In 2019: TeleHealth Becomes a Standard of Care

Mark Luck Olson is CEO of Trainer Rx, a leading innovator of orthopedic digital health solutions. A 30-year healthcare veteran, Olson’s areas of expertise include market development, consumer engagement, and health management and delivery models. The Trainer Rx platform improves the cost and quality of care for musculoskeletal conditions by driving up consumers’ adherence to their own recovery. 

After decades of trial and careful use, the time has come for “telemedicine” to complete its transformation to “telehealth.” By the end of 2019, we foresee that telehealth will begin to approach mainstream use as a standard of care.

While the phrase “telemedicine” was first coined in the 1950s to define delivery of health services from a distance, it has taken nearly 70 years for telemedicine to become an accepted service offering. There were several obstacles hindering progress, including lack of reimbursement, shifting consumer attitudes, physician availability, steep technology costs, access restrictions, and security concerns. The Centers for Medicare & Medicaid Services (CMS) faced resistance from physicians and professional groups when attempts were made to insert telemedicine into its value-based reimbursement model. 

Easy access to information led to a rise in consumers’ desire to access their care on their own time and in locations of their choice. On-demand care and virtual visits enabled consumers convenient access to providers and specialists. Innovations in technology led to greater connectivity between health care entities and secure access to electronic health records. It was not long before remote healthcare services began to expand. So, what do we envision 2019 will look like for telehealth? 

We will see broader acceptance of telehealth for musculoskeletal conditions. Until recently, telehealth was narrowly focused on services in primary care, behavioral health, dermatology, and pediatrics. But as the population ages, the prevalence and scope of musculoskeletal (MSK) conditions will continue to increase, and simultaneously, increase health care costs for patients with worsening conditions. One form of telehealth expanding in MSK conditions is telerehabilitation, physical therapy provided outside of the traditional in-office setting. 

Telehealth services will expand to include innovative patient engagement tools. Telehealth services will expand to include disease awareness, signs and symptoms, and medication monitoring. It will enable patients and their caregivers to recover on their own terms, guided by evidence-based content. More importantly, telehealth platforms have begun to incorporate gamification and other behavior modification tactics to keep patients engaged. With greater adherence by consumers, clinical and economic outcomes improve.

Health care companies will face an unrelenting pressure to accelerate their adoption of telehealth. According to CMS, total health care spend in the United States has reached approximately $3.3 trillion. For MSK conditions, the US Bone and Joint Initiative estimates the annual cost to be $254 billion in treatment care and lost wages. To reduce costs and improve efficiencies, providers and health systems will have little choice but to offer remote services at a faster pace. 

Health plans are looking to finance telehealth. Health insurers initially limited funding for “untested” technology given questions about supply-induced utilization. Today, major health plans like Aetna, Anthem, Cigna, and UnitedHealth announced their support by expanding coverage. Blue Cross Blue Shield, which limited telehealth services for years, has begun to cover virtual care. Three reasons why payers have acquiesced; (1) a growing library of studies demonstrating that telehealth visits are indistinguishable from face to face; (2) undeniable financial value in making these service offerings available; and (3) significant patient engagement driven by generational shifts in attitudes and expectations.

CMS outlook on telehealth significantly improves. In November 2018, CMS finalized plans to improve reimbursements for remote patient monitoring, encouraging health systems and providers to begin incorporating telehealth into their workflow. CMS also eliminated geographic restrictions for services focused on opioid recovery and treatment.  Next year will bring greater reimbursements as CMS executes the new CPT codes.

Platforms that fight opioid and other forms of substance abuse will be in great demand. While traditional treatment plans have focused on group therapy and care in the doctor’s office, telehealth platforms enable providers to connect with patients at any time and place. Online service offerings include peer support, on-demand access to caregivers, virtual visits, and patient monitoring using wearables. Telerehab platforms that treat the root cause of opioid addiction, pain, will see accelerated growth in 2019 as providers prescribe the remote self-care services to a greater number of patients.

Practice groups will scramble to invest in new technologies in order to offer telehealth services. One of the main reasons providers were slow to adopt telehealth is that its reimbursement was approximately 30% lower than face-to-face visits. New CMS guidelines and acceptance of telehealth services will usher in new service offering from providers. Providers seeking to differentiate themselves and increase their patient base will begin to promote their remote services aggressively in 2019.

Despite telehealth’s expoential expansion, virtual services will not replace provider or clinician care. They will, however, augment medical care, giving patients greater access to better health care and ultimately, better quality of life. With multiple barriers that have in the past, interfered with its growth now dissolving, “telemedicine” is poised to transform into “telehealth” and become a new standard of care by transforming health delivery in the United States and solidifying a place for value-based care in health care.