Source : Medtech Insight
The COVID-19 pandemic has accelerated the rise of telemedicine, but the conversation about how telehealth will fit into the overall health system continues, said Amwell co-CEO and president Roy Schoenberg at the virtual HLTH 2020 conference in a conversation with health insurance exec Mario Schlosser about the future of telehealth.
Schoenberg noted that various stakeholders continue to discuss how to “reimagine” health care with telehealth — a conversation that Schlosser added is creating tension.
“The reality is there is a really, really big question as to whether these technologies are part of the delivery side of things, or whether these technologies are a payer ability to really redistribute health care availability around the country. That sets the stage for many interesting conversations in the year to come,” Schoenberg said, noting that perspectives from insurers, the care delivery side and regulatory side are not aligned.
“The reality is there is a really, really big question as to whether these technologies are part of the delivery side of things or whether these technologies are a payer ability to really redistribute health care availability around the country.” – Roy Schoenberg
Schlosser, who runs the New York-based consumer-focused health insurance start-up Oscar, told the virtual audience that the shift to telehealth is a huge opportunity to curb health care costs and improve outcomes.
But this will require a shift among key players and decision-makers toward value-based, patient-centered care. Providers’ pay must shift from fee-for-service to being based on patient outcomes, otherwise it might be “inflationary not deflationary,” he explained.
“If you pay for fee-for-service and are now shifting toward a modality that over time may get reimbursed less, your value will go down,” Schlosser said. He believes that the shift to telehealth care will demand a greater shift toward risk, which will be contentious.
Schlosser said that one big health system reported a 3,000-fold increase in telemedicine visits early this year, then saw remote visits decline by 85% this fall, but still experiences greater demand for telemedicine than it did 10 months ago. He said the reason for the drop in virtual care isn’t that patients are less interested in telehealth visits, but rather due to “reimbursement anxiety” from providers.
Telehealth reimbursement beyond the pandemic remains uncertain.
According to a study by the Kaiser Family Foundation, which has been tracking telemedicine trends, many regulatory and practice changes to telehealth use and reimbursement are temporary.
“Overall, it is unclear whether we will continue to see high rates of telehealth utilization once the pandemic is over. Many of the policies enacted for private insurance plans have sunset dates, though several have extended the policies, some through the end of 2020 or until the public emergency is over,” the Kaiser study found.
On 15 October, the Centers for Medicare and Medicaid Services added 11 new services to the Medicare telehealth services list for Medicare reimbursement through the COVID-19 public health emergency, including cardiac and pulmonary rehabilitation services and certain neurostimulator analysis and programming services. With these new additions, Medicare will pay for 144 services performed via telehealth under the Medicare Physician Fee Schedule – including emergency department visits, initial inpatient and nursing facility visits, and behavioral health.
Schoenberg said he’ll be watching the Medicare fee-for-service schedule, and lamented that the perception by regulators that telehealth is trying to catch up with in-person services is fundamentally false.
He said what’s lagging is leadership among regulators to create a different infrastructure for health care.
“It only looks at, ‘Can we imitate stuff that we’ve done physically through technology?,’ rather than thinking ‘How is the world going to look like when health care will travel?’,” he said.
The Kaiser Foundation also found that there are many barriers that have impeded the expansion of telehealth services in the US, including the highly regulated and fragmented health care system, technology challenges, reimbursement and provider resistance.
Schoenberg said that historically, when it comes to health care, providers and payers have dominated the conversation.
But he said that the patient voice may be getting louder, noting that the pandemic introduced many consumers to virtual care and other new technologies that they now have become comfortable with and want to continue experiencing.
“Maybe we can demand a new health care … the opportunity through these technologies to allow the end-recipient to actually have a voice and say, ‘My expectation from my health care experience is no longer [down there], it’s [up here], and with these technologies I expect my ability to follow up with my doctor differently … and get to health care more quickly,” Schoenberg said. “These are the kind of voices that we’ve never heard in health care before and telehealth has allowed them to enter and ask us to reimage a completely new system for them.”
Schlosser agreed with Schoenberg, but also noted that health care is not very transparent, saying that unlike in other industries, the “best product doesn’t always win.” He feels to create change, existing players need to be enabled to deliver care differently and get paid differently. He described the process as starting “a revolution from the inside out.”
“I don’t see physical disappearing. I think there is a comfort level of being seen, being touched, and of course there is a whole lot of medicine that cannot physically be done or safely be done through technology.” – Roy Schoenberg
Schoenberg, however, said that other industries have shown that using technologies that offer consumers a superior experience can inspire change.
“Granted, you have to have a deep breath and the ability to sustain yourself for a long time … but over time, delivering a superior experience has created … the Apples of the world and the likes, and I think because people have tasted how liberating the availability of health care through technology is ... [it] will be the calling card of the change,” he said. “We are a service industry – we tend to forget that – but if we can create a gratifying experience to the people that we serve, over long-term, that’s a winning strategy,” Schoenberg said.
In the future, Schoenberg predicts a new balance between physical and virtual visits.
“I don’t see physical disappearing. I think there is a comfort level of being seen, being touched and of course there is a whole lot of medicine that cannot physically be done or safely be done through technology,” he said.
He predicts that the home will become the most coveted care setting in the future, noting that more aging patients want to stay in their homes as they age so they can remain self-sufficient and independent.
He noted that he’s already seeing more physicians creating group practices “without walls,” or telehealth-based, and he expects that trend to continue.
In a separate conversation during the HLTH meeting, Schoenberg and Google Cloud director of health care solutions Aashima Gupta discussed the critical role of new technologies such as artificial intelligence and the cloud in telemedicine, and how the two companies will work together to drive that effort.
This comes after the two companies announced in August that they have entered into a multi-year partnership where Amwell will be able to leverage Google’s strength in artificial intelligence and machine learning to support the development of its telehealth platform and patient triage, while Google supports Amwell’s ambition to scale its international business. As part of the deal, Google invested $100m in Amwell.
“There is a collective realization in the industry that the future will not look like the past,” Gupta said. “It’s truly inspiring to see how cloud and technologies like AI will not only shape, but also revolutionize, telemedicine as we know it.”
She said based on customers and partners’ feedback, three key themes are emerging about the future of health care services. Care will be tied to people, not places; interoperability and data access will bring new context to care; AI and machine learning will help with human productivity.
“We can bring experiences like chat bots, virtual agents that speak multiple languages to really change the experience both from the provider [many of whom are experiencing burn-out] and help the frontline workers with the intake, inquiries and triage,” she explained. She said it’s still early days, but “as we are looking into ‘How can we help our customers with this future-backed strategy?,’ it became very clear we cannot do it alone.’”
Calling Amwell a “category leader in the space,” she noted that both companies have a shared vision to increase health care access to people worldwide, enabled through Google’s global reach.
“We know that the world of health care is filled with tremendous disparities and opportunities and technology will be the key enabler,” she said.
Schoenberg said all of these technologies – AI, sensors, the cloud – open a “new narrative” to reimagine health care where “we bring together a critical mass of health care to ease the parts of life where health care is burdening people the most [through all stages of life]. “We know this will take a village, we know that this will take more than just Google and Amwell to make this a reality. But we still intend to come together to bring that call to action.”
By Marion Webb