Next steps for telehealth: Showing a link to value

Feb. 28, 2022 / By Megan Carr

As we look ahead to March, the only thing my son wants to know is if he can have his eighth birthday party at the indoor laser tag place his brothers went to pre-COVID-19. 

“Can we go – but just wear masks if that is what you want, mom, please?” he pleaded. While we feel our way out of the pandemic, we know that some things will not go back to the old normal. And that is true for a lot more than just my hesitancy regarding indoor events with a lot of people. 

Certainly this applies to some of the changes put in place to keep the health care system going during COVID-19, such as telehealth. Telehealth essentially went primetime during COVID-19 as a vital technology to meet patient care needs in unusual times. Its expansion in use by some (or new adoption by others) flew past traditional mile markers for new technologies or methods of care. And it needed to do so. The things that held telehealth back in the past – understanding its impact to utilization, the cost, the method of delivery, or its impact on quality of care – all needed to be set aside so the system could simply take care of the basics of “seeing” patients in a virtual or audible way during a crisis.

We can all point to instances where audio and video telehealth improved access to care, reduced delays in diagnosis and treatment, and allowed for remotely managing patients. We know it can decrease no-show rates, allows insights into a patient reality by observing their home experience, and can alleviate patient anxiety related to in-office physician visits.

But now, as the health care system slowly returns to a new version of normal, there is a need to assess how this telehealth technology has changed or is changing the health care experience. Indeed, Congress is struggling with the right balance for telehealth going forward. There is bipartisan support for it, both for rural and underserved urban areas. There are also bipartisan questions about its costs and impact to driving better value in the health care system. What components of telehealth policies should be made permanent, and for whom or where? This isn’t unique to telehealth – it is part of the larger question about the growth of health care in settings outside the walls of the hospital and outside the walls of a doctor’s office.

So, as we aim for that new normal, we return to the questions about showing value, reducing costs and improving the patient experience. All things telehealth will need to start doing. Is telehealth managing patients in a way that reduces the need for potentially avoidable ER visits or hospital admissions? Do patients feel they are receiving the same level of care and services through telehealth?

Stepping back to consider the question before us today, it is important to note that, to date, technology has not driven down health care costs. Spending trends have remained on a seven percent compound annual growth rate (CAGR) trend each year since 1970. Much new technology has hit the health care scene over the past half century, but the cost growth trend has remained stubbornly persistent. (Please note, I’m not trying to be negative. I’m a strong proponent of health technology and believe technology can make health care more efficient and help improve outcomes.) 

But technology needs to start clearly showing its contribution to driving down costs. It must help make value-based payment and alternative payment arrangements successful in controlling costs while improving patient care.        

As we look at telehealth and other new tech taking center stage, the questions of effectiveness and value are crucial to adoption and growth. For some technologies, like medical devices, these questions start early as part of the coverage determination. For others, the questions come in when payment might be set, or as part of a value-based payment arrangement. Regardless, quality and patient experience measures are here to stay as part of the technology assessment equation. 

As to the next steps for telehealth, I personally believe that such efforts can further support and highlight the value that telehealth brings to the patient and the health care system. Data should help disprove much (not all) of the concerns about overutilization and effectiveness of the treatment modality by proving its cost-effectiveness and better patient management and clinical outcomes. 

Of note, determining the kind of assessments that should be done is just as important as the action of doing them. The more compelling and powerful approach is with an outcomes-focused, rate-based quality measure approach over that of a disease-centered measure approach. An approach like this focuses on overall system efficiency to drive quality. Using disease process indicators is a highly granular way to perform quality measurement that creates a significant burden of work for clinicians in practice, often articulated as a great loathing of clinical documentation resulting in clinician burnout. In spite of advances in technology that mitigate this burden, the emphasis on granular process indicators misses too much of what is important in health care delivery. It implies that guideline-driven care processes are the pinnacle of practice, reducing the clinician patient relationship to a series of gaps in care transactions.

3M is engaging with researchers and states now on ways to assess variation of system efficiency to drive reduction of potentially avoidable health events, such as potentially avoidable hospital admissions, readmissions and/or ER visits. These system efficiency measures can be combined with HEDIS-like outcomes for a comprehensive approach that drives the Triple Aim. In this effort, it will be critically important to ensure the research or quality evaluations ensure case mix adjustment for clinically similar cohorts of patients – allowing for benchmarking, regardless of overlaid social factors. 

As we transition to our new normal, we will see governments pull back on masking requirements, nervous parents will let their kids go to laser tag…and payers and patients alike will demand that health care technology quantifiably prove its value to impacting health care at the intersection of cost and quality.

Megan Carr, head of the Regulatory and Government Affairs team at 3M Health Information Systems.

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