The Telehealth Era is Just Beginning: More gains in quality, affordability, and accessibility are on the way

“Having analyzed health outcomes data from the independent National Committee for Quality Assurance, health plan member satisfaction surveys from J.D. Power, and internal data from our own organizations, we are confident that full implementation of five opportunities would improve clinical quality nationwide by 20%, increase access to care by 20%, and reduce health care spending by 15% to 20%.

  1. Reduce Expensive and Unnecessary Trips to the ER
  2. Reverse America’s Chronic-Disease Crisis – For members of large multispecialty medical groups such as Kaiser Permanente [KP], high blood pressure is a much more manageable problem [outside of KP, control rates hover around 70%]. KP consistently achieves a control rate above 90%. It’s not that it has better doctors or medications than other providers do; the biggest difference is frequency of disease measurement and timeliness of treatment—factors facilitated by virtual care.The traditional approach to managing chronic disease is intermittent and episodic. Once a doctor makes a diagnosis, he schedules follow-up office visits on a routine basis, usually every four to six months. Most Americans are used to this cadence, but it makes no sense. Some patients with well-controlled chronic diseases might not need to see their doctor for a year, while others would benefit from monthly evaluations. But traveling to the doctor’s office once a month, often for nothing more than a blood-pressure check, is time-consuming, inconvenient, and for many people expensive. [..] The combination of telemedicine and wearable devices allows for more-frequent medication adjustments, resulting in faster and better disease control and fewer complications at a lower total cost.
  3. Address Disparities in Health Care
  4. Make Specialty Care Faster and More Efficient – When treating patients who require specialty referrals, primary care doctors have a common complaint: They have 95% of the expertise needed to accurately diagnose and treat but no easy way to obtain the other 5%. Sometimes all they seek is assurance that their diagnosis or plan is appropriate. But without that missing 5%, their only option is to make a referral for an in-person specialty consultation, leading to treatment delays and higher costs. [..] Across the most common medical and surgical specialties, KP’s remote-specialist model resolves patients’ problems 40% of the time, with no specialist visits needed. Patient satisfaction is 10% higher than for in-person consultations. When a patient does need to visit a specialist for a procedure, the appointment is scheduled after the virtual consultation; no in-person consult is required.
  5. Provide Access to the Best Doctors

[..] KP and Intermountain’s experiences suggest that 30,000 to 50,000 enrollees are needed to support the requisite hiring of primary care and specialty physicians. Few businesses have that many employees in a given geography or the financial ability to make the necessary changes themselves. But 15 or 20 companies together could achieve critical mass. [..]

When telemedicine is at the heart of care delivery, patients require fewer specialist visits; as noted, KP’s experience suggests that primary care physicians can resolve 40% of problems with the help of telehealth-based specialists. What’s more, collaboration among doctors and the improved overall health of patients mean fewer medical complications and surgical interventions. Finally, the availability of experts for rare and complex diseases facilitates correct diagnosis and treatment at the outset.”

Full article, R Pearl and B Wayling, Harvard Business Review, May-June 2022.