Contributor: Sustaining the “New Normal”—The Future Is Still Bright for Telehealth in the Wake of COVID-19

,

Consumers want telehealth and telehealth can help achieve organizational goals of avoiding unplanned care, closing care gaps, and achieving care targets.

One of the positive outcomes of the COVID-19 pandemic was the fast-forwarding of telehealth scaling, innovation, and uptake by providers, consumers, and payers. As the pandemic wanes and society moves towards a “new normal,” health care organizations must now harness the powerful lessons of this experience and reframe their strategy of how to meet consumers where they are to deliver affordable and high-quality care.  

Imagine this scenario: a single mom starting a new job develops a poison ivy rash on her hands and arms. The rash spreads, her right arm swells and becomes hot to touch, and she develops a low-grade fever. Her primary care provider has no convenient appointments. Between the demands of her new job and her family, she cannot find time to drive to the nearest urgent care center and wait to be seen. She recalls that her new employer’s benefits include access to telehealth video visits through a mobile app. She downloads the app on her smartphone and creates an account. Minutes later, she has an appointment for a video visit with a nurse practitioner scheduled in the half hour window of time between her afternoon meetings. She experiences a punctual visit, from the privacy of her home office that takes only 15 minutes. Within the hour, she receives a text message from her neighborhood pharmacy notifying her that a prescription strength ointment for the poison ivy rash and an antibiotic, for what the nurse practitioner diagnosed as cellulitis, are waiting for her.

A decade ago, this scenario probably would have sounded like a futuristic case study touting the potential benefits of telehealth. However, the pandemic pushed health care systems to rapidly scale up their technology solutions and train their staff to meet patient needs and survive as a business. According to an October 30, 2020, Morbidity and Mortality Weekly Reportarticle reporting CDC data, “During the first quarter of 2020, the number of telehealth visits increased by 50%, compared with the same period in 2019, with a 154% increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019.” At UPMC Health Plan, the rate of increase for telehealth video visit usage for ambulatory care was 453% in December 2020 compared with the pre-pandemic monthly average. Within UPMC Health Plan’s commercial plans, 72% of all outpatient professional behavioral health visits between March 2020 and December 2021 were provided via telehealth.

The pandemic also necessitated a “trial run” of telehealth technology for consumers who may have not known it existed or were hesitant to try it. For many in the post-pandemic moment of Telehealth Week 2022, video visits are now “the new normal” way to access convenient, high-quality, and cost-effective care in certain situations. It offers our members many advantages, including less time off work and less travel expense.

Telehealth video visits are ideal for non-emergent issues, such as bronchitis and cough, cold and flu symptoms, diarrhea, pink eye, rash, seasonal allergies, sinus infection, tick bites, and urinary tract infections. They can also be used by consumers to engage in activities outside of prescriber-based services. A consumer may initiate video visits to promote personal wellness—for example, regularly seeing a health coach to support weight loss, stress management, or smoking cessation. Video visits are often low cost, not to mention costs saved by not driving to a provider’s office, missing work, and/or having to secure childcare to see a provider. UPMC AnywhereCare—the telemedicine platform described in the above scenario—is one example of how consumers can conveniently and affordably connect with providers by video to address non-emergent issues and support their wellness.

UPMC Health Plan also uses telemedicine to support its members with complex and chronic diseases. One our surgeons in the colorectal surgery division has had telemedicine visits with more than 600 new, post-operative, hospitalized, and long-term follow-up patients over the last 15 years. We have been able to maintain a high-level of surgical care using telemedicine and find that it adds humanity to medical practice. Telemedicine is the natural evolution of health care in a digital world—it gives clinicians remarkable and high-quality access to patients at home and work and prevents a significant amount of unnecessary and expensive travel. A patient who lives 3 hours away from clinic remarked “it saves a lot of time.” Another patient who converted an in-person clinic appointment to a telemedicine visit due to a snowstorm was “grateful for the telemedicine option.” It is unlikely that these visits will completely replace the need for traditional in-person outpatient doctor’s office visits, but they do have the ability to improve access to health care services, the timeliness of treatment, and the health care experience for patients/consumers. We anticipate that about 50% of new and returning patients with complex chronic colorectal conditions will be seen using telemedicine as our team expands surgical care.

Although telehealth video visits have the potential to expand access to care, they also require consumers to have access to the appropriate technology and possess a level of technological literacy. Health care organizations must be mindful of existing disparities in the telehealth space and incorporate tactics to address them as part of their long-term telehealth strategy. A new system-wide launch of 8 telehealth kiosks within existing UPMC Health Plan Connect Centers, which are situated in community malls across Pennsylvania, will work to address tech disparities by providing consumer access to telehealth technology and support in using it.

Telehealth video visits are only the beginning of the possibilities. The Women’s Health Service Line at UPMC Magee-Womens developed a postpartum remote blood pressure monitoring program for women with hypertensive disorders of pregnancy (HDP) for home monitoring and management of hypertension from the time of hospital discharge through the first 6 weeks after delivery. Patients enrolled in the program are provided with an automatic blood pressure cuff that is validated in the office setting.They are then prompted via a daily text to complete a series of questions including their blood pressure reading along with some symptom surveying of their current physical state. A nursing call center receives the patient responses and follows an evidence-based algorithm to determine if any outreach or next steps are needed.

This program has demonstrated high compliance with more than 90% of women reporting at least 1 blood pressure reading in the first 10 days postpartum (the highest risk time period for maternal morbidity) and is helping to narrow the racial disparity in postpartum hypertension. Women enrolled in the program have also shown improved control of hypertension and a reduction in hospital readmission. In addition to interventions like these, consumer electronic apps for telemonitoring vital parameters such as blood pressure or weight for patients with chronic diseases could offer a real opportunity for physicians to better manage care of conditions like congestive heart failure and chronic obstructive pulmonary disease. Furthermore, “niche” telemedicine apps involving intensive care unit care and intraprocedural mentoring may help extend the specialty health care workforce’s reach to places where there are gaps in access to care.

We at UPMC Health Plan believe that consumers want telehealth and that telehealth can help achieve organizational goals of avoiding unplanned care, closing care gaps, and achieving care targets. Furthermore, we believe that telehealth can support our health care infrastructure navigate the staffing shortages that we are all facing post-pandemic. We are committed to supporting telehealth by providing clinicians training to adapt their practice (for example, teaching virtual examination skills) and developing cost-effective and user-friendly telehealth technology that enhances access to care and value for consumers, providers, and purchasers.

Amy Meister, DO, MRO, is the associate chief medical officer of the UPMC Insurance Services Division, where she leads digital health development. She also facilitates the development of innovative clinical programs for all health insurance and benefit management products, including assuming responsibility for clinical oversight of digital and telehealth approaches.

Andrew Watson, MD, MLitt, FACS, is a primary colorectal surgeon at University of Pittsburgh Medical Center (UPMC) and professor of surgery in the Division of Colorectal Surgery at the University of Pittsburgh. He specializes in Crohn disease and ulcerative colitis. He actively uses and helps to develop telemedicine at UPMC with a focus on remote patient monitoring. He has conducted more than 750 virtual consults including pre-operative, post-operative, tele-rounding, intra-operative, and remote patient monitoring. He works for the UPMC Health Plan as a senior medical director for digital health. He is past-president of the American Telemedicine Association and an advisor to the American Board of Telehealth.