Primary care is changing. Even before the coronavirus pandemic, workforce, technology, and demographic trends were prompting shifts toward home visits, retail clinics, and virtual care. And experts were predicting that home will be the new center of healthcare delivery

Telehealth has shown its potential to serve a variety of patients — from elders at home to busy executives in the office and parents coordinating care for children — and has helped extend services to nursing facilities and augment emergency care in remote locations. Widespread shutdowns earlier this year prompted a sharp drop in in-person elective and preventative visits — and the decline has been partially offset by a significant increase in telehealth. Virtual care may have finally found its use case during the pandemic.

What is telehealth?

Telehealth — a broad term that refers to virtual support for patient care, health-related education, and administration — includes telemedicine, which specifically refers to the delivery of clinical services via telecommunications technology. 

Telehealth may take the form of a Zoom call with your doctor, but it’s not only real-time video and phone calls via platforms like Teledoc. Telehealth includes asynchronous solutions like Text4Baby, Hello Alpha, and Bright.MD that deliver support via text messaging, questionnaires, or automated screenings. And telehealth is also remote monitoring — via connected camerasstethoscopesglucose monitors, and other devices. There are many modalities and a huge number of startups: In 2019, there were at least 275 companies providing telehealth services.

Telehealth also plays an important role in virtual clinical trials and other research, creating opportunities to increase engagement and improve the quality of data. For example, Evidation Health’s initiative, funded by BARDA and the Gates Foundation, analyzes self-reported behavior and symptom data to develop an early warning algorithm for COVID-19.

What’s happening now

Telehealth isn’t just convenient if you’re stuck at home or your provider’s office is closed; it also alleviates in-person burden on the healthcare system during a pandemic. On-demand telemedicine is an approach to “forward triage” that screens and prioritizes patients before they arrive at an overwhelmed emergency department. Delivering virtual care to patients at home prevents both patients and providers from unnecessary exposure to infectious disease. And healthcare workers — doctors, physician assistants, and nurses — can also safely provide telehealth services when they themselves are quarantined. 

Federal and state agencies have enacted a number of emergency declarations to expand access to telehealth during the crisis, including increasing the services that can be provided via telehealth and enabling providers to bill for telehealth consultations at the same rate as in-person visits. The Centers for Medicare & Medicaid Services (CMS) waiver also allows hospitals to use telehealth to conduct medical screening examinations, as required under the Emergency Medical Treatment and Active Labor Act. These rules are set to expire once the national emergency is declared over, but lawmakers are pushing to extend them. This week, CMS administrator Seema Verma expressed support for continuing telehealth in the long term

Regulation, cross-state licensing, and reimbursement have been among the most significant hurdles to telehealth adoption. If CMS and private payers won’t commit to continued support for telehealth, health systems and providers are unlikely to invest in the platforms, infrastructure, licensing, and training required to scale long-term telehealth adoption. 

That’s not to say there should be no rules at all. Policies should recognize the wide range of telehealth services and enable flexibility, with decisions based on value — improving quality, decreasing cost, and increasing access to care. Earlier this month, the National Committee for Quality Assurance announced revisions to its Healthcare Effectiveness Data and Information Set — a standard for measuring the quality of care — intended to “reinforce the use of telehealth during the pandemic and after.” 

Many experts caution that expansion of telehealth may actually increase disparities. Older people, people of color, and poor communities — the same populations disproportionately impacted by COVID-19 — often face barriers to using telehealth because they lack digital literacy, access to technology, and reliable broadband connections. Part of the Federal Communication Commission’s planned $200 million investment in telemedicine could go toward providing underserved communities with the technologies they need to access telehealth services.

Telehealth’s big year could get even bigger. Boston-based Amwell, a virtual care platform, is preparing to go public after raising nearly $200 million in funding. The company has reportedly seen a 1,000% increase in telehealth visits — with up to 45,000 telehealth visits per day — during the COVID-19 crisis. Other companies have experienced similar gains: Shares of Teladoc are up 88% this year; Livongo, a disease management platform that connects patients to providers, has more than doubled its stock price this year; and shares of One Medical, which offers both telehealth and in person visits, increased 120% from its IPO price in January.

Just like the shifts to online banking and online shopping required the financial and retail industries to rethink everything from organizational structures to customer experiences, scaling telehealth adoption will require the government and private-sector health companies to think expansively about how technology can meaningfully improve access, cost, and quality of care. 

How might we increase adoption of telehealth?

Read the problem statement — along with opportunities to provide clear guidance and services for physicians, address reimbursement challenges, and invest in telehealth infrastructure — and share it with someone working in this space.