The Edges of Telehealth’s Efficacy

“She had that look—she was determined, and she wasn’t going to take ‘No’ for an answer,” said Avivit Ben-Aharon MS Ed., MA CCC-SLP, founder and clinical director of Great Speech. Ben-Aharon was recounting the recovery story of Mary, a 91-year-old patient who suffered a stroke at the start of the COVID-19 pandemic. Though her doctors were not very optimistic given her age and the pandemic’s challenges, her family made a strong effort to ensure she got the speech therapy intervention she needed—safely and virtually.

Great Speech has been in operation since 2014, providing HIPAA compliant, tailored speech therapy virtually for patients of all ages. While their business model is not a COVID phenomenon, the pandemic has drastically increased demand, as it has for the broader telehealth industry.

“If we didn’t have this virtual model, she would not have made the progress she’s made,” said Ben-Aharon. “Since COVID began, families are reaching out more. We are getting a lot of inquiries from geographically separated adult children whose elderly parents need care and new parents seeking early intervention for their children. They can log in and join the therapy sessions virtually and monitor their loved ones’ progress online.”

Accessing Data for Better Care Coordination

Although Great Speech is seeing high family participation in care coordination—they may be somewhat of an outlier. For most patients, the availability of virtual care has not created some magically seamless healthcare ecosystem. Platforms don’t always integrate, and care teams don’t have consistent access to information from one provider to another. In many ways, we’ve transferred an already opaque in-person patient experience to our computer screens… and added the complexity of remembering more passwords.

Electronic medical records may be technically available for patient and family member access, but they often have no idea where to log in or how to get started—and more importantly, they’re not even sure who to ask for help. The pure-play technology platforms are great in theory, but the support required to facilitate proper use and long-term adoption is still in the early stages. Healthcare entities must ensure their teams are correctly leveraging the technology, working with other providers to share it, and then educating patients and families on utilization.

Managing the Effects of Managed Care

“Allowing a doctor to transfer their existing practice to telemedicine also doesn’t solve for the fact that most patients do not have a real relationship with a primary care physician,” said Guy Friedman, co-founder and CEO of SteadyMD, a direct-to-consumer virtual concierge medicine platform. They match patients with physicians for personalized, comprehensive care for a monthly fee.

In a traditional setting, doctors see 20 to 30 patients per day and spend the rest of their time billing insurance. Putting them online doesn’t mean they are necessarily seeing fewer patients or having higher-quality interactions. In many cases, they are actually seeing more patients per day than before.

Nationally, we are trending more toward urgent care versus the primary care physician-patient relationship we have had in the past. The introduction of telehealth alone does not solve this issue—but alternative methods like concierge medicine are helping to alleviate this for patients who are aware of it and can afford it.

Imaginary Lines, Real Limits

Prompted by COVID, regulators temporarily relaxed restrictive geographic rules, giving doctors and therapists the ability to care for patients outside of their state of licensure. Both Friedman and Ben-Aharon say they hope cross-state licensure eventually becomes the U.S. healthcare system’s permanent norm. Despite the win this shift would represent for patients, there is a lot of money at stake. State governments and insurance providers are not currently incentivized to support a long-term change.

“I would rather that doctors are able to practice anywhere with their one state license. Without that, you’re just restricting access to care,” said Friedman.

There’s no real reason or logic to maintain these regulations—they are simply artifacts of historical use cases where virtual visits did not exist, and doctors saw patients within their town or county. If cross-state regulations can become more relaxed—and permanent—many practitioners feel society at large will be better for it, not just healthcare businesses.

“One of the major issues we have to be aware of is that therapists have to be licensed in their state of residency and the state where the client is being seen. Everyone has to have multiple licenses to support our large client base,” said Ben-Aharon. “I hope, eventually, we can have shared licenses or compacts between states so that we don’t have regulations standing in our way of delivering therapy.”

“COVID propelled the industry and regulatory bodies to see the value of ensuring people can follow licensing guidelines more efficiently. At least it brought up conversations among legislators,” Ben-Aharon added.

The Manual and Mechanical Must Remain

Telehealth’s more obvious limitations are of the manual and mechanical variety—you can’t do blood work, chiropractic adjustments, surgeries, pap smears, or samples on a video call. Virtual visits and monitoring will never replace 100% of the healthcare ecosystem—even revolutions have their bounds.

While remote monitoring technologies like heart rate and blood pressure monitors are commonly used, patients are not always comfortable with or trusting of remote monitoring. When you’re having your first child, you’re likely going to want the certainty of an in-person visit with your doctor, for example.

Solutions exist and are evolving, but they have not yet been fully adopted, partially because physicians have not been economically incentivized to reduce the number of in-office visits. Many insurance companies only recently started reimbursing telehealth visits at the same rate as in-person sessions. Insurance companies are also wary of potential fraud factors, causing a lag in the reimbursement landscape compared to in-person visits. Moving into 2021, however, we are leaps and bounds ahead of prior years.

“The insurance companies are recognizing the value of the virtual model, which is huge,” said Ben-Aharon. “The fact that they are willing to have conversations about covering telehealth services is a game-changer. Before COVID, we couldn’t even have the discussion.”

Despite the enduring need to do some things in-person, virtual care has supplemented these necessary live visits in meaningful ways. You can see your physical therapist in-person and then do multiple follow-up visits between your next trip to their office, for example. The impact of this one-two punch should not be underestimated.

Even with the Work Ahead, Telehealth is a Winner

In spite of its limitations, telehealth’s rapid adoption as part of the ongoing healthcare ecosystem is an enormous net positive for patients and practitioners. Pioneering healthcare company leaders and forward-thinking regulatory bodies have an excellent opportunity to make a positive impact—overcoming most of these challenges with time, innovation, and unique approaches.

These adjustments will also impact companies’ strategic options and the M&A environment. Our team is focused on providing nuanced advisory services for companies and investors who believe, as we do, in the future of telehealth. For more information and analysis of the space, view our full Telehealth Industry Report here.

Please do not hesitate to reach out to our team using our contact information below.

Kevin Cable
Managing Director
(206) 696-7922

Adam Stormoen
Managing Director
(612) 720-8136

Novan Le
Vice President
(206) 436-2510

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