The coronavirus outbreak has sparked more virtual experiences, from video conference happy hours to online concerts. The move to online experiences has also been reflected in medicine, but the uptake is a bit more complex.
Doctors are seeing more patients virtually than ever, as non-emergency visits have been canceled to abide by social distancing guidelines and stay-home orders.
Government health agencies have taken steps in recent weeks to encourage more doctors and patients to use telemedicine during the outbreak. These changes will only apply until the pandemic has ended, but it may be the springboard that makes telemedicine more mainstream.
These government changes addressed several pain points of telehealth: privacy, insurance coverage and remote monitoring.
“You can put this in the broader context of a variety of things over the past few years in the healthcare environment where there’s potential tension between a policy goal and privacy and security,” explains Kirk Nahra, co-chair of the privacy and cybersecurity practice at WilmerHale. “There’s been a push across the healthcare system to get patients better access to their own records, for example. The government wants patients to have their records, and they favor patients getting records even if security is not perfect.”
Several agencies within the Department of Health and Human Services (HHS) have taken steps so far.
The Centers for Medicare and Medicaid Services (CMS) addressed the insurance issues, opening up more telehealth services to coverage under Medicare and Medicaid.
The agency did this in two waves. First, in mid-March, CMS said it would cover telehealth for elderly patients to reduce potential exposure to COVID-19 by visiting their regular doctor’s office. On April 1, the agency went further, expanding coverage to remote patient monitoring for both chronic and acute conditions not related to coronavirus and for phone calls to patients.
The HHS Office of Inspector General (OIG) also made a change to affect costs. The OIG is allowing healthcare providers to reduce or waive deductibles or other cost-sharing associated with telehealth.
The HSS Office of Civil Rights also announced in March that it would not enforce HIPAA penalties for doctors using telehealth during the pandemic. This effectively removed any worries doctors may have about violating the health privacy law.
“There have been two main impediments to telehealth being a more consistent part of the healthcare system,” Nahra explains. “One is the concern about appropriate privacy and security and the second is that doctors didn’t get paid for it. These changes were designed to help people feel comfortable.”
Beyond costs and privacy, the Food and Drug Administration (FDA) also has made it easier to monitor patients remotely. The FDA issued a guidance allowing providers to use consumer health devices to remotely monitor patients. The new policy includes devices that measure body temperature, respiratory rate, heart rate and blood pressure.
“It’s part of a trend where healthcare is changing and the HIPAA rules are sometimes viewed as impediments to doing certain things,” Nahra says. “The changes are saying if the reason a doctor hasn’t been doing telehealth is because they weren’t comfortable that it was consistent with privacy rules, we’re taking that issue away.”
Regulatory barriers have been lowered, but other barriers still remain for patients and doctors using telehealth, whether that’s simply unfamiliarity with the process or technology or cost issues.
A survey conducted by G&S Business Communications found that 82% of Americans still don’t think telehealth is available to them. That survey was conducted in late March, after many social distancing restrictions and most of the telehealth regulatory changes above were put in place.
Despite not knowing whether it’s available, interest in using telehealth has spiked by 40% in Americans aged 18 to 44 and more than 30% in those aged 45 and older, according to the survey. Two out of five said the COVID-19 pandemic made them more likely to use telehealth.
Rachael Adler, SVP of healthcare at G&S Communications, says it may be because some payers aren’t effectively communicating about telehealth.
“The biggest piece of news for me is the overarching lack of awareness of access to telehealth,” Adler explains. “Looking at it from a comms perspective, there is a lack of direct communication from payers to members in an effective way.”
One insurer, Oscar Health, is working to change that while demand for telemedicine services spikes.
The biggest piece of news for me is the overarching lack of awareness of access to telehealth.Rachael Adler, G&S Communications
Ivan Wicksteed, chief marketing officer at Oscar Health, says demand has soared. Over the past month, he notes, the company has seen a 60% year-over-year increase in weekly telemedicine consults per 1,000 members.
What used to be a quick, urgent care solution has become a longer term journey, he says. Oscar also offers telemedicine at no cost to its members, a longstanding policy at the company.
“Consumers are looking for answers and care from their homes, so demand for telemedicine has skyrocketed,” Wicksteed explains. “The outbreak of COVID-19 is transforming the way members think about using telemedicine to guide them through recovery. This journey can last two weeks or more, so we’re seeing our members use telemedicine for more longitudinal care than they have in the past.”
The company has been working to keep members informed about healthcare options and COVID-19 during the outbreak. Oscar has introduced a digital COVID-19 self-assessment to help members understand their risk. It’s also focused on communicating with high-risk populations, Wicksteed says. Those patients receive more personalized resources for reducing their risk.
Adler says the key to encouraging more people to use telehealth is to keep it human.
“It’s important not to lose the human touch,” she explains. “Just because it’s virtual care doesn’t mean it has to feel like there is a barrier.”
The challenge Oscar faces to increasing telemedicine use is that many patients simply don’t associate it with insurers.
“People know Oscar for health insurance, and they don’t always associate an insurance company with telemedicine,” Wicksteed notes. “Getting people to start their telemedicine journey with Oscar takes constant education. Currently, this education is focused on the variety of ways members can use our digital tools, routing them to telemedicine at the right moments. It also means letting them know when telemedicine isn’t the best option.”
Telehealth proponents hope the current situation, while terrible, might open up the service for more people in the future. Once the pandemic has passed, telehealth may be even easier to implement in areas that need it, such as rural towns, Adler says.
Regulators may be faced with an interesting dilemma post-pandemic, Nahra says, especially if there haven’t been any major privacy or other violations because of the relaxed rules.
“There are so many opportunities and applications and it’s encouraging to see, even in this horribly difficult time, that telehealth is finally becoming utilized, and I hope it continues,” Adler adds. “People are starting to be comfortable with this type of communication and we’re all craving that level of human connection. Figuring out how to use telehealth and marry it to real human connection is what is going to be needed to continue.”