abuse, or mental health. The annual visit still has a role to play and for many patients may be all that’s needed, but others needing more frequent touchpoints, these can be provided in a lower-intensity, more patient-friendly context.
For both patients and doctors, a traditional office visit can feel like the only chance they’ll get to decide on a course of treatment, making one or both more likely to push for a higher-level option — for example, prescribing an antibiotic rather than trying an over-the-counter remedy first. Given the ease of access of telehealth, a doctor can be more likely to try a more appropriate low-level treatment first, knowing they can keep in touch and escalate care at any time.
A more dynamic approach to care over the course of an illness can be both more effective and more cost-efficient. If a referral proves necessary, the provider can handle the bulk of the preliminary diagnostics and due diligence beforehand, ensuring optimal use of the time the patient spends with the specialist.
As the Covid-19 pandemic nears a resolution and a sense of normalcy approaches, simply returning to the healthcare status quo would be a tragic missed opportunity. The lessons we’ve learned about telehealth over the past year point the way to a better healthcare delivery model for all of us — patients, doctors, and payers. It’s a remedy we should wholeheartedly embrace.
