More healthcare providers are carving out telehealth leadership roles in their C-suites, a trend that will likely accelerate as a result of the COVID-19 pandemic, governance experts said.
There was around a 40% increase in the number of telehealth leadership roles among health system C-suites from early 2019 to early 2020, according to data from SullivanCotter, an executive compensation consulting firm. Telehealth use skyrocketed amid the COVID-19 pandemic, facilitated by temporary regulatory waivers and reimbursement boosts.
But the increased demand created logistical challenges for providers. They had to boost their technology and staffing capacity. Managers had to train staff, adapting as best practices emerge. Providers also had to redirect patients who are accustomed to in-person care.
Meanwhile, health systems are eying evolving regulatory guidelines, reimbursement models and quality metrics as they weigh short- and long-term strategies.
While it's uncertain to what extent care will remain virtual beyond the pandemic, industry experts agreed it's important for health systems to have an executive accountable for building a sustainable telehealth program.
"As more and more encounters are delivered via telehealth, the importance of having an executive who is driving that part of the operation is just more and more critical," said Michael Brookshire, a partner at consulting firm Bain & Co. Without a designated lead, systems might find they have many leaders who "care about (telehealth) a little bit, with a little of their time," rather than someone who's tasked with spending most of their time on it.
He suggested health systems think about designating a telehealth lead similar to how they would appoint a president of a single hospital. That executive would take ownership of one area, but still report to a senior executive.
"The challenge with expanding the number of C-suite titles is that it becomes less clear who owns what, and who actually has decision authority and responsibility," Brookshire said.
Telehealth has helped to close care gaps and improve patient access for the past several years. Its standing has grown, albeit slowly, as it has provided a more effective means to monitor patients with chronic conditions, a safe space to broach mental health issues and a more efficient medium for busy families.
Telehealth only accounted for around 0.2% of U.S. privately insured medical claims prior to the pandemic. Utilization skyrocketed to 7.5% in March 2020, according to new data from Fair Health, a not-for-profit research firm. About 20% of all office, outpatient and home health expenses across Medicare, Medicaid and commercially insured populations could be converted to virtual care, amounting to $250 billion in telehealth spending in 2020, researchers from McKinsey & Co. noted in a new report.
But recent research has indicated that telehealth use has declined since hospitals began resuming non-emergency care in April—though it has plateaued at a notably higher rate than before the pandemic.
"Providers are dipping their toe in because of the current environment, but they are taking a wait-and-see approach to see if it will be an area of focus for the long term," said Jess Jones, managing director and chief operating officer in Huron's Studer Group business. "Is it leading to the care that we want; do patients want that type of interaction; are physicians comfortable? We don't have those answers yet."
Several states have implemented permanent changes for state-regulated health plans and Medicaid, and President Donald Trump on Aug. 3 ordered CMS to review and continue Medicare's coverage of telehealth services. How much of the telehealth wave sticks will depend on the post-pandemic payment parity between virtual and in-office visits, experts said.
"We know Seema Verma said CMS is behind this. But ultimately it will depend on what the payment parity looks like," said Matt Miclette, senior director of clinical operations at NeuroFlow. "You don't need the same infrastructure, so you don't need to pay as much for a telehealth visit as an office visit, but it will be interesting to see the breaking point for hospitals and doctor's offices to continue to roll out these services."
We may see more states follow the likes of Colorado and Idaho and take steps to cement telehealth coverage, said Mark Madden, managing principal of Cejka Search.
"If providers want to be seen as innovative and an advanced health system, they have to talk intelligently about telehealth and what it means to patients, access and governance," he said, adding that he expects more chief of telehealth officers to come into the fold.
That may include a dyad role, where the administrator is paired with a physician, Madden said.
"There needs to be a focus on the clinical and quality measure standpoint, and that physicians understand how to best use it," he said, noting productivity issues and other pain points with electronic health records. "That is going to be a major learning curve and I think you need to have leaders help make the transition, so we can get to the best outcomes."
That's the case at Ochsner Health in New Orleans. As Ochsner Health continued to build out its digital medicine programs, executives realized they needed to set up a new leadership structure, said Warner Thomas, the system's CEO.
"Trying to run it as part of our typical operations or for somebody to add it on as something to do was not going to work," he said, noting there's different considerations to manage when setting up telehealth and digital medicine programs, compared to traditional healthcare services. "We needed to have someone who focused on it all the time, if it was going to be successful."
About two years ago, the health system added two leadership roles related to telehealth: an administrative title dubbed the vice president of telehealth services, as well as naming a physician as a system chair of telehealth and digital medicine.
The vice president, who reports to the health system's executive vice president of digital health, works on building up the technical infrastructure and network of clinicians needed for remote care. The system chair of telehealth and digital medicine oversees care quality and figuring out which services are a good fit, reporting up to Ochsner Health's chief medical officer.
But there's multiple ways to structure telehealth accountability. It doesn't necessarily mean adding an executive that's exclusively focused on the practice, experts say.
In recent years, hospitals have started building telehealth oversight into vice president positions, said Hillary Ross, managing partner and leader at executive search firm WittKieffer's information technology practice. That trend was occurring before the COVID-19 pandemic. "Historically, this position was mostly a director-level role—until a few years ago," she said.
Now, Ross said it's common to see hospitals creating joint titles like vice president and chief health informatics officer, chief digital officer or chief innovation officer who oversee telehealth.
Recent telehealth growth could lead health systems to add something like a chief telehealth officer, where telehealth is their job's primary purpose, rather than one component, she added.
"There doesn't seem to be any cookie-cutter roles or structures," Ross said. "They're all a little bit different."
At MedStar Health in Columbia, Md., the chief medical officer oversees telehealth with support from the Medstar Telehealth Innovation Center, a program launched within the system's innovation institute in 2017.
"We made an active decision of creating either a center or (naming) somebody as the chief telehealth officer," said Dr. Stephen Evans, MedStar's executive vice president for medical affairs and chief medical officer. "We really preferred the center, because it had much greater connectivity across the system."
That oversight structure has made it easier to integrate telehealth as a "critical enabler" of care transformation, and not viewed as a process separate from care delivery, according to Evans.
Sheila Talton, president and CEO of Gray Matter Analytics, a company that uses data to help providers and payers reduce costs, cautioned that creating a separate executive responsible for telehealth could add complexity. Designating a telehealth lead could result in different care quality standards for remote and in-person care.
She hopes that she won't see health systems adding designated telehealth leads at the executive level.
"Any time you separate the chain of command, you risk (that) the metrics will be different," Talton said.
If a health system does add a telehealth leader, they should report to the chief medical officer and chief quality officer, she said.
It wouldn't be surprising to see health systems adding C-level executives exclusively focused on telehealth, said Dr. Christopher Sharp, chief medical information officer at Stanford Health Care. But he cautioned health systems against separating telehealth as a practice from what should be its intended goal: better clinical care.
"There's a risk that we focus on the process, without really looking all the way at the outcome as the primary leadership objective," he said.
Sharp leads much of the telehealth work at Stanford Health Care, with input from the health system's technology, operations, legal, finance and compliance teams. But telehealth ultimately falls under the chief medical officer's purview, he said. Sharp expects that to remain the case.
"Telemedicine is, at its core, another modality for care to be delivered," Sharp said. "There needs to be a very strong connection back to the clinical lines and the clinical leadership."