Health

Telehealth skeptics miss the forest for the trees – STAT


The role of telehealth and its staying power in our health care system is up for debate.

As someone working in the telehealth universe, I’ll be the first to say it’s not a panacea: some people are best served by in-person care. The reality, though, is that even before the pandemic emerged, the U.S. health care system struggled with stark limitations in access, vast disparities in outcomes, and out-of-control costs — largely without ever using telehealth to its full potential.

Telehealth, even with its constraints, delivers significant value for patients by complementing their in-person care, expanding access to affordable services, and supporting equitable health care experiences. I think that those who want to allow telehealth policies, regulations, and reimbursement to revert to a pre-Covid status quo, effectively putting the brakes on virtual care, are missing the forest for the trees.

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Complementing in-person care

As soon as federal and state policies governing telehealth were liberalized in the spring of 2020, its use by providers and patients skyrocketed. While the initial surge can be attributed to the pandemic, the ongoing popularity of telehealth services indicates that technology can meet the pent-up demand for health care experiences that better match peoples’ lives — convenient, efficient, and accessible.

Despite this, some argue that telehealth threatens to dissuade people from seeking in-person care, even though there is little evidence to show that telehealth will spell the end of that traditional type of care — or, vice versa, that the pandemic’s eventual subsiding will quell demand for virtual care.

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At its peak last year, telehealth still only made up 32% of office and outpatient visits. And with the easing of Covid-19 regulations, which gives hospitals and clinics greater capacity, many people have returned to seeking in-person care. Telehealth use still remains far, far above pre-Covid levels though, as the health care system begins to witness a rebalance. People are recognizing that they can complete a virtual visit for one condition and drive to their specialist for another.

This is the right resolution. Telehealth’s role in the health care system should be determined by what is best for each individual — making it the first choice for some and a complementary service for others. But preserving telehealth’s availability is important for another reason too: It’s sometimes the only option people have. Individuals seeking in-person care face average wait times of more than three weeks for new appointments, millions live in care deserts far from clinics or hospitals, and many more simply can’t take time off during business hours to sit in a waiting room for a brief face-to-face visit. It’s this reality that has meant — without telehealth as an option — too many people were left out of the health care system with no options.

Offering affordable options

Two primary arguments are made about the cost of telehealth. One is that giving people more options means they will have too much access that will result in a spike in utilization. The other is that those who use telehealth may still need downstream in-person care, thereby driving up total costs.

The U.S. does not have a problem with “too much access” to care. A shocking number of Americans deal with care deserts, provider shortages, and cost barriers. Telehealth may mean new utilization for those typically blocked from care. But it’s important to recognize what this use means downstream for both health outcomes and costs.

The access and affordability of telehealth can act as an entry into the health care system. Imagine someone who has not seen a physician for several years. A telehealth visit may lead to a diagnosis of an unmanaged chronic disease. In this way, telehealth can help promote more proactive, preventive care, which is better in the long run for patients’ wellbeing and costs.

It’s possible that some people will use telehealth for a certain condition and then seek additional in-person care for that same condition, whether that’s due to the complexity of their condition or acting on a provider’s referral. But for as many times as that happens, telehealth also has the ability to act as an affordable triage or treatment option for individuals who then do not need in-person care. About 1 in 7 people who used telehealth said they would have sought care in an emergency department or urgent care if telehealth had not been available, and more than half of them had their primary health issue resolved virtually. Triaging or solving patients’ needs through telehealth, rather than in costlier sites of care, has the potential to create significant cost savings at the population level.

Closing gaps for underserved communities

There is a difference between evaluating telehealth as a solution for every individual — something it is not — and assessing its impact on health care equity broadly. On both fronts, the in-person health care system has fallen short for decades, and things got worse during the pandemic.

Health care stakeholders must implement telehealth with a keen eye for reducing existing inequities and avoiding new barriers to care. For instance, telehealth providers must pay careful attention to the digital divide to ensure that those without digital literacy, without broadband internet access, or without access to a computer or smartphone are not left out. The health care system can learn how to do this successfully by acknowledging the role that telephone-only visits have played during the pandemic for lower-income patients who may not have broadband or video-visit capabilities.

Telehealth can also fill gaps that create disparities in the health care system. It has been used to meet demand for services that face a shortage of providers, such as mental health, and make specialized care available for underserved populations, such as LGBTQ+ patients.

Telehealth must be implemented in a clinically sound, affordable, and equitable manner. In this in-between time, it’s important to measure telehealth not just for its limitations but for its value for patients and for a system that has historically dealt poorly with fundamental problems. All of us — analysts, policy makers, health care providers, patients, and others — need to embrace the opportunity to welcome a new age in the health care system, one that offers more options for high-quality care.

Melynda Barnes is a facial plastic and reconstructive surgeon, an otolaryngologist, and chief medical officer of Ro, a direct-to-patient healthcare company.


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