More on Telehealth

With telehealth here to stay, healthcare looks to sustain it through patient engagement

Thinking about telehealth as a site of care is a philosophical consideration for those looking to sustain success with the care model.

Jeff Lagasse, Associate Editor

Telehealth adoption has skyrocketed during the COVID-19 pandemic, and with good reason: Patients are hesitant to venture into brick-and-mortar care settings, and yet they have health needs that must still be addressed. This poses a challenge for the healthcare industry, as providers not only look to implement new remote care technologies, but to sustain these models over the long term. Telehealth usage may decline somewhat post-pandemic, but it will remain higher than it was, and has established itself as a care setting in its own right.

The use of virtual care requires that health systems adopt best practices to reach larger populations in ways that are quite different from the physical experience, all while responding to the increased demand. The models should be considered carefully so consumers can gain an understanding of how to use it and when it would be appropriate to do so. 

This challenge is all but universal. Some entities, such as the ones that have been ahead of the curve on population health management strategies and new models of care, were a little more prepared for this paradigm shift at the start. But nearly all organizations had to either implement or scale up their capabilities quickly at the start of the health crisis.

"I think it's safe to assume that the massive influx we've seen is now where the pendulum will swing back," said Shara Cohen, vice president of customer experience at Wolters Kluwer's Clinical Effectiveness business. "I don't think this influx is the new normal, but we'll see virtual visits far above the levels prior to COVID hitting."

A big shift in thinking is that telehealth and virtual visits are being considered as new sites of care. Healthcare has been moving people out of acute settings and more into surgeries and urgent care, and that's offering a new avenue that in some cases is more clinically effective for some patients when used appropriately.

"As an industry, we tend to focus on the provider and the delivery side, but we can't lose sight of the patient and their compliance and their needs," said Cohen. "The good news is the learning curve probably isn't very steep. We just have to make that adoption curve easy."

To do so, many hospitals are taking a back-to-basics approach. One component of that is outreach to consumers about the viability and eligibility of visiting virtually. Another is education on how to actually use it. While it seems like an obvious point, not everyone may be aware, for example, that they need a computer, internet connection and a camera. Helping people to understand these fundamentals, said Cohen, can accelerate use and adoption.


To be effective, much of this communication needs to occur outside the clinical setting. Standard procedures can offer an example: The better a provider is at getting patients to prep for a procedure, the more likely it is to comply and actually attend those procedures, and that's fundamental to performance in a healthcare environment that's still largely fee-for-service. There's a strong correlation between that and virtual care. The preparation looks different – securing a camera, ensuring smooth Internet access – but it's just as important in terms of compliance and attendance.

"What COVID has done is to vastly accelerate people's understanding of the benefit that telehealth can provide, but it hasn't originated from that site of care," said Cohen. "The first challenge for providers in adopting virtual care was reimbursement, and the models of it, and now there's the other side of the coin – how to get patients to comply."

Patient engagement becomes critically important in this scenario. Many healthcare organizations rely on the patient portal for engagement and outreach, but depending on the quality and attractiveness of the portal, this can have mixed results. Better, said Cohen, to communicate with a patient on the latter's terms, relaying information such as when telehealth can be used appropriately and whether it's covered under insurance.

"That initial education to push into a health consumer's hands I think is an important first step, and then coaching them through it," said Cohen. "This is an old challenge with a new face. Ten years ago, when we talked about patient satisfaction, part of the way organizations responded was to coach their staff, talk about those measures, and track those measures with their clinicians. But it was also to help patients understand the context of their care. They're better prepared for what the experience will be like, and they'll be more forgiving in a survey. Same goes for virtual care. This is a new front door for patient access, so how do you align the strategies for them so they can use it to its fullest?"


Step one is to do things as far upstream as possible. Health consumers have expectations of how they're going to be engaged that are influenced by factors outside of the healthcare industry itself. Netflix, for instance, knows our tastes, our preferences, and everything about us. Yet no matter how many times a given patient goes into a health system, it can be like they're meeting people for the first time. Organizations that find success in the future will consider the patient side of that experience, and think about what things will be like for them regardless of the care setting in which they're interacting.

"Where we see organizations most successful is where they don't think about the virtual visit only in isolation," said Cohen. "Healthcare is unfortunately a very disconnected, siloed experience, so when organizations think about those silos in isolation, they're exacerbating that. Where health systems need to focus long-term is how one setting relates to the other setting, and what is the path or continuum."

Philosophically, there's a lot that can be borrowed from population health models, which consider social determinants and matching patient need with access. Luckily for the industry, telehealth offers the ability to scale. New buildings and an expanded physical footprint aren't necessary, just the ability to connect the right people to the right services.

The pandemic has provided a kind of proof-of-concept for telehealth and virtual care, and for long-term success, there needs to be a recognition among hospitals that these models can provide important venues for care within the overall continuum.

"This put a magnifying glass on a lot of things we already knew," said Cohen. "We haven't created a new need, we just illustrated more clearly the needs we're all aware of: more care outside of traditional brick-and-mortar; making care more convenient; addressing health inequities related to access; and the availability of technology as a social determinant of health.

"The benefit telehealth provides has always been accepted. The premise was there, but the adoption wasn't. Now we've proven the benefit. We can't expect the heights in utilization to stay where they are, but they'll be much higher than they were prior. I expect about 25% growth over the next few years, year over year."

Twitter: @JELagasse
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