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If you look up the definition of “health care consumerism”, according to Wikipedia, the term means a movement toward patients being more involved in their own health care decisions. It’s more than that. It is also about patients setting the terms by which they will seek and receive health care services. The old paradigm of making an appointment between 9 a.m. and 5 p.m. two weeks in advance doesn’t work anymore. People are busy. They want health care when they need it and they aren’t afraid of receiving it via technology.
There is plenty of evidence of consumers’ desire for convenience and how it is driving health care options. Retailers are offering on-site clinics in more and more locations; urgent care centers are popping up in busy neighborhoods across the country; and telehealth is surging. It’s easy to see why retail clinics and urgent care centers are successful, but what about telehealth? Will consumers really accept remote care in place of in-person visits or an ongoing relationship with their provider? The answer is yes.
In the “Telehealth Index: 2015 Survey” conducted by Harris last year, 76 percent of patients said that they prioritize access to health care services over the need for human interactions with health care providers. The same poll found that 70 percent of patients are comfortable communicating with their health care providers via text, email or videos, in lieu of seeing them in person.
Polls are one way of measuring acceptance. What about a head-to-head, real-time choice between telehealth and an in-person visit? A study released by CVS Health last summer measured just that. CVS Health piloted a capacity management solution using telehealth in select MinuteClinics. Patients at busy MinuteClinics were given the option to use telehealth to connect with a provider in another MinuteClinic rather than wait for an in-person visit. The study is unique because participants were already standing at a location with a practitioner and were given a choice to use telehealth. Of the more than 1,700 respondents who used the telehealth option, 33 percent liked telehealth better than an in-person visit, 57 percent liked it just as well, 10 percent weren’t sure, and only 1 percent found it worse. More than 95 percent of respondents were highly satisfied with the quality of care they received, the ease with which technology was integrated into the visit, and the timeliness and convenience of their care.
Consumer preferences aren’t the only development driving telehealth’s growth. Employers’ desire to save money and decrease absenteeism plays a big role. The National Business Group on Health “Large Employers’ 2016 Health Plan Design Survey”, a survey conducted of 140 employers with 10,000 or more employees, found rapid growth in telehealth – from 28 percent of employers offering telehealth as an option in 2014 to 74 percent (projected) in 2016. According to the “United States Telehealth Market Opportunities, 2011-2021” published by Pharmaion in February 2016, the telehealth market is set to grow to $13 billion by 2021.
Initially telehealth was offered as a benefit largely separate from medical benefits. Now, more and more insurers are offering telehealth as an integrated part of their traditional benefit package. Anthem leads the way, but other large insurers like United Healthcare and most Blue Cross Blue Shield plans are including telehealth in their offerings. This will make telehealth even more mainstream as patients are given the choice to visit remotely with a provider through their insurer.
The biggest remaining challenges to fully meeting consumer needs with telehealth are 1) the absence of telehealth in the traditional provider office; 2) payments in public programs; and 3) inconsistent standards of care across states. A recent survey by Anthem and the American Academy of Family Physicians of 1,500 family doctors found that about nine in 10 family physicians said they would use telehealth to treat patients if they were paid for it, but only 15 percent said they had used the technology in the last year. The Anthem/AAFP survey found users are more likely to be younger, rural and use an electronic health record.
Much of the reason physicians don’t use telehealth is because they don’t get paid for it. Imagine if your boss told you that you are allowed to work remotely but you couldn’t get paid on those days. You wouldn’t work remotely. Given the high number of physicians that would use telehealth if they were paid, it’s time we have consistent reimbursement policies across public and commercial insurers.
There is a major effort underway in Congress to reimburse for telehealth in Medicare. Giving access to telehealth to seniors is a priority for a bi-partisan group of senators and representatives who introduced the CONNECT for Health Act last month. Led by Senators Brian Schatz (D-HI) and Roger Wicker (R-MS), the bill will help physicians serving Medicare patients who are transitioning to value-based care, provide a permanent telehealth benefit to seniors in Medicare Advantage plans, and establish a remote patient monitoring benefit in Medicare. It is good public policy that will provide Medicare beneficiaries access to convenient care that will replace in-person services in more expensive settings. Enactment of the CONNECT for Health Act will go a long way toward improving access to telehealth for all Americans.
Finally, a consistent regulatory framework at the state level would enable telehealth providers, employers and health plans to offer telehealth with greater ease. The boards of medicine and pharmacy are two good examples. Some states allow prescribing over telehealth modalities while others don’t. Some states allow direct-to-consumer telemedicine while others don’t. For multi-state employers or entrepreneurial physicians, these varying regulations are a barrier.