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How Telehealth Becomes, Simply, Health

Updated: Nov 16, 2020

In the world of retail, “e-commerce” has long been indistinguishable from “commerce", as customers embraced online shopping as a new normal. Virtual healthcare, on the other hand, has been slow to catch-up. However, the explosive growth of telemedicine during the pandemic shows promise for a healthcare system that seamlessly integrates digital health into every aspect of the patient journey. Ashwini Zenooz, MD, Chief Medical Officer at Salesforce, and John Fox, PhD, Co-Founder & Principal at Slipstream, explore this significant shift in healthcare delivery and share key requirements for a successful transformation.

Years from now, when we look back on this moment, we will no doubt see it as the time when telehealth emerged from the shadows to assume center stage. I expect we will also view it as the beginning of the end of telehealth as a useful concept and category.

By now, the overnight “acceleration of digital transformation” during the COVID-19 pandemic is news to no one, with explosive growth in the percent of US consumers using telehealth for the first time -- and three-quarters of them saying they expect to keep doing so. Having taken this leap forward, where do we go from here? To build on this momentum, we must shift from the current tactical deployment of virtual care to the strategic, seamless integration of digital health into every part of the ecosystem -- and from the current focus on episodic care to enabling continuous care across the entire patient journey.

In doing so, healthcare will as usual be playing catch-up with the world of retail where “e-commerce” has long since become indistinguishable from “commerce.” A world where even online retailers view brick-and-mortar stores as simply part of a “one brand, many channels” strategy, where the consumer (and their mobile device) is at the center of a connected, data-driven shopping experience.

With the pandemic serving as an urgent tailwind, challenging norms and breaking through regulatory barriers, virtual care is rapidly infusing the entire ecosystem of care. Health systems that were behind the curve are now recalibrating their technology investments with an eye toward recovering lost patient volumes and staying competitive in the still murky “next normal.” Beyond synchronous telemedicine (virtual visits and provider-to-provider consults), other promising areas include:

Remote monitoring and disease management. The pandemic has tragically underscored the vulnerability of the 147 million Americans living with chronic conditions, and the critical role of remote monitoring in helping them manage their conditions from the safety of their homes. The recent $18.5 billion merger of Teladoc with Livongo Health speaks volumes to the future of patient-centered remote care for managing a set of diseases whose costs account for nearly 6% of the US GDP.

Hospital at home. COVID-19 has also accelerated interest and investment in hospital-at-home (HaH), which combines in-person home visits with virtual monitoring to provide high-quality acute care to older adults. By bringing care to the patient, noteworthy HaH programs -- such as those at Mount Sinai and Johns Hopkins --have been shown to lead to improved clinical outcomes, a less stressful and shorter length of stay, lower readmissions, and a 20-30% cost savings over traditional inpatient care.

Virtual behavioral health. In the wake of the pandemic and its economic aftershocks, a staggering 40% of Americans recently reported experiencing one or more adverse behavioral or mental health concerns. Even prior to recent events, licensed behavioral health specialists were in short supply, with only 43% of people receiving treatment, according to a recent Accenture report. Virtual behavioral health has served as a lifeline for many in recent months and will continue to extend critical access and serve as a powerful force multiplier for traditional care.

Remote clinical trials. Telehealth is also rapidly disrupting other corners of the health ecosystem, including digital therapeutics and clinical research. IQVIA, Virtrial, and other innovators in the pharmaceutical space have been leveraging AI algorithms to improve recruitment and patient eligibility matching. They are also using telehealth capabilities to decentralize and improve access to trial participation by virtualizing some or all clinical visits.

Although each of these applications of virtual care is available and taking place right now -- some at significant scale, others still on the fringes -- making them work together as part of an integrated consumer-driven care model comes with a number of challenges and make-or-break requirements.

First, with more devices comes more data. A 2018 report by the International Data Corporation predicted a 36% rate of growth for healthcare data over the next five years. To ensure the rise of telehealth doesn’t add a cacophony of endpoints and further compromise healthcare’s signal-to-noise ratio, we need to accelerate progress on interoperability and seamless data-sharing via APIs.

Second, we have to treat patients as the consumers they are and put them at the center of this expanded ecosystem with secure and equitable access to and control over their healthcare data.

Third, beyond aligning physician reimbursement models to these new modes of care, we must make sure we don’t add to physician burden and burnout by expecting them to swivel among yet more screens and data feeds. More than ever, doctors will need a measure of “care traffic control” and a unified view of the patient so they can focus fully on delivering care.

Finally, the integration of virtual care will only be successful if it can prove to measurably improve health outcomes and the experience of both patients and providers while reducing the cost of care. To pull this off, telehealth’s momentum must be matched equally by progress toward value-based payment models.

As we continue to battle the pandemic and begin to look toward recovery, now is the time to envision and create the healthcare experience we want and deserve. There is no question that virtual care will, and should, be an integral part of that experience. But if we do our jobs well and thoughtfully, in the coming years “tele-health” will have gone the way of “e-commerce” and become, simply, “health.”

About the Authors:

Ashwini M. Zenooz, MD, is the Chief Medical Officer and Senior Vice President for Healthcare and Life Sciences at Salesforce. Dr. Zenooz was most recently the Chief Medical Officer at the Department of Veterans Affairs (VA) overseeing the national EHR modernization program. Dr. Zenooz is board certified in radiology and continues to practice medicine today.

John Fox, PhD, is an anthropologist who was previously head of content and communications at athenahealth. He is currently principal and strategy lead at Slipstream.

The views and opinions of the authors are their own and do not necessarily reflect those of The Aspen Institute.

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