Five Questions for John League with Advisory Board on the State of Telehealth Today and What’s Next?

By Claire Thayer, March 16, 2021

Thanks to the pandemic, telehealth is here to stay! Advisory Board’s Senior Consultant, John League, joined us for a recent webinar on the state of telehealth today, offering insights for health payers in rethinking the digital experience to address downstream utilization, digital inequities, and more!  We caught up with John on five key takeaways:

1. Data is essential to advancing telehealth initiatives. What are the key data elements payers need to prioritize?

John League: All stakeholders need a better understanding of the downstream impact of upstream telehealth. Payers have tended to focus on data about utilization and per-service unit cost of telehealth—which are both important—but that doesn’t provide perspective on longer-term total cost of care or outcomes. We need data on things like how telehealth facilitates care coordination (are care coordination codes used more or less frequently via telehealth?), limits readmissions (including readmission and transfer from skilled-nursing facilities), and impacts other types of utilization (including labs, imaging, referrals, and prescriptions). 

2. What are some of the major challenges and barriers patients face in telehealth adoptions?

John League: Plans and providers can’t simply offer telehealth services; they have to recommend them as appropriate. I hear a lot of organizations worry that patients are increasingly choosing to do in-person visits over telehealth options. When I dig deeper, I often find that patients are getting no guidance on whether telehealth is a good option for their visit. Providers have the most influence here, but plans have a role, too. A recent Optum survey showed that half of patients who had actually used telehealth found out about it from their own doctor. Another 27% found out from their plan. 

Patients also need a quality virtual experience. It should have as many of the features of an in-person visit as possible. It should be at least as easy to schedule. It should provide a diagnosis, treatment plan, prescription, referral, or follow-up steps as appropriate. There should be clear steps for technical preparation and support. And they need to know how much it costs. Most cost-sharing is waived during the public health emergency, but a clear understanding of out-of-pocket costs is going to be essential in the future.

3. How can payers best understand, mitigate, and eliminate disparities and inequities in healthcare using telehealth?

John League: Addressing digital disparity begins with understanding the patients and communities in front of us: Does your organization understand how digital inequity presents in its members and patients? This also means diagnosing the nature of the inequity: Is it a challenge of connectivity, digital literacy, or trust in your organization and platform?

With that information, organizations can assess how their digital health priorities and investments mitigate digital inequities—or, unfortunately, maybe even deepen them. Only when each organization understands the nature of its members’ equity challenges and its own capacity to address them can it begin to partner with other organizations or advocate for policy change.

4. What do you see as the biggest challenge for payers in widespread telehealth adoption?

John League: The biggest challenge for payers is in helping patients and providers make the most valuable use of telehealth possible. I talk a lot about overall utilization rates—percentage of total visits done via telehealth—because that’s relatively easy to understand and quantify. It’s also a decent indicator of overall interest in telehealth. It’s also deceptive.

It's much more important to get the right visit types done virtually than it is to get any specific overall percentage of visits done virtually. There are some visit types that could almost all be virtual, and that’s where there’s big value for members. Are we getting prescription refills done virtually? What about pre- or post-op visits? What about behavioral health visits, or annual wellness checks?

Creating the right incentives and pathways so that patients trust telehealth for those purposes and providers are appropriately compensated for offering it is a significant but not insurmountable challenge.

5. What are your key takeaways in terms of where payers need to go and how to get there on their telehealth journey?

John League: First, don’t rely on pre-pandemic assumptions about telehealth. Telehealth was never deployed at scale before Covid-19. There is more data on its use than ever before. We need to dig into that hard-earned evidence and reassess how telehealth can help meet strategic objectives.

Second, focus on telehealth as a part of the overall care journey. It’s easy to focus on the unit cost of a telehealth visit, but that orientation ignores its potential to reduce total cost of care in other ways.

Finally, remember that telehealth has not reached a tipping point for the underserved. Many of the patients who could benefit most from telehealth aren’t able to access it. Work to develop an understanding of the ways that digital inequity affects your own members and how your organization’s priorities for digital investment will mitigate or deepen that inequity. 

If you missed this informative webinar presentation, Understanding Telehealth Today – and Preparing for its Next “New Normal”, we invite you to watch the full On-Demand webinar video, short webinar re-cap video, or reach John League directly at leaguej@advisory.com.