The U.S. healthcare system often moves at a glacial pace, but COVID-19 catapulted it into the future with the overnight acceleration of telehealth as a care option.
During the first four months of the pandemic, telehealth accounted for 23.6% of all doctor visits—up from almost none a year earlier. But while experts predict virtual care is here to stay, the emergency legal provisions that allowed its emergence are beginning to expire. Now we must figure out how to keep telehealth before time runs out.
What we know is that telehealth is increasing interactions between patients and their doctors. As the pandemic eases, in-person visits to doctors' offices are returning to pre-pandemic norms—while telehealth remains strong. At Mount Sinai Health System, we are completing over 42,000 visits per month on average in 2021, which is many times higher than our pre-pandemic yearly totals.
The dramatic change in volumes reveals how telehealth has created new access opportunities for patients. Working families, communities of color, undocumented immigrants, the uninsured and others have long struggled to receive care in the standard model because of transportation, childcare, work schedules, costs and more. Remote interactions with doctors can ease these challenges, creating flexibility for patients so they can receive care without negotiating the logistics—potentially improving health outcomes.
But one obstacle to telehealth growth is that during the pandemic, federal, state and city health officials took many measures to expand telehealth that were designed to be temporary. If the steps that allowed telehealth to flourish end up expiring, the losers will be patients, who have come to depend on telehealth as a reliable and convenient option to stay healthy.
For instance, medicine's state-based licensing model has traditionally restricted telehealth so that it can only be delivered in the state where the patient currently lives. But during the pandemic, interstate cooperative agreements allowed patients living across the country to receive care from their regular physician via telehealth. If the old system of licensing returns, a patient in New Jersey may be barred from scheduling a telehealth visit with a Manhattan doctor—because their doctor might not be licensed in New Jersey.
Health economists could argue that the increase in total healthcare appointments will result in an unnecessary escalation in healthcare usage—raising total costs. But there's a path forward that keeps costs down.
First, we can focus on granting more telehealth privileges to health systems that use it as part of their commitment to keeping patient populations healthier through preventive measures. In these value-based care arrangements, insurers commit to rewarding hospitals and doctors whose patients continue to stay healthy, not those who rack up the most (costly and potentially unnecessary) tests and procedures.
Telehealth is a natural fit for this kind of incentive model. It allows doctors to connect with their patients regularly, at lower cost or inconvenience to them or their patient, and as a result keep patients healthier. By prioritizing patient health regardless of how we're meeting patients' care needs, we can help manage conditions in our patient populations and improve quality of life, so patients get and stay healthier.
Another important step is tying telehealth to innovative delivery methods to connect communities with the care they need. We started a program working with community health workers at AIRnyc who facilitate telehealth visits for physical, behavioral and social care. Patients referred to AIRnyc, who come from lower-income neighborhoods, are less likely to engage in technology-enabled, home-based care. But in partnership with a community health worker, we have proven that many of the barriers can be overcome. With smart program design and investment, there are ways to improve delivery of care, even without technical skill or access.
We should also tailor the permanent implementation of telehealth toward a population health approach. One significant drawback with telehealth is that many vulnerable patients still struggle to get the technology and internet access needed to ensure telehealth is reliable. The federal government should use telehealth as motivation to finally provide a real, sustainable investment in the infrastructure that makes telehealth possible, and that starts with universal broadband and WiFi access. Internet is no longer a commodity, it's an essential tool for health and economic development. We need the federal government to step up and guarantee universal WiFi for all.
Finally, and most importantly, we need the federal government to work with state licensing boards to permanently expand the privileges established during the pandemic that make telehealth more flexible.
Making a permanent place for telehealth in our healthcare system not only improves the health of communities, it's also smarter for the overall economics of healthcare delivery. It will cost less to provide care to patients and put less stress on the health system to deliver that care. The time is now to glean every lesson from this pandemic to take our healthcare system into the future.