Making the case for telehealth and its potential

After telehealth reached unprecedented levels of usage in the worst of the COVID-19 pandemic, fewer adults are opting for virtual care.

Carrie Nelson, chief medical officer of KeyCare, says telehealth remains an important way to help patients get access to care.

In 2022, 30% of adults engaged in telehealth, down from 37% in 2021, according to the Centers for Disease Control and Prevention. In addition, Walmart ended its telehealth services earlier this year, just as the retailer also shuttered its primary care clinics.

Even with changes in the industry, Carrie Nelson, MD, chief medical officer of KeyCare, says she sees telehealth playing a valuable role in the healthcare industry. KeyCare, a virtual care company, has partnered with a host of hospital and health systems to deliver primary care and behavioral health services via telehealth.

“We've gone through a time here, with the pandemic and everything where our eyes have been opened as to the potential of telemedicine and yet, we've also realized the limitations when you don't have that information fully integrated,” Nelson tells Chief Healthcare Executive®.

Health systems want to be sure telehealth providers are delivering good service to patients, Nelson says. She notes that KeyCare is on Epic, the same electronic health record system used by many large hospital systems, so there is transparency in the service being provided. Plus, KeyCare has full access to patients’ medical records.

Looking more broadly, there are some areas especially suited for telehealth, Nelson says, and some patients prefer virtual care options for certain needs. Plus, health systems with staff being pushed to the limits are going to need help reaching their patients, she argues.

Telehealth and mental health

While telehealth visits have dropped in some areas, analysts see strong demand for behavioral health services delivered virtually. Nearly two-thirds (62.8%) of telehealth visits in the fourth quarter of 2022 were for behavioral health appointments, according to an analysis by Trilliant Health.

When it comes to seeing a mental health clinician, some patients would prefer a virtual appointment over going in person, Nelson says.

“People are really hungry for the kinds of solutions that allow them some privacy, in their own home potentially seeing a provider versus driving to an office and waiting in a waiting room where you might see your neighbors,” she says.

For patients needing mental health services, telehealth removes some obstacles such as lining up child care or the time spent traveling to and from a clinic or office. Some patients also find it more comfortable discussing deeply personal matters at home.

“I think it really helps ease some of the burden of those logistics, and the fear around taking that journey by being able to access it in your home,” Nelson says.

Providing access

Health systems continue to have staffing challenges, and physician shortages are likely to grow. The Association of American Medical Colleges projects that the nation’s shortage of doctors could reach 86,000 by 2036.

“I just can't see a world where telemedicine isn't seen as a viable and really vital solution to those problems,” Nelson says.

Health systems can use telehealth to expand access to rural areas, where providers face particularly acute staffing challenges. Telehealth options could offer expanded maternal health services in areas where obstetric services have been reduced, she adds. While some prenatal visits need to take place in person, some check-ins could be done virtually to make sure patients aren’t experiencing complications, she says.

Beyond rural areas, some patients in urban neighborhoods could benefit from more virtual care options. Pointing to her home base of Chicago, Nelson says it’s not uncommon to spend up to two hours traveling across the city, and some patients don’t have reliable transportation options.

Some seniors appreciate virtual care options that help them avoid driving to appointments, and she notes that contrary to some stereotypes, many seniors are comfortable with the technology needed for telehealth.

Telehealth also can help patients with disabilities get the care they need, and that’s an important consideration as hospitals aim to close disparities. For some patients with disabilities, traveling to a provider’s office requires enormous effort and planning, and can easily be an all-day effort, she says.

“That is an understated advantage that the telehealth world has brought,” Nelson says.

Extending flexibilities

Like many telehealth leaders, Nelson is anxious to see Congress and the Biden administration approve permanent reform for telehealth programs. At minimum, health systems are hoping for an extension.

The federal government eased restrictions on telehealth in the early days of the COVID-19 pandemic, and lawmakers and President Biden brokered extensions late in 2022. Those extensions expire at the end of 2024.

The American Telemedicine Association submitted a letter Wednesday to the Centers for Medicare & Medicaid Services urging the government to extend flexibilities.

Kyle Zebley, senior vice president of public policy for the American Telemedicine Association, warns that telehealth provisions are slated to end in just over four months.

“We urge CMS and the Administration to advocate for Congress to swiftly extend or make permanent pandemic-era Medicare telehealth flexibilities to allow uninterrupted access to safe, affordable and appropriate care when and where it’s needed,” Zebley said in a statement.

While telehealth advocates are hoping for permanent changes to sustain telehealth, they also acknowledge the possibility that Congress will approve another temporary extension before the end of the year.

The U.S. House Energy and Commerce Subcommittee on Health approved a bill in May that would extend most telehealth programs. The Telehealth Modernization Act, which has bipartisan supporters, continues many telehealth flexibilities for an additional two years. The measure would offer a five-year extension for hospital-at-home programs.

Nelson says she’s heartened by the backing of Republicans and Democrats.

“Telemedicine has broad bipartisan support,” Nelson says. “It's just a matter of getting the legislation exactly where everybody wants it to be.”