On Tuesday, July 7, Cleveland Clinic held its first webinar in the Transformation Tuesdays virtual series on telehealth. Panelists Lisa Alderson, CEO & Co-Founder, Genome Medical, Ann Mond Johnson, CEO, the American Telemedicine Association (ATA), and Jennifer Schneider, MD, President, Livongo Health joined moderator Will Morris, MD, Executive Medical Director, Cleveland Clinic Innovations to talk virtual care, its applications, performance through COVID-19, and future implications for long-term use.
Their discussion started with an analysis of ‘the why.’ With any health initiative, this is crucial to understand, but with initiatives that change the nature of an industry like telehealth for healthcare, we must gain a deeper understanding of its purpose. Why telemedicine? What’s its true value? Why work so hard to bring it to the mainstream? Questions that Ann Mond Johnson, CEO of the American Telemedicine Association, has perfected answers to after two years with the organization. Said Mond Johnson, “[the why] is to ensure that people get care where and when they need it. And that when they do, they know it’s safe, effective, and appropriate – all the while ensuring clinicians can do more good for more people.”
For Lisa Alderson, CEO of Genome Medical, ‘the why’ is more niche – addressing a nationwide shortage in specialty genomics care. “There are very few specialists in the country – these are clinicians that are in high demand and short supply,” said Alderson. “As there really isn’t a component of the physical required, cancer genetics and cardiovascular genetics are extremely attractive to perform via telehealth. Therefore, we are able to reach patients no matter what Zip Code they're in.”
Understandably, ‘the why’ often influences company strategy – with products and initiatives launched to serve this ultimate goal. And though COVID-19 has caused company strategy shift in nearly all industries, many telemedicine companies are singing a different tune. “Allowing people with chronic conditions to stay home, stay healthy, and empower care in a [virtual] environment is what Livongo has been about from the inception,” said Jennifer Schneider, MD, CEO, “Coronavirus has not changed our strategy.” Instead, Dr. Schneider noted, “[Coronavirus] has accelerated the acceptance of these very strong business models that were in existence before the pandemic. I think there's a broader realization and an understanding of the values of remote monitoring and telehealth in this current setting. Due to the experience users have had, I don't think people will ever go back.”
The discussion of “returning to normal” struck a chord with our panel. Picking up where we left off, in some ways, can be viewed as regression to an outdated model of care. Rather what our panelists and many providers, payors, and consumers would like to see is an adoption of a new normal – leveraging these technologies and virtual care programs to improve access and outcomes when they’re optional and not required. It is the aforementioned opinions of different members of the health ecosystem that hold the power to drive this new normal. “When I look at Livongo's results, people love the experience, they're getting better clinically, and we're saving money for the end payor. That means the consumer wins because they love it, physicians win because they get paid more money based on outcomes, and we're saving money for the overarching payor or large self-insured employer – so they win as well,” said Dr. Schneider. Physician and consumer benefit can also be seen in the example of Genome Medical, “The value of telehealth here, is that you are providing access to clinicians that many patients wouldn’t otherwise have – there's an efficiency gain. From the provider's perspective, they get to see more patients, resulting in greater impact. From the patient's perspective, we can route to the right specialist who might be states away. Eliminating extenuating travel to be able to see these specialists is incredibly convenient,” said Alderson. Mond Johnson agreed, noting telemedicine’s aid to the national and global insufficiencies of the clinical workforce in general, but drawing focus to lack of care for aging, and those seeking help for behavioral health.
The group agreed the ability to turn tables and sufficiently supply care to these populations lies in the use of existing technology in new and innovative ways. Said Mond Johnson, “If you look at some of the most successful [virtual care] players, they’re monitoring as much as possible and automating as much as appropriate. The technology is really being used to scale and reimagine. If we just used telehealth and technology to replace a face-to-face visit in the same vein, I don't think we'd get any further along.” Dr. Schneider followed this comment with a refreshing take on the mindfulness of her digital care model. “To me, the value is in the combination of consumer-directed virtual care and long-standing connection to consumers’ providers.” Said Dr. Schneider, “We use the phrase ‘powered by technology, guided by humanity.’”
Though these telehealth specialists’ models existed long before COVID-19, there are some aspects of delivery that the pandemic has greatly influenced – namely interstate licensure and payment parity. The group shared a realization that the current climate has provided a huge opportunity to ensure a ‘catch up’ between regulatory measures and technological capabilities for maintenance of telehealth efficiency moving forward. Said Mond Johnson on concrete steps taken, “the most important thing that I think we overcame was removing the restrictions on where people are. This directly correlates with ‘the why’ – we want to get care to people where and when they need it.” When asked of licensure, Mond Johnson said, “The interstate licensure is an interesting issue. While there are many who advocate for national licensure, it’s a pretty big sword to fall on right now. Instead, what we're doing at the ATA is promoting the use and enhancement of [licensure] compacts for more widespread care.”
The second notion of payment parity was addressed in a collection of policy principles released at the ATA. Mond Johnson and the organization agree that “federal programs, Medicare and Medicaid, should be at payment parity.” Recent history predicts increased energy around these initiatives, but a lot of work remains to be done at both the federal and state level for many.
COVID-19 has undoubtedly turned a centuries-old care model on its head – but the health ecosystem was not as flustered as one might think. Adapting swiftly to provide and even encourage care through virtual means, providers and patients everywhere have warmed up to the ‘new normal,’ with many hoping the old care model never returns. To view the full discussion and learn more about COVID-19’s impact on the delivery and adoption of telehealth, click here. We want to thank Genome Medical, The American Telemedicine Association, and Livongo for their insights and participation in this session. Be sure to join us for our next telehealth webinar from 1:00 – 2:00 pm (ET) on Tuesday, July 21, where we’ll talk telehealth’s intersection with remote monitoring technology and these solutions’ abilities to bring the doctor’s office into the home.