8/26/2021
David Foster, Sr. Director, Analytics and Insights
Editor's Note: Advocating for telehealth supports our mission of helping people make better health decisions—wherever they are. We encourage access to care initiatives and keeping the most vulnerable out of high-risk care settings and safe at home, but with the continued care oversight they need.
Take a close look at the illustration accompanying this post. There’s something depicted that used to bother me whenever I saw this in telehealth graphics. How would a physician use a device like a stethoscope in a telehealth encounter? Whenever I pointed this out, Healthwise CEO Adam Husney, MD, would remind me that physicians who conduct telehealth encounters also provide in-person care. This inside joke that he and I share contains a kernel of truth that’s worth considering: that telehealth will never replace the physical work of caring for people in real life. Instead, telehealth is a means to extend what clinicians and the people they care for can do in between those physical encounters, keeping people safe with continuity of care.
At HIMSS21, many presentations and discussions centered around the impact of the COVID-19 pandemic on accelerating the implementation and use of telehealth to deliver health care services when remote care became the safest option for patients to connect with providers. We’ve heard so much about the rapid shift to virtual care, in real-time and asynchronous encounters, that you might then assume telehealth is here to stay. Unfortunately, only the public health emergency allowances in the Coronavirus Aid, Relief, and Economic Security (CARES) Act and other actions taken by CMS enabled much of this digital and telephonic care delivery.
While some legislative activity has clarified the legality of delivering mental health care services over telehealth channels, there are still limitations, such as requiring an initial in-person visit before telehealth services can begin. Telehealth advocates have addressed many of the concerns raised by lawmakers, yet we still do not see the statutory changes necessary to make telehealth care permanent.
One of the concerns raised by policy makers is the digital divide prevents people without internet access from connecting to telehealth services. To address this concern, we must continue with broadband infrastructure improvements, including wireless internet services and funding for end-user devices so rural Americans and people who cannot afford telecommunication plans can connect to telehealth care. Ubiquitous, universal internet services will also allow people to become involved in their care through access to their health data and patient education. When in-person care dropped off in March of 2020, Healthwise mission impact monitoring also showed a decline in the rate that people received information about their health—leaving people without trusted health information that they typically received from their providers. And as care shifted online, so did health education. Digital access to care instructions will play an essential role as care shifts outside the four walls of care and into the home. Addressing the digital determinants of care will ensure that people remain informed and connected to their care plans. Just as we recognize the social determinants of health—such as food and shelter, and the importance of utilities like electricity and refrigeration—digital access is increasingly going to be a factor that impacts health.
Congress is looking for telehealth innovators and advocates to submit their analysis to guide legislative activities, particularly in the area of mental health care. Healthwise signed on to the letter written by the Alliance for Connected Care, eHealth Initiative, and others showing why this model of care needs to be permanently allowed under the law. While value-based care models are ideal for supporting care innovations like telehealth, there is evidence in fee-for-service models that telehealth encounters are substitutions for in-person care, not additional care encounters. Additionally, consider that 57 million people, including 1 in 5 older Americans, live in rural areas. Telehealth solutions allow these patients to receive care at home, rather than transporting them to a physical location or making them drive long distances when in-person care is unnecessary. Permanent allowance of telehealth and broadband supports are just as necessary as Congress’s actions to pass the 21st Century Cures Act that gave patients and members unprecedented access to their health data.
We hope you will join us in supporting telehealth and digital care for all. Learn more about the essential impact of telehealth by participating in Telehealth Awareness Week, September 19–25, 2021.
To find out how you can help this effort, visit https://connectwithcare.org/ and https://www.americantelemed.org/.