Uncovering the true value of telehealth to improve care outcomes

Len Strazewski , Contributing News Writer

The COVID-19 pandemic may have pushed the health care community to expand use of telehealth and other digital health technologies, but AMA research points to a positive and permanent outcome—to better care and increased value. 

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AMA researchers Meg Barron, and Vimal K. Mishra, MD, presented their research findings on digital health technologies during the Telehealth Academy, an immersive, eight-week webinar program for health care executives ad clinicians.

“The pandemic pushed telehealth to the main stage and while we know there are a lot of opportunities for enhancement, both physicians and patients want telehealth to remain,” said Barron, vice president of digital health strategy for the AMA. “So, we are now at this critical stage where legislators and regulators have this massive opportunity to make permanent policy that supports many of the advancements that we have seen during the pandemic.”

The AMA research on digital and remote technologies began in 2016 but amid the pandemic, the AMA collaborated with the COVID-19 Healthcare Coalition to develop physician and patient telehealth impact surveys to see how telehealth and the initial use of new technology was being received and used. From the 1,300 participants, the researchers said they saw a consistent theme in questions from physicians and health care organizations. 

Among them: How do I more comprehensively measure the value of my virtual care and telehealth programs?

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Historically, digital health innovations have only been measured for financial return on investment (ROI). Other patient values and satisfaction were not being aggregated and measured.

The result was the AMA “Return on Health” framework, which Barron said was created to show the true value of virtual care in the pandemic-driven medical environment, which goes beyond the dollars and cents of providing care.

The framework identifies specific value streams, including clinical outcomes, quality and safety; access to care; patient, caregiver and family experience, and physician satisfaction experience. Financial return on investment and health equity is also imperative, Barron said.

The AMA researchers also tracked the evolution of digital health technologies from 2016 to 2019 and reported that the two modalities that saw the largest increase in use were telehealth and remote-patient monitoring, but that they still have much room for wider scale adoption. However, in the spring of 2020, the pandemic generated dramatic increases in the use of telehealth which “made 10 plus years of progress in a matter of weeks.”

Use of telehealth and remote-patient monitoring, however, is not new. Before 1990, all health care was in-person care organized around a clinic, hospital or health system, but later physicians and others began experimenting with some forms of what the researchers termed “digitally enabled care.”

The benefits of expanded telemedicine are clear. Join physicians who are advocating to permanently expand virtual care coverage

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Prior to COVID-19, virtual care was more of a niche with limited application at Virginia Commonwealth University (VCU) Health System. Dr. Mishra is associate professor of medicine and health administration at VCU and also the AMA’s director of digital health. 

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For example, VCU had offered telepsychiatry since 1995, but usage was low. After COVID-19, access to care and usage increased dramatically. Telepsychiatry grew to 120% of clinical volume compared with use before the pandemic. Physicians and other clinicians were more productive, and patients reported that they could more easily connect with them, Dr. Mishra said.

The system evaluated performance using the Return on Health framework, which he said provides a “balanced scorecard” approach to measuring and realizing the full potential of virtual care. Since then the health system has expanded use to generally telehealth and several forms of remote-patient monitoring.

“What we see right now is the age of moving from analog care to digitally enabled care models that hybridize the care delivery,” Dr. Mishra said.

The AMA reports that 75% of clinicians polled by the organization indicated that telehealth enabled them to provide quality care and 68% of respondents are motivated to increase telehealth use in their practices, the researchers said.

Physicians and health care organizations also are innovating in other areas of digital health, Dr. Mishra said.

“We’re thinking beyond video conferencing—to sensors, augmented intelligence, and more to improve health outcomes, care experience, and work-life balance, and reduce cost,” he said.

Learn more with the AMA Telehealth Implementation Playbook, which outlines 12 distinct steps that physician practices can take to support efficient, successful implementation of telehealth programs and the AMA Telehealth Immersion Program, which provides educational content and programming focused on optimizing and sustaining telehealth.