A bad patient experience with telehealth can blunt adoption regardless of the incentives for developers and doctors. Griffin Mulcahey, chief compliance officer at Wheel Health Inc., of Austin, Texas, said during a recent webinar that users of these digital health apps and telemedicine programs may need assistance to get up to speed on an application, a critical effort that may make the difference between success and failure in telehealth.
Mulcahey was one of several who spoke on the webinar hosted by Fiscalnote of Washington, which took up the question of how digital health will play out as the COVID-19 pandemic eases. Chandni Mathur, senior industry analyst at the San Antonio, Texas office of Frost & Sullivan, said developers might lose track of the patient-user experience in the rush to ensure compliance with federal regulations and to bring payers into the conversation. An overly tight focus on those two areas can lead to blind spots when it comes to designing an interface that users – particularly older Medicare beneficiaries – will not find off-putting, Mathur said.
Mulcahey said a user may who is not particularly adept at information technology may need an intervention in the mold of a ‘Geek Squad’ model. This might be critical to ensuring that the physician-patient relationship is able to traverse “the last mile in digital health.”
“That investment in the last mile will be the payoff that allows these tools and technologies to be used by everyone,” Mulcahey said, but there is still the nagging question of who will cover the cost of that implementation. While payers may be reluctant, those costs might seem vanishingly small in many instances relative to the benefits. One such instance is the savings associated with allowing the elderly to “age in place” rather than be admitted to a skilled nursing facility or another congregate living arrangement, he said.
Adoption leveling off, baseline higher
Christina Silcox, a policy fellow at the Duke-Margolis Center for Health Policy, said that while the sharp increase in telehealth use seen in 2020 has leveled off, the baseline of use is now higher than prior to February 2020. That baseline is unlikely to recede to pre-pandemic levels, although Silcox observed that some medical specialties and services lend themselves more readily to telehealth. One problem for health care professionals is that the equipment and software needed still presents an uncertain economic footprint on the practice of medicine.
Mental and behavioral health are two areas in which telehealth might make serious inroads in the months and years ahead, Silcox said, a particularly salient consideration as the opioid epidemic surges anew. As for artificial intelligence (AI), “machine learning doesn’t actually work that well” when a new disease arrives, for understandable reasons, she stated. Some algorithms were useful in predicting the spread of the SARS-CoV-2 virus, but there were few, if any algorithms that were helpful in predicting patient outcomes. The base of data is close to sufficient in terms of volume and quality that some adaptive algorithms are making a difference in patient care, however.
Mulcahey said the Health Insurance Portability and Accountability Act of 1996 is directed to both privacy and patient access to their own health information, but controversies over privacy have swamped the access question in recent years. Nonetheless, users are more focused on accessing their data than on privacy matters and may be willing to waive some restrictions on how to access those data. This puts the onus on entities that store and deliver the patient data to ensure their practices are in strict regulatory compliance and are resistant to cybersecurity issues, which applies to remote patient monitoring systems as well. Developers of the associated software apps must be wary of data sharing practices that cross an ethical or regulatory line, Mulcahey said.
Karen Howard, director of the science, technology and analytics office at the U.S. Government Accountability Office, said AI’s reliance on large sets of de-identified patient data presents its own easily forgotten hazards. De-identified data can be obtained without consent in some circumstances, but patients and users of digital health apps are not always aware that de-identified data can be re-identified, a predicament which suggests that the Health Insurance Portability and Accountability Act (HIPAA) is in need of a statutory refresh. Howard said the need for a national approach to update privacy standards is highlighted by the chaos that ensues when several of the 50 U.S. states undertake their own privacy legislation.
Old-school tech to the rescue
While there is little statutory support for coverage of audio-only telehealth, the importance of this mode was highlighted by the roll-out of vaccination programs for the COVID-19 pandemic. Howard said many state and local authorities had set up vaccination registration systems online, and were surprised to discover that the first group eligible for vaccination, the elderly, were not signing up in the expected numbers.
“The shocking thing is that they were surprised by this,” Howard said, adding that some state and local authorities ultimately resorted to calling seniors on the phone about vaccination, which boosted uptake to 80% in this highly vulnerable demographic. That problem underscores the notion that telehealth tools must set new standards for user-friendliness and accessibility, particularly for the elderly and the cognitively impaired, “or they won’t be used, and we’ll have a large segment of our population left out.”
Mulcahey said the question of payment parity between in-person and telehealth appointments should account for the prospect that there are efficiencies in telehealth that are not available to in-person care. Administrators of high-deductible plans might also want to consider tweaking their cost sharing approaches to telehealth if they want to reduce overall spending down the line, given that a high out-of-pocket telehealth spend for plan enrollees may drive more patients back to the clinical setting, even for services that can be ably handled via telehealth.