Telehealth And The Rise of Systemic Change in Healthcare

Doctor using laptop with a stethoscope at their side
Credit: Elnur -

The exponential rise of telehealth, telemedicine, and remote patient monitoring has a simple explanation: the pandemic has forced healthcare services to be delivered to patients where they are, as opposed to requiring physical presence at healthcare facilities. The dynamic is an incredible shock to a system that is the most expensive in the world, and at the same time, not traditionally patient-centric. But these are very early days, and real change is brewing.

The sudden preference that patients not visit facilities has fueled a new economy overnight, as the patient-centric modalities -- livestream video, remote devices, and asynchronous communications -- are now in high demand by patients and providers. Regulatory frameworks have played along to throw fuel on the fire. The new economies have some obvious short-term winners (livestream video), but the pandemic will commoditize such services, and successful technologies that effectively deliver patient care for chronic diseases will create true disruption.

Shifting Healthcare Services

Livestream video appointments means that brick-and-mortar facilities could be in a lot of trouble as health plans guide their members to their preferred providers via appointment hyperlinks for routine and non-critical needs. This shift will make care more convenient, but not necessarily better. At least patients will not have to wait months for appointments in overcrowded waiting rooms for easy-to-address issues.

The seismic shift will come when the fascination with livestream video appointments fades, and patients begin to realize that the co-pays and costs are the same regardless of modality. 2021 will be the year of the rapid virtual check-in as consumer demand for convenient and more efficient modalities explodes.

Necessity Drives Change

Let’s look at what happened to Tuberculosis care from 1980 to 2020 to see what’s about to happen to the rest of healthcare as the patient becomes the center of the universe. Patients with Tuberculosis take their medication using a process called Directly Observed Therapy (DOT). Every single public health department in the country holds a medication management appointment with Tuberculosis patients each day for the entire six to nine month regimen.

In the 1990s, the wall-mounted video phones were used to make this more convenient. Then came Skype, and eventually FaceTime, once stringent healthcare security standards were achieved.

In 2020, the country’s largest health departments all use asynchronous video (i.e. recorded video messages) to fulfill this high-touch -- but still patient-centric -- model of care. They sometimes switch over to a livestream video call, and less frequently, they see the patient in-person. Public health nurses, physicians, and healthcare workers still drive the outcomes; they’ve just shifted the platform of delivery. The same change is happening now for pediatric asthma patients in Baltimore.

The future of healthcare is a mix of in-person, live video, and asynchronous care modalities, each used when needed or convenient. This directly tracks with how we communicate socially, or at least how GenX and Millennials do: asynchronous video messages via platforms like SnapChat or Instagram. Live chats with Skype or FaceTime. And if there weren’t a pandemic, it would be great to meet in-person.

Healthtech Investment on the Rise

This does not mean that all healthcare will be technology-delivered, only that technology will play a large part in delivering healthcare that is increasingly patient-centric.

Humana’s investment in Heal is a prime example, as Heal has essentially reinvented the primary care house call. Using technology to drive efficient delivery, Heal has proven that facility-based care will be reserved for acute patients, while routine health checks, healthcare questions, and daily disease management will shift to patients’ homes. The remarkable aspect of Heal is the promise of more contact to the physician; this shows that the underlying force of change is not technology, but patient convenience.

Another example is Teacher’s Health Trust in Las Vegas: every tool in the technology arsenal will be deployed to help their members -- the teachers of Nevada -- return to school safely.

Impact to Businesses

Every business is now a healthcare business, which will be another dynamic that shifts the cost of care in employer-funded plans. In light of the pandemic, businesses now screen for symptoms and check the temperature readings of their employees. Not some businesses -- all of them.

Municipalities, retailers, schools, universities, and investment banks have deployed technology to identify COVID-19 cases in order to keep their workplaces safer. They will soon determine that they can provide additional health services through technology as they begin to deliver and experience more efficient care.

Employer health plans account for about 80% of insured Americans, and healthcare costs have steadily risen over the last two decades. In 2022, employers will see the benefits of remote care, and demand that their health plan partners offer disease management services that are efficient and cost-effective -- as opposed to wellness packages that never achieved the promised ROI. They may even choose to give employees the funds and the choice, which will create incredible competition in the remote care markets.

Change for Good

While all this change is generally a good thing, the change is too slow and not accessible to large segments of the population. The most vulnerable and high-risk patients -- patients with addiction, depression, pediatric asthma, or immunocompromised organ transplant recipients -- are often marginalized populations who lacked access to healthcare before the pandemic, and now struggle with the same issues plus a higher risk of COVID-19.

These populations are not using the “clap” emoji on Zoom meetings. They do not have broadband internet. They are often communities who traditionally lack access to care.

In the next two years, effective, convenient, and continuous chronic disease management will become critically important as the hiatus from care for these patients results in increased ER visits and hospital stays. Early assessments indicate that COVID-19 may have long-lasting pulmonary and cardiovascular effects, and so the drive to accessible, affordable remote care cannot come soon enough. Large mergers like Teladoc and Livongo may represent a sea change right now, but in a couple fast years, we will realize that this overhyped move was just the curtain opening up for the real show.

Here’s hoping that the pandemic ends soon, but that not everything in American healthcare goes back to normal.

Sebastian Seiguer is the CEO and Co-founder of emocha, which provides remote monitoring services for patients to monitor their health through virtual check-ins and scalable human engagement. The platform is being used by public health departments, hospitals, health centers, and managed care organizations across the globe to radically improve medication adherence for patients with diabetes, tuberculosis, opioid use disorder, asthma, COPD, hepatitis C, and other chronic and infectious diseases, and to monitor COVID-19 symptoms for those at risk.

The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of Nasdaq, Inc.

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