As the COVID-19 pandemic struck like a bolt from the blue, much of the medical world had no choice but to adopt telehealth – virtual healthcare. From a pre-pandemic share of less than 1% the percentage of telehealth/virtual patient visits shot up to 37% within the first few weeks of the pandemic. (Today it has levelled off at about 15%).

Behavior Healthcare Especially Strong

Behavioral health has especially strong: by percentage, more patients are seeking telehealth for behavioral health than for physical healthcare.ll specialties did the best they could on the fly.

Most specialities did well, considering. Telehealth, by and large, is working. Still, up to the

time of this writing, an estimated 6% of healthcare practices— 16,000 providers—have had to close their doors.

So it’s time to get our bearings. As is true in every social crisis: at first we take it day by day. But as soon as we get some breathing space we have to ask: What’s the story now? What’s working? What’s not? What will the future bring?

Now is that time.

“We’re not going to back to 100% face to face and 0% telehealth like it was for many practices before the pandemic.” says Susan R., Bailey AMA president.

“(Telehealth is) going to become…an increasingly important part of physician practices going forward,” says Todd Askew, an AMA Vice President.

These comments reflect the fact that by and large physicians and patients are accommodated to telehealth. It is working right now, and can continue to provide benefits after the pandemic if we pay attention.

In Behavioral Health, the potential is especially strong: a case study by Brigham Health in Boston, Massachusetts showed that fully half of behavioral health services were characterized as appropriate for telehealth treatment.

Indeed, some very major related shifts in healthcare may be in the offing. A report by McKinsey, estimates that up to $250 billion of current US healthcare spend could potentially be virtualized. (Virtual healthcare such as telehealth now accounts for a $30 billion spend)..

In 2020 the Centers for Medicare and Medicaid Services reported over an 11,000% increase in virtual visits

As a result, patients’ profiles are different. Both urban and rural areas have seen explosive growth. Some practitioners are reporting relatively greater success with children, who previously were often resisted visiting an office. Patients over 65– even though tending to be uncomfortable with technology—have increased their telehealth usage by 16% over pre-pandemic, equal to the increase among GenZ. (Born mid-late 1990s).

It may be that the patient profile for small practice and small clinics has changed for good..

Providers using telehealth report fewer missed appointments, more efficient use of previously unbilled time, administrative cost savings through automation, convenience for patients, less stigma and lesser resistance from children, along with insights for professionals who are, after all, meeting “in the home” of patients.

But more subtle advantages accrue.

As one clinic report put it,

“Telecare also allows clinicians to assess patients’ living environments.

“In mental health, evaluating components such as lighting, household clutter, and organization provide context on day-to-day well-being. The presence or lack of privacy is a flag.”

Meanwhile, in acute cases or with children or other dependents, caretakers or parents can more easily be present.

On the minus side, some practitioners have told us that they miss the subtleties of body language information. Body position, context, environment are limited.

One noted, for example, “it’s hard not to be able to watch the responses in peoples’ hands.”

From a practical standpoint, not all patients have access to an audiovisual device, or are not comfortable with technology.

And of course, 100% telehealth treatment is not always appropriate.

Professional groups and initiatives around the country are addressing these drawbacks, and trying to help amplify the advantages.

As many behavioral health professionals have told us, the need is to embrace the new, and help overcome obstacles.

Instead, even today telehealth is too often presented as an add-on service, missing prominence on on websites, social media, email communications, office signage.

Telehealth cannot be successful when presented as a second string solution. It has become fundamental to health care practice, and doubly

so for behavioral health. It offers convenient, stigma-free and privateaccess to patients, creating a workable way to treat children and who may resist trips to the office, access in rural areas where mental health professionals are sparse or non-existent, to and older adults who may find it physically difficult to travel.

As of January, 2021, state lawmakers are considering more than 300 bills aiming to discard the barriers to telehealth adoption.

The FDA, as we write, is taking comments on its second monster funding for telehealth adoption, this one approaching $250 million.

An earlier program granted $200 million. And while the FDA grants have so far gone largely to very large institutions, they still create an atmosphere and expectation for telehealth delivery by all.

A Senate committee held a public hearing in 2020 on telehealth expansion. The US Senate Health, Education, Labor & Pensions Committee has continued to keep the issue in the limelight.

All these are indications that telehealth is well on the way to becoming normalized.

The shortage of behavioral health professionals is well documented. For example, according to the journal HealthAffairs.org, 2 out of 3 primary care physicians reported difficulty referring patients for mental health care.

The shortage is driving social pressure to adopt telehealth and other measures that could make mental health care delivery much more efficient.

From a practical point of view, the floodgates to telehealth were opened by the waiver of regulations and limitations by the emergency cares act.

These include cross-state licensure, prescription of medication by telehealth, parity in reimbursement in many states, and lifting of the previously draconian coverage limitations by Medicare.

Sentiment in the medical community seems strongly in favor of making at least the core of these waivers permanent.

In a letter this January, 70 health care-related organizations, advocacy groups and companies urged Congress to keep telehealth access at its current levels.

Telehealth delivery in place today may change the cadence and stages of a treatment plan.

Vidit N. Munshi and Ipsit V. Vahia write in the Harvard Business Review:

Providers will ...need to pilot different models of timing and length of appointments with telemedicine. Compared to infrequent in-person visits of longer duration, telecare can allow for shorter regular visits to, for example, monitor the impact of a new medication change or to assess prognosis following a hospitalization.

In sight are the possibilities of “digital health care:” an increasingly connected healthcare technology network.

Information from wearable fitness monitors and smartwatches like Fitbit and Apple Watch that can track sleep and movement patterns over time, providing clinicians with insights into real-world functioning and a range of psychiatric conditions such as depression, anxiety, and PTSD.

Newer generations of wearables are providing physiological data such as blood pressure, oxygen saturation, and skin conductance.

Write Munshi and Vahia: “When merged with other data streams, this data will generate new insights into the dynamics of mental illness outside of the clinic.”

One professional gave this example: “If we can know when and in what context panic attacks happen, we will have much better insight into the trauma, and adjust our treatment plan accordingly. The result, we think, are better outcomes.”

What are the benefits of telehealth?

Providers using telehealth report

Fewer missed appointments

More efficient use of previously unbilled time

Administrative cost savings through automation

Convenience for patients

Less stigma and lesser resistance from children, along with insights for professionals meeting “in the home” of patients.

What legal and regulatory changes made telehealth expansion possible?

• Medicare will pay physicians the same rate for telehealth services as they do for in-person visits for all diagnoses, not just those related to COVID-19, throughout the national public health emergency.

• Patients can be in their home, or in any other setting, to receive telehealth services.

• Patients do not need to have an existing relationship with the physician who is providing telehealth assistance.

• Physicians are allowed to waive or reduce cost-sharing for telehealth visits.

• In many states, physicians who are licensed in one state are allowed to see a patient in a different state.

AMA comprehensive summary

Will the widespread use of telehealth continue after the pandemic subsides?

Both professional and legal winds are blowing in the direction of continued telehealth; and very significant financial incentives are already coming into place. While the shape of telehealth delivery may change, to accommodate hybrid models, for example, telehealth appears to be here to stay.

How can behavior healthcare providers improve the way they present telehealth?

Telehealth must become a fundamental part of health care workflow, presented prominently and continuously to patients. Valuable detail is given in the AMA’s

What impact will technology have on healthcare delivery?

Telehealth, as a key part of a larger network of health technology, called digital health, may be poised to create a major shift in healthcare delivery.

Telehealth has exploded into public view during the pandemic. At the heart of a digital network which has the potential to change healthcare delivery in the not too distant future. If your practice aims to position itself for the coming changes, Hungry Monster can help with website design, content marketing, business development collateral, patient communiation, written and visual support for staff, and much more. Please see What We Offer for details.

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