Who would have thought that a global pandemic would have been the stimulus we needed to radically accelerate the transition to digital healthcare in the United States?
No doubt about it, 2020 has offered up something to surprise every one of us. In healthcare, the biggest, most unexpected change has been the widespread adoption of digital health technologies. According to a McKinsey report, just 11 percent of consumers were using telehealth in 2019. By May of this year, however, nearly 50% of in-person visits had been converted to digital visits. Clinicians saw 50 to 175 times the number of patients via telehealth than they did pre-COVID-19.
For years, many people — including myself — speculated that digital health would become a dominant mode of healthcare delivery. But that’s all it ever was — speculation. A host of circumstances would first have to change, we said.
And so we waited. We waited for the culture of medicine and healthcare to change. We waited for the adoption of new payment policies. We waited for public sentiment to become more accepting of virtual care.
We waited for a future that never came.
Until the COVID-19 pandemic came along.
Within a matter of weeks, and in some cases, days — medical practices and health systems once fully committed to brick and mortar, in-person visits changed course and began seeing patients virtually and digitally.
There are many lessons we can learn from this radical transformation.
1. We can change quickly. Very quickly, in fact. The speedy adoption of telehealth showed that change in healthcare does not have to be slow, deliberate, and plodding. Can you imagine where our patients would be if we’d decided to try out yet another telehealth pilot?
As an industry, we have an obligation to our patients to make this speedy pace of change the new normal.
2. Our preconceptions may be misconceptions. The rapid embrace of telehealth shattered many long-held assumptions about digital healthcare delivery. In the world I work in—senior care—the dominant perception was that aging adults either couldn’t or wouldn’t use digital technologies to access care. But they proved us wrong. According to the U.S. Department of Health and Human Services, 0.1 percent of Medicare primary care visits were provided through telehealth in February 2020. By April, 43.5 percent of visits were virtual.
Older Americans used telehealth to access primary care, behavioral health care and cancer care. But strikingly, not only did they use it — they embraced it. A recent poll conducted by Better Medicare Alliance found that 91 percent of older people enrolled in Medicare Advantage plans who used telehealth services during the coronavirus pandemic had a favorable telehealth experience. 78 percent said they were likely to complete a medical appointment via telehealth again in the future.
My mother wasn’t among those polled, but I know just what she’d have said if she were. A few weeks ago, I was by her side during a video visit with a specialist she’d never seen.
You don’t know my mom, but trust me when I say she’s a bit “old school.” She has always judged the quality of a doctor’s visit by three criteria:
1. Did the doctor make consistent eye contact?
2. Did the doctor listen carefully to her?
3. Did the doctor perform a thorough physical exam?
Given these considerations, I expected her to hate the video visit. But she loved it. She said the specialist made eye contact with her consistently and that she felt heard and her questions were addressed thoroughly and thoughtfully. He couldn’t perform a physical exam, but she admitted that it was unnecessary for her condition. And, with some of her age and condition-related mobility challenges, she especially appreciated that she didn’t have to travel to the doctor’s office, find parking nearby, locate his office in an unfamiliar building and languish in a waiting room — all for a 20 minute visit.
My preconceived notions about her preferences were completely wrong. So were hers, by the way.
And I know from my work with seniors that even those, like my mother, whom we swore would never adopt telehealth, have embraced the technology and its benefits—especially when we support them in using it.
Of course, it’s important to note that even patients who want to access telehealth services can sometimes have great difficulty doing so. SCAN Health Plan, the company I lead, provides Medicare Advantage care to more than 200,000 older people in California. Earlier this year, a member survey showed that about one-third of our most vulnerable members did not have access to the technology needed to access digital health services. Likewise, language barriers and hearing and vision impairments can also make it difficult for older people to use these technologies. But rather than abandon such efforts, we’ve begun to supply our most vulnerable members with the technology they need and we’ve even sent community health workers to their homes to help them operate it.
What are some of the other stereotypes that are holding us back?
What I’ve learned about telehealth and older adults has gotten me wondering about other preconceived notions that may be limiting our ability to make improvements in healthcare delivery.
I’ll venture a few:
● Do we truly need as many big box hospitals as we have in America? Or could Hospital-At-Home offer a model of care that’s more patient-and family-centered as well as less costly?
● Do all healthcare services need to be provided locally?Already, in response to growing demand for telemedicine during the pandemic, many states, as well as CMS, have altered their in-state licensure rules to allow practitioners to treat patients across state lines. Is it time to imagine a true national marketplace for procedures and care? Reforming the United States’ outdated system of state-based medical licensure can help expand the use of virtual care services and improve access to care in rural and medically underserved areas.
● Do we need to provide care that’s more culturally competent? Today’s standard care is delivered in English with little regard for patients’ culture, gender, age or race. No doubt this is because of a lack of age, gender, racial, and ethnic diversity in the rooms in which we make healthcare decisions in this country. How can we build healthcare systems that are culturally and linguistically competent and that reflect the diverse population of people that we serve?
Much of the way we deliver care is rooted in outdated, outmoded, and ill-considered perspectives on who patients are and what they want. 2020 is a year that is forcing us to re-examine our assumptions about American society. The collision of our global pandemic and social unrest not only represents a challenge for our society, but also an opportunity — to rethink who we are, how we work, and how to imagine the future of American healthcare unbridled from preconceived notions that stem from false assumptions.