One incredible lesson from the pandemic is how quickly a mode of care, such as telehealth, can be adopted and widely used by so many people in innovative ways. That said, as we heard from each of the speakers at our virtual All-Council Conference yesterday, sustaining and delivering high quality equitable telehealth will take more than a keystroke.
Even though the use of telehealth and telemonitoring surged over the past year, we know that use and access was uneven. That’s why we invited a nationally recognized physician leader and our member experts to share their experiences on “Telehealth Equity – Bridging the Digital Divide.”
Their real-life examples of successful uses of telehealth, as well as its challenges, are an important starting point for us to figure out, collaboratively, how to advance telehealth so that it works for everyone.
In our recently released Emerging from COVID-19: An Action Plan for a Healthier State, which contains 24 consensus recommendations, we included some recommendations on telehealth and urged stakeholders to pay particular attention to how telehealth use varied by age, insurance type, race, ethnicity, and language during the pandemic. As we consider whether to maintain any regulatory changes beyond the health emergency, we should put the patient at the center. We should ask whether such changes increased access and reduced barriers for patients. Perhaps telehealth meant patients did not have to take off from work, for instance, or pay for childcare or transportation to an in-person health care visit. Our speakers outlined the benefits of virtual visits, such as seeing patients or clients in their home settings and being able to conduct team visits with additional health care providers and caregivers who can be included via technology.
Our keynote speaker, Debra Patt, MD, PhD, MBA, a breast cancer specialist in Austin, Texas, shared how during the pandemic telemedicine enabled her to follow her existing patients during their treatment, as well as see new patients. She was even able to diagnose inflammatory breast cancer virtually. Telehealth was critical because as COVID-19 rates surged, oncology evaluation and screening visits decreased. Dr. Patt emphasized the benefits of using telehealth to support a team-based practice and she shared the importance of setting up a process for how telehealth will be used and the role of each team member. In her practice, telehealth enabled providers to see patients sooner and to more easily provide additional specialists, such as dieticians and others not always available in person at every office location. Telehealth use also enabled her to safely remote monitor patients post-discharge, which enabled them to come home sooner.
The conference panelists also shared the following examples of how they are enabling more people to access telehealth:
Drew A. Dyson, Ph.D., Chief Executive Officer of Princeton Senior Resource Center, told us how the Center recruited volunteers to teach older adults how to use technology. Once that adult knows how to use their device, they can use it for telehealth appointments, but also to connect with family to reduce loneliness and to access Center programming. A continuing barrier, however, for some older adults is lack of broadband in affordable housing units.
Elizabeth Cherot, MBA, MD, Chief Medical Officer of Axia Women’s Health, shared how important it is for her and her colleagues to be able to see their patients over the internet to know that their pregnancies are progressing well. Through telehealth video visits as well as the use of wearable belts to monitor the vitals of pregnant patients, Dr. Cherot is excited about the possibilities that telehealth offers. Dr. Cherot set the “wearables” pilot program up with Horizon Blue Cross Blue Shield of New Jersey.
Sophia Chang, MD, MPH, who is Chief Clinical Informatics Officer at Clover Health, candidly shared just how challenging it has been to engage with and support both the smaller primary care practices that Clover Health works with as well as its frailest patients. To address these challenges, they enabled practices to use a virtual telehealth platform with any of their patients. They also quickly set up and delivered ready-to-use tablets to their highest-risk members so they could connect with their care managers.
Susan Loughery, MBA, Director of Operations for Catholic Charities in the Diocese of Trenton, explained how changes to the requirements that patients must be at a specific location for treatment were essential to the success of telehealth and the organization’s ability to support its clients during the pandemic. Patients have been able to obtain telehealth at the location of their choice. Her clients may need help with or access to technology when they go to a trusted location. The organization embedded community health workers at those trusted locations and helped people with their telehealth visit.
The pandemic required health care leaders to create new ways to connect with their patients. Our members and other health care leaders around the nation responded with ingenuity. As Dr. Cherot observed, we used to have house calls from a doctor with bag, then we went to the doctor’s office, and now we’re back to home visits, but virtually. This journey will be challenging to get right and to ensure that we include everyone. At the Quality Institute, we accomplish our best work when we bring our members together to share their successes and challenges and work collectively on how to achieve sustainable improvements in health care. As telehealth advances, we look forward to working with you to achieve its full potential.