Telemedicine – Utilization and Quality Gaps Are Hurdles
(c) Thomas Northcut
Heavily touted as a cost-effective means of delivering quality healthcare to the masses, telemedicine has caught the attention of employers and policy makers alike. Over 70% of employers with 500 or more employees are offering telemedicine as a benefit, according to Mercer’s 2018 National Survey, and the Center for Connected Health Policy reports more than 160 telehealth bills were introduced in 44 states in 2018. By the end of 2020, the global market is projected to surge past $34 billion, up from $6.3 billion in 2016. But is telemedicine truly living up to its promises?
Telehealth is offered through multiple modalities across a variety of care spectrums, including mental health, dermatology, and neurology. By far the most widely available model provides access to primary care for acute care needs via video-facilitated interaction between physician and patient who have never met before. But while many employers are offering this model of telemedicine through vendors like Teledoc, MDLive, Doctor On Demand and others, employees just aren’t using it that much. Utilization is typically reported to be anywhere from 7-18%. With such low utilization to date, the cost savings are meager at best.
Regarding clinical quality, not all telemedicine programs are created equal and reports are mixed. When considering quality, we need to evaluate several factors:
- Are telemedicine physicians practicing with the best evidence in mind? I’ve yet to find a decent study that provides insight into this question, so I’ll give my opinion. It’s likely a mix of yes and no, just as it is with traditional practice. However, it is reasonable to opine that the very nature of this model of telemedicine creates a situation that may influence prescribing habits. Example, after a 10-minute discussion regarding a patient’s productive cough x 1 week, the telemedicine provider prescribes an antibiotic to treat a diagnosis of bronchitis when the best evidence says not to. The influence was simply the nature of fragmented care: a lack of rapport and trust; a gap in the ability to readily follow up with the patient; and the desire to provide quick, “valued service” to the customer.
- Are the services delivering value to the broader health strategy of the population? As noted above, this model delivers care that is fragmented and siloed. High value health services create continuity in patient care rather than fragment it. In contrast, there are models of telemedicine where continuity and integration do exist. These typically extend from a central point of care, like an onsite employer-sponsored clinic or a primary care physician’s office, where the same providers are using the same electronic medical record in both face-to-face visits and virtual (telemedicine) visits to care for patients. In fact, 33% of employers with 10,000+ employees surveyed by Mercer in 2018 say their onsite clinic vendor offers a centrally based telemedicine solution.
- Are telemedicine visits creating a valued experience in the eyes of the patient? Video interaction certainly brings value in connecting physician and patient compared to phone, texting, or email alone, but there’s still a significant gap that only face-to-face interaction can fill. We are humans who need human interaction to thrive, and when dealing with personal health issues, we need it even more. You may have heard of the case of the “robot doctor” delivering bad news which illustrates this point to the extreme, but even when dealing with a minor illness, the human touch of a physician can go a long way in bringing value to the interaction.
As a physician, I’m watching telemedicine with a discerning eye. While I see great value in providing convenience and improving access for patients, we’ve got some distance to go in the areas of utilization and quality. But through collaboration, focused effort and clinical diligence, I am confident this model of telemedicine will eventually shape up to bring great value in the delivery of quality healthcare. Employers should continue to consider available telemedicine options, evaluate specific models that may effectively help them reach their goals, and implement with a detailed plan of how to effectively drive utilization.