Telehealth’s Promises and Challenges

The COVID-19 pandemic has already spurred many health systems and patients to adopt telehealth as a substitute for in-person doctor visits. Questions remain, however, about telehealth’s impacts on the long-term cost and quality of care, the limitations of remote practice, and the adequacy of conventional healthcare policy to address this growing service. Private payers and the Centers for Medicare & Medicaid Services have adopted regulatory and payment changes, and privacy regulations, for telehealth, but what will happen when life returns to normal?

On July 8, 2020, the Manhattan Institute hosted a live virtual panel discussion of telehealth’s promises and challenges. The speakers were Amwell Chief Medical Officer Peter Antall, Forest Hill Consulting President Robert Horne, and Harvard Medical School Professor Ateev Mehrota.

“In the world of telehealth, it’s been an incredible year,” Antall said. “It’s been one of those inflection points that’s totally changed the industry.” He added that he has been in the industry since 2008 and Amwell is very excited to be playing a meaningful role in the burgeoning world of telehealth.

Antall showed a slide about how the telehealth rush impacted Amwell. There was a nine-fold increase in average daily visits compared with this time last year. “In three weeks, we went to a 900-percent increase in volume,” he said.

Amwell sees itself more as a technology platform that allows health plans and health systems to deliver virtual care than as a care delivery service in itself.

In addition to visits addressing physical health concerns, Amwell offers behavioral health services, and the company has seen a 44x increase in virtual therapy appointments and a 27x increase in virtual psychiatry visits. “Not only do we have a COVID pandemic in this country, we have a behavioral health pandemic,” Antall said.

Antall said telehealth has the potential to increase patient compliance and provide other services like remote patient monitoring. “Patients have a variety of needs, and I think what telehealth does is that it allows us to think differently about how we project the abilities of providers in new and more efficient ways … how we build new models of care, how we improve access by doing things like solving for geographic disparities. And also, what we’re able to do at the same time is make care really patient-centric,” he said.

“On the industry side, we work with a lot of hospital systems and health plans and employers. Those that are embracing outcomes, those that are embracing risk, those that are most interested in consumer experience are the organizations that tend to engage [with telehealth],” Antall said. But there is a fundamental lack of alignment between the needs of hospitals, payers, and consumers, and the only way he sees to get that alignment is through value-based care. And, he added, value-based care providers are the ones who tend to be the most engaged with telehealth.

The speakers went on to discuss concerns about licensure to practice medicine, which at this point is solely granted by individual states. Amwell is a member of the Alliance for Connected Care, a telehealth lobbying organization, Antall said. When addressing medical licensure concerns—whether licenses should still be granted by individual states or whether there should be a national licensing exam so providers can work in all 50 states—ACC will be lobbying for a federal licensure compact. “That’s still a work in progress,” Antall said. “A federal license would be wonderful, but … that might be a step too far.”

The speakers also discussed other concerns about telehealth including interoperability and privacy issues. But ultimately, they agreed that the way forward is a flexible system that provides in-person care to those who want it and telehealth visits for those who would prefer that. However, overutilization—which could cause an increase rather than a decrease in medical costs—needs to be studied and addressed by, for example, initiatives that allow limited expansion in fields where providers are lacking such as behavioral health, opioid use disorder, and certain chronic conditions.

Watch the full video here.