Telehealth is a broad term used to describe the delivery of healthcare services using telecommunications technologies. The American Telemedicine Association, Federation of State Medical Boards, Centers for Medicare and Medicaid Services (CMS), and individual states all have varying definitions, many of which take into consideration coverage and reimbursement specifics. But generally speaking, telehealth is a way of delivering care that enables providers to treat or counsel patients without the two having to be in the same location.
The delivery of telehealth services is done using a number of platforms and devices, and it can be performed in several ways:
- Real-Time - synchronous, often using live video
- Store and Forward - asynchronous, through the transmission of information using an electronic communications system
- Remote Monitoring - collecting a patient’s clinical indicators and data using an implanted or manual reporting technology, and responding or taking action on the data
Within the broad category of telehealth there are many subsets. For example, telepsychology is the remote delivery of behavioral health and counseling services by a psychologist. Telemedicine is the remote delivery of medical services by a physician or non-physician provider. Telepharmacy is the remote delivery of medication counseling or management by a pharmacist or pharmacy technician.
Telehealth can be performed in a variety of different location types – from a patient’s home or workplace to a rural hospital or school. And the number of services that can be delivered via telehealth is fairly extensive, including:
- Treatment of minor acute problems - colds, flu, rashes, otitis media, and allergies
- Consultation with a specialist
- Post-visit and post-operative follow up
- Chronic disease management
- Vital sign monitoring, as well as monitoring of other indicators such as fluid output or measurements recorded by an implanted device
- Review of test and lab results
- Medication management
- Medication adherence counseling
- Dietary consultations
Some physicians also use equipment such as digital otoscopes, stethoscopes, spirometers, or ultrasound probes to gather additional clinical data during the visit.
Telehealth’s Lift Off - Why Now?
Although it’s been talked about for decades, there’s been a huge uptick in the use of telehealth by healthcare systems and provider organizations over the last several years. I think this is due to the coalescence of five key forces:
1. Lower Technology Costs
Ten years ago, platform, licensing, and equipment costs were huge barriers to organizations that wanted to launch telehealth initiatives. Teledermatology and teleradiology were early telehealth adopters because the platforms required to review images and render an opinion were not as costly, and both specialties were sparse in rural areas so giving access to them via telehealth filled an important patient access need. But technology that enabled providers and patients to interact in real-time were expensive to implement back then, and reimbursement was scarce to none. The result: slow to no adoption.
Enter new, lower cost platforms and solution providers over the last few years, such as AmWell, Vidyo, Doctor on Demand, Carenet Health, MDLive and others. Today, no special telehealth equipment is required. Most providers and patients use mobile devices and tablets, removing the previous need for specialized (read: costly) equipment.
2. State Approvals of Telehealth
State policy defines what can be considered telehealth for beneficiaries within that state, as well as where telehealth is covered and how, and the types of technologies, services and providers that are eligible for reimbursement. There has been sweeping change at the state level over the past several years, in favor of telehealth. State Boards of Medicine and legislatures recognize the benefits of improved access, better care, and reduced costs, and have changed their laws accordingly.
As an example, more than thirty states have payment parity regulations that require commercial payors to reimburse telehealth services at the same rate as face-to-face visits. These laws do not legislate which types of services must be reimbursed, however, or under what conditions. Some follow CMS guidelines, some have their own.
If you’re interested in conducting state-specific research for your organization's contracted plans, the American Telemedicine Association has a State Policy Resource Center that makes this easy. And, for specific state telehealth regulations and coverage requirements, search this cool, interactive map (https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-policies) maintained by the Center for Connected Health Policy.
3. New Codes and Reimbursement Changes
When state legislatures and boards of medicine began embracing telehealth, coverage and reimbursement requirements got clearer and stronger. In 2018, CMS implemented new codes and telehealth coverage. And in 2019, the agency implemented new codes and incentives for remote patient monitoring.
As the adage goes, “where Medicare goes, other payors follow.” Most of them began covering telehealth services several years ago but again, the rules and requirements vary considerably. Still, the fact that nearly every commercial and Federal payor - as well as the majority of state Medicaid payors - covers at least some telehealth services, has motivated many provider organizations to pursue offering them.
4. Proven Care Improvement and Cost Reduction
The resulting cost savings from telehealth has been significant for many organizations. Here are two examples: Patients enrolled in the telemedicine program at Geisinger Health experienced 44% lower readmissions over 30 days and 38% lower over 90 days, compared to those not enrolled in the program. And Frederick Memorial Hospital’s telehealth program for chronic care patients living at home cut ER visits in half, drastically reduced rehospitalizations, and cut treatment costs by about 50 percent.
5. Patient Satisfaction
It’s well understood that patients love the convenience of telehealth options. Patient satisfaction data is abundant, but here’s one stat from a recent Massachusetts General Hospital study: 68% of patients rated telehealth visits a nine or ten on a ten-point scale.
At Kaiser Permanente, virtual visits have been so desired by patients that 52% of the organization's more than 100 million annual patient encounters with company physicians are virtual visits. A study of Kaiser's virtual visits that were video based telehealth found that 93% of patients who responded to the survey found that the encounter met their needs.
 A Surgeon’s Guide to Getting Started with Telehealth, a white paper by Betty Hovey for the Johnson & Johnson Institute, 2018.
 The Promise of Telehealth for Hospitals, Health Systems, and their Communities, American Hospital Association Special Report, January 2015. http://www.aha.org/research/reports/tw/15jan-tw-telehealth.pdf
 Kaiser Permanente Chief Says Patients Are Flocking to Virtual Visits, Dave Barkholz, Modern Healthcare, April 21, 2017, https://www.modernhealthcare.com/article/20170421/NEWS/170429950/kaiser-permanente-chief-says-members-are-flocking-to-virtual-visits
 Kaiser Permanente Sees Good Benefits with Video-Based Telehealth, Eric Wicklund, mHealth Intelligence, October 16, 2018, https://mhealthintelligence.com/news/kaiser-permanente-sees-good-results-with-video-based-telehealth