When Healthcare Goes Remote, It Should Be For A Reason
Dr. Corey Scurlock MD, MBA is the CEO & Founder of Equum Medical.
Just as my life has been a tale of two worlds, from a childhood in a small Texas town with few prospects to a physician entrepreneur in New York, so has the nature of the market space I work in: telehealth. Pre-pandemic telehealth was successful in bringing big-city medical expertise to small and rural healthcare facilities, mainly because of precisely targeted Medicare reimbursement regulations. Once the rules were relaxed during the public health emergency, there was a 63-fold jump in telehealth visits, most in urban centers.
In its omnibus spending bill passed in March, Congress extended the public health emergency’s relaxation of rules against broad expansion of Medicare coverage for telehealth services for five months and called for research into its financial, clinical and legal implications moving forward. Many are assuming the answer will be that telehealth is here to stay, but until we better understand the outcomes it is achieving and how much in-person care is essential, all bets are off.
Not surprisingly, as the pandemic raged, a barrage of tech-enabled telehealth offerings came to market, some seemingly quite innovative, but with high price tags.
There are obvious benefits from telehealth, such as ease of access to care, including scheduling, case management and medication adherence. Then there is expert remote care for patients in hospital when a specialist in critical care or psychiatry isn’t available. More than 50% of U.S. counties do not have a psychiatrist and the average age of psychiatrists is in the mid-50s. There is the advantage of patients not having to schlep from the suburbs downtown for a 15-minute follow-up visit. And patients are demanding it. Elsevier Health and Ipsos recently released a Clinician of the Future report that found that while Baby Boomers still prioritize in-person care, 60% of Millennials prefer telehealth and 71% would like their doctors to adopt a mobile health application.
Telehealth has purpose within all organizations, but I see two truths emerging from all of this activity. One is that if reimbursement is limited, I think it should go to those community hospitals most in need. The second is more nuanced: In today’s more value-oriented reality, innovation needs to fit into the budget, workflow and culture of the healthcare organization. It needs to be almost frictionless in implementation, including for overstretched IT departments. And it needs to deliver clinical and financial ROI much more quickly than in the past.
I spent some years as the telehealth department leader of a multi-hospital healthcare system in suburban New York, so I was a good prospect for many patient monitoring and informatics companies. I was approached with products and services and plans for implementing them across my organization. Beyond the sticker shock, I noted that though I was the potential customer, it was on me to turn these products into "solutions"—meaning I was to find a problem for which the cool new technology was the perfect answer.
In many cases, I couldn’t see the immediate need, but I could anticipate the potential for these new solutions to cause disruption to our care workflows. Learning curves were often steep and time-consuming and involved technical steps everyone had to learn and relearn.
During this time, I began thinking of starting my own company. I quit my job and picked up telehealth shifts serving hospitals around the New York metro area at first and later farther from home. I observed which of the many of the solutions hospitals had found were actually improving care access, solving provider shortages and improving clinical outcomes.
I learned that any scalable and repeatable telehealth solution had to conform to the client’s needs, with variable elements of people, process and technology directed at clear challenges. More than one third of hospitals in the U.S. are non-urban community-level institutions, so if the marketed products fit more with urban integrated delivery networks, that could be an issue.
The company I ultimately formed went away from a focus on technology and national networks or remote “command and control centers” to cellular, pod-style customer alignments, where locally based specialists licensed to provide medicine in the states they serve are available 24/7. Having implemented telehealth systems across the U.S., I know that not every hospital needs the same telehealth “system,” and many systems today are at different stages of telehealth maturity, with as many as 30 different pieces of telehealth hardware and software spread across the enterprise. The need to prioritize and streamline these systems is paramount for many providers.
Here are some key steps for healthcare leaders looking to start, optimize or expand their telehealth programs:
1. Assess: Start with an assessment of where you are today. As an organization that’s adopted telehealth through the pandemic, chances are you have technology with redundant capabilities. Is there one platform you can use to support the use cases you have identified?
2. Lead: Change management requires executive sponsorship to jumpstart a new initiative, tying it clearly to organizational mission, vision and value.
3. Measure: Leaders should measure the ongoing use and outcomes of the program against organizational key performance indicators, so buy-in supports further interest and investment for future telehealth expansion.
4. Prepare: Anticipate the disruption telehealth will create to clinical workflows. You are creating a new standard of care that’s a hybrid of in-person and virtual, so you need to set expectations. (My company is doing research in this area, and I will share outcomes in a future article.)
5. Grow: Add to your telehealth program only as the clinical and business use cases become clear.
I contrast the two epochs of my life and see now what I couldn’t see as a youth in Texas: the glaring inequities in access to care for many of the most vulnerable in our society. As a physician and as a businessperson, I see opportunity for the healthcare industry to do good by unlocking the potential of providers to deliver expert care from anywhere to where it is most needed, at a sustainable cost.