Telehealth or telemedicine–the provision of care through telephone or digitally, including video visits and online care–originally was designed to meet the needs of patients otherwise unable to access care, such as people living in rural areas. But, telehealth is on the rise, increasingly meeting the needs of people who want to avoid leaving work to travel to the doctor and keep their costs down.
Now, according to a July 2016 article on the State of Telehealth in the New England Journal of Medicine, a large number of institutions offer virtual doctor’s visits at low cost 24 hours a day. For many, it’s a great alternative to waiting 20 days to get a doctor’s appointment and then spending 2 hours traveling and waiting for a 20 minute visit.
People are now more interested in using telehealth to treat a variety of chronic conditions. Nearly half the U.S. population has one or more chronic conditions, 140 million people. And, telehealth is moving from the hospital to the home, where it can meet the care needs of frail older adults and people with disabilities for whom leaving home is difficult. Combined with sensors on the patient and in the home, providers can learn a significant amount about a patient.
Health systems with integrated care, such as Kaiser Permanente, the Veterans Administration and the Department of Defense, are finding that telehealth can promote health at less cost than in-person care. Kaiser predicts that it will provide more telehealth visits than in-person visits this year. In 2014, the VA provided more than 2 million telehealth visits. The Mayo Clinic says it will serve 200 million people remotely by 2020, including many who do not live in the United States.
The biggest constraint on telehealth is that most insurers are not yet covering the cost of the services. But, telehealth coverage is on the rise. And, 29 states now require commercial insurers to cover telehealth services in the same ways they cover in-person care. Already, Medicaid covers some telehealth services today in 48 states.
Medicare is behind on telehealth services, limiting coverage to areas where it is hard to see a doctor, as we reported here on Just Care. And, digital doctor visits present a bit of a challenge for older adults since only 58 percent of them are online. Moreover, state licensing restrictions limit the out-of-state care doctors can provide. But, there is a bill in Congress, the Tele-Med Act of 2015, which would give providers the right to treat Medicare patients in any state.
According to Bloomberg BNA, the National Business Group on Health (NBGH) projects that, in 2017, 9 out of 10 large employers will offer employees telehealth services. NBGH further predicts that virtually all large employers, 97 percent, will offer telehealth services within four years.
Large companies still don’t have a good sense of whether telehealth is bringing down their care costs. In fact, just four years ago, only 7 percent of these companies offered telehealth to their employees. But, they now believe it is a valuable benefit that promotes employee satisfaction. It can save people time and money. And, many insurers are now offering the service.
Telehealth has its limitations. It puts less of a premium on the doctor-patient relationship–what the doctor can learn from looking a patient in the eye and conducting a physical examination as well as the trust that can be built–than in-person care. Continuity of care is easily lost, with fragmented care taking its place. And, lack of integration in the delivery of telehealth care could lead to conflicting treatments and poor outcomes. There are also privacy concerns.
On the flip side, telehealth can lead to greater equity in the delivery of health care, reducing racial, gender and age disparities and well as disparities in treatment between people in rural areas and people in urban areas.
Here’s more from Just Care: