Amy Shideler had barely put down roots in northeast Ohio in fall of 2020 when she tested positive for COVID-19. Aside from a friend who lived 30 miles away, her support system had yet to be built, and her parents, in Indiana, were recovering from the virus themselves. Beset by fatigue and fever, she worried about being alone, especially since she had a history of asthma. “It was a very isolating feeling.”
But a new home monitoring program at Cleveland Clinic, where Shideler is employed as a social worker manager, made her feel less alone. Each day, she used the MyChart app on her smartphone to log her symptoms, temperature and oxygen level, which were then assessed by care coordinators at the clinic. Within 10 minutes of reporting shortness of breath one morning, she was called by a nurse and connected to a physician, who immediately prescribed a new inhaler. In all, the medical center’s virtual team evaluated her three times for symptoms that might otherwise have sent her to the emergency room. “I felt very cared for,” she says. “It was comforting to know I was going to get what I needed right where I was.”
The Benefits of Telemedicine
Caring for patients where they are has long been the promise of telemedicine, but it took unexpected and explosive demand in 2020 to make the promise real. Cleveland Clinic, whose telehealth work pre-pandemic amounted to second opinion and urgent care video calls, went from some 37,000 virtual visits in 2019 to 1.2 million in 2020. Virtual care company Teladoc Health facilitated 10.6 million visits last year, a 156% increase over 2019.
As normalcy returns, what should patients expect of virtual care in the future? Demand has leveled off, but experts predict that telemedicine — from doctor and psychotherapist visits to remote monitoring of chronic conditions — has established its place as a key mode of care delivery. “Now that people have been exposed to it, it’s going to be a part of everything that we do,” says Dr. Steven Shook, a neurologist and lead for virtual health at Cleveland Clinic. Consulting firm McKinsey estimated last year that up to $250 billion of the U.S. health care industry has the potential to become virtual, up from a pre-COVID revenue of $3 billion annually; providers estimate that as much as 50% of care could be delivered remotely.
The extent to which the industry grows depends largely on whether or not Congress makes permanent changes to rules that allowed for the expansion of telehealth services, such as more favorable reimbursement rates and allowing remote care without geographic restrictions. At press time, sustaining expanded telehealth services had wide bipartisan support, but it’s the eventual fine print — for example, the rates at which various telehealth services are reimbursed compared to those in clinical settings — that will shape the future.
Home as a Clinic
To that end, a group of providers that includes Intermountain Healthcare, Ascension and Amazon Care recently formed a coalition — called Moving Health Home — to advocate for policy changes to designate the home as a site of clinical care. Members argue that advances in medical record-sharing, remote monitoring technologies and digital therapeutics have made it possible to deliver even acute care in the home in many cases. Salt Lake City-based Intermountain, for example, treats patients at home with everything from heart failure to some types of cancer with a combination of technology and visits from an interdisciplinary caregiving team.
Consumers, for the most part, like the idea. McKinsey found that 76% of consumers are now interested in using virtual care, compared to 11% prior to COVID.
To be sure, any visits that require hands-on evaluation, such as orthopedics, are limited in their telehealth potential. On the other end of the spectrum, the possibilities for behavioral health are wide open: Mental health visits through Teladoc Health grew more than 500% in 2020 alone.
Another promising area: chronic diseases such as diabetes, which drive 80% of the health care costs in the U.S. Before COVID-19, Dr. Rachel Caskey, an internal medicine and pediatrics physician at UI Health in Chicago, only very rarely used telehealth. Today, she manages many of her patients with chronic conditions remotely by, for example, having those with diabetes rely on a glucometer to keep track of their blood sugar and people with hypertension use a blood pressure cuff to take their own measurements. “Coming into a clinic every three months can be onerous, so a quick 20-minute call is no problem,” she says. “I’m finding that at least every other visit can be replaced.”
Likewise, at the Medical University of South Carolina, diabetes patients are monitored through cellular-connected glucometers, which beam data via a secure cloud to a team of nurses who can adjust insulin.
The coronavirus itself became a case study for remote monitoring. In one study, UI Health partnered with the digital health care company physIQ to send COVID patients home fitted with a biosensor patch to collect data on heart and respiratory rates and arrhythmias, as well as movement. The sensor, which is connected to an Android device — essentially a burner phone — sends the data to a team of nurses who check in with patients once a day. The goal is to mine the collective data for markers that precede a decline of a patient’s condition. “This kind of technology can and should be given to patients with lots of other chronic conditions,” says Dr. David Chestek, one of the investigators and interim chief medical information officer at UI Health.
Value of Virtual Care
Indeed, a study last year by physIQ and four VA hospitals found that such analytics accurately predicted hospitalization for heart failure patients. And because these patients often have other health issues, it also predicted adverse events such as pneumonia and renal failure.
For all its technological promise, telemedicine has the potential to foster a more patient-centered health care system, proponents argue. Consider that much of routine care has been delivered in 15-minute increments once a year, says Dr. James McElligott, the medical director for the Center of Telehealth at MUSC. “It’s all about one point in time, but that’s not how health and wellness work.” McElligott thinks telehealth will provide the opportunity to check in more often with patients where they live, with more of a focus on their functioning and wellness. “A big page has turned,” he says. “I don’t think we can go back to where we were.”
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