What Will Telehealth Look Like Post Pandemic?

As the United States and the rest of the world continue to return to normalcy after COVID-19, a question of whether certain pandemic-prompted services may begin to fade away must be addressed.

The COVID-19 pandemic has undoubtedly sped along telehealth adoption, and policy changes have helped pave the way toward strengthened and improved virtual care along the way. As America’s health care system looks ahead to life beyond this public health emergency, some stakeholders say it is essential to extend these changes—or make them permanent—so that telehealth can continue to thrive. Others, meanwhile, are highlighting the work that must be done to fix the pitfalls observed during this period of unprecedented telehealth utilization and growth so that all can benefit.

Before COVID-19 arrived, “The provider community was very resistant to telehealth,” explained Joshua Hollander, DC, MBA, director of health solutions at FTI Consulting, a global consulting firm based in Washington, DC. “There was a general consensus that the care was less effective.” But in the wake of the pandemic, “Those perceptions changed dramatically.” Providers came to realize that if they wanted to continue delivering care, telehealth would be their main route. It also became apparent that patients, by and large, value telehealth and do not necessarily perceive lower value care when comparing remote experiences to traditional visits.

“As the pandemic eases and we get back to normal activities there has been a wide variance in the permanent adoption of telehealth by providers,” he told First Report Managed Care. Although many have returned to primarily in-person visits, relying on telehealth as the exception for certain cases or patients, some specialties—such as behavioral health—have maintained high levels of telehealth usage. He added that the provider community can use the pandemic as a “real-life research study” to determine which specialties and conditions lend themselves to telehealth and which ones ought to remain in-person moving forward.

Why work toward breaking down any remaining barriers standing in the way of expanded and enhanced telehealth services? In short, insurance providers say because it offers a viable way to lower patient costs, increase the availability of providers, offer patients more provider choices, and improve the quality of care.

Telehealth offers cost-saving benefits like shorter hospital stays, according to AHIP, a national association of health insurance companies. It also opens the door to a wider pool of providers. More choices can enable patients to receive care from medical professionals with certain expertise or from providers with a similar background, especially when they might be challenging to find closer to home. Beyond that, telehealth can potentially enhance access to care in rural regions, enabling patients to quickly connect with providers instead of spending time and money driving lengthy distances to receive traditional care.

Yet the state of telehealth remains uncertain as payers, providers, patients, and other stakeholders envision and prepare for life beyond the pandemic. Policymakers “must recognize its value by allowing for telehealth to be counted as another site of care, and visits should be counted towards network adequacy requirements, risk adjustment calculations, and quality measurement,” AHIP has argued.

Telehealth will continue beyond the pandemic, predicts Michael Seavers, PhD, MHA, MBA, MS, a professor of health care informatics at Harrisburg University of Science and Technology. The infrastructure is now in place, and hospitals and health care providers have been educated on how to use telehealth, noted Dr Seavers, who is also the project investigator for Pennsylvania’s State Health Improvement Plan. But looking ahead, many important questions still need to be sorted out. For example, how will this remote care be paid for? One curiosity is whether Medicare will continue to pay for telehealth services. “Commercial insurance normally follows Medicare’s direction,” Dr Seavers told First Report Managed Care, so “Everyone is keeping an eye on Medicare payment policies in the next few months.”

Another central question, according to Dr Seavers, is whether states will continue to allow cross-border licensing. To help illustrate, he pointed out that Pennsylvania has allowed doctors in the neighboring states of Delaware, Maryland, New Jersey, New York, Ohio, and West Virginia to practice telemedicine in Pennsylvania during the COVID-19 pandemic. If the state’s temporary legislation is withdrawn, however, only doctors licensed in Pennsylvania can practice telemedicine in Pennsylvania. Some wonder whether doctors ought to be licensed at the national level. If so, he said that “Telehealth would be easier to sustain over time.” Otherwise, to practice telemedicine across the United States, a doctor would have to be licensed in all 50 states, he added, and this is “a huge burden for medical professionals to accomplish.” 

Yet another aspect that warrants discussion pertains to parity laws. “These laws state that a virtual, telehealth office visit should be paid at the exact same rate as an on-ground office visit,” he explained, and there are different vantage points and opinions on this issue. Health insurers tend to argue that telehealth visits ought to be paid at a lower rate considering the provider does not necessarily have to cover certain expenses like rent, office supplies, office labor, or equipment. On the other hand, providers and hospitals tend to point out that while telehealth may make it possible to trim office related costs, these expenditures have been offset by IT software and hardware needs like enhanced computer networks and faster Internet speeds. 

Although telehealth has expanded rapidly since the arrival of the pandemic, thanks in part to policy changes at the federal and state level, some Americans have benefited more than others. Despite all the upsides of telehealth, some populations—like rural residents, older adults, and those with limited English proficiency—have experienced challenges accessing and utilizing virtual care. “Not everyone has access to the Internet,” Dr Seavers noted, “or if they do have access, they do not have the high-speed bandwidth needed for solid telehealth visits.” In addition, some people do not have the know-how needed to set up access and make use of telehealth, so training may be needed for vulnerable populations. 

For example, a study published earlier this year showed that older people with limited English proficiency and digital literacy skills face significant barriers when accessing high-quality telehealth services. The study assessed experiences at two community health centers with large immigrant populations—primarily Chinese and Latino. The University of California researchers found that third-party language services were challenging to weave into video visits and that the availability of bilingual and multilingual personnel capable of delivering translation during video visits is crucial.

They also found that audio-only visits helped reach older adults with limited English and digital literacy skills who tended to lack access to devices, avoid video visits, or have difficulties using video technologies. “Continued use of telemedicine is contingent on reimbursement policy decisions and interventions to increase patient digital literacy and technological resources,” the study noted. “Results highlight the importance of reimbursing audio-only visits post-pandemic and investing in efforts to improve the quality of language services in telemedicine encounters.”

According to study author Denise Payan, PhD, an assistant professor of health, society, and behavior with the University of California, Irvine’s Program in Public Health, the investments needed to support accessibility pertain to technology as well as personnel and training. “While clinic personnel and patients like the convenience of telehealth options, privacy concerns in clinical and home settings need to be addressed,” Dr Payan told First Report Managed Care. “Telehealth also presents an opportunity for the use of remote monitoring devices and increased involvement from family members to better support ongoing patient chronic care management.”