Telehealth is the ‘New Front Door’ Amidst a Pandemic


Urgent considerations on the intersection of traditional telehealth and the rapidly evolving coronavirus pandemic.

Dan Shellenbarger, Minoo Javanmardian, PhD, and Bruce Hamory, MD

12 min read

Editor’s Note: The following article is part of an ongoing series offering our strategic advice and expertise on what hospitals, healthcare workers, providers, and caregivers should do immediately in response to the rapidly evolving novel coronavirus (COVID-19) pandemic. What follows are strategies and tactics that we hope will help hospitals and health systems prepare for and contend with the coronavirus pandemic. 

The threat of COVID-19 has grown increasingly real, infecting well over 122,000 worldwide (and growing), spreading across boundaries and oceans, and rattling the global economy.

Your urgent strategic imperative is telehealth and virtual patient engagement modality. As demand surges, these channels will enable the healthcare system to maximize its capacity at precisely the time this capacity will be tested. 

For years, we’ve been talking about telehealth’s promise. But we have strained to find the one trigger that would unleash consumer demand for it, and provider acceptance of it, as an essential modality.

Did you know? 65 percent of consumers are willing to use telehealth, but only 8 percent actually have so far. Twenty-three percent of doctors offer telehealth, but only 6 percent of consumers think their doctors offer it.

It seems inevitable that telehealth and COVID-19 preparation are two vectors that must intersect. Why? The threat of COVID-19 may dramatically increase the demand for clinical care. This demand surge will meet a US healthcare system with a fixed amount of clinical capacity – the supply side. Telehealth (defined broadly as telephonic and video interactions between patients and clinicians) can prove to be a powerful and vital path to keep as much clinical capacity as possible on the front-lines of care, helping a concerned population stay on the safest course of care.  

Why Now for Telehealth?

For the benefit of all, most people looking for COVID-19 screening, information, and advice are better off not coming to an emergency room (ED), urgent care center, or physician’s office. If they are not already infected, they increase their risk of catching the disease during the visit, as is believed to have happened in many cases during the SARS epidemic. Telehealth is a pathway that can provide appropriate levels of care, identify those who need additional treatment or support, all while freeing up other clinicians to deal with the most severe cases in person.

While this may intuitively be a solution, there are some urgent questions to consider, including:

What about payment?

This has been a perennial telehealth obstacle. For COVID-19, this barrier is actively being removed. Last week, President Trump signed into law a COVID-19 spending package that waives restrictions on telehealth services for Medicare beneficiaries. And states like Colorado and Maryland have instructed insurers to promote telehealth to their members and waive copays for telehealth services. Many insurers have followed suit, and are actively promoting their telemedicine services to members – both for the coronavirus and as a means of dealing with other ailments as this situation plays out. 

Who’s providing services? 

Here’s some good news: many payers and health systems have telehealth and video visit capabilities readily available to patients and members. What will be important is to effectively flex capacity across the system as this epidemic plays out over the coming weeks. Wherever telehealth and video solutions are not in place, providers (and payers) may want to consider either access packaged solutions and/or developing their capacity to support the coming wave of potential coronavirus cases. 

"Here’s some good news: many payers and health systems have telehealth and video visit capabilities readily available to patients and members. What will be important is to effectively flex capacity across the system as this epidemic plays out over the coming weeks."

How can telehealth “untrap” trapped capacity?

Clearly, not all providers have fully integrated telehealth and video visits into their normal practices, let alone in a manner that will allow them to effectively respond to potential coronavirus demands. Further, front-line clinicians will face full schedules for months to come, making the idea of extra after-hours visits a difficult proposition. Finally, as front-line workers are taken off the line for quarantine (a seemingly inevitable challenge), capacity will constrict.

Despite these challenges, telehealth is a critical channel to release capacity that might otherwise become “trapped” in the system. Consider the following examples: 

  • Where room capacity tightens due to isolation and decontamination requirements, telehealth can allow providers to engage patients at home.
  • When providers are quarantined – provided they are well enough – they can still engage and support telehealth protocols with patients.
  • Where clusters of cases emerge, idle capacity in one location can be used to relieve pressure on providers nearest to the cluster.

Hospitals, health systems, and medical groups must plan ahead so providers can “stay in the fight” as this situation continues to evolve and the health system becomes increasingly strained.  

Identify Your Telehealth Path

Now is the time for employers, health plans, and government sponsors to uniformly endorse telehealth and streamline the path from patient to clinician. Early signs are good, and clearly in this direction. Many large insurers have started engaging and educating members about how to access telehealth and video visit services.

While it is often not all that difficult to complete a telehealth visit, people often find the “getting started” process daunting. Where do I go? What do I need? Can I do it for my mom or child? Is the doctor going to know what to do? How much will it cost?

Communicating and clarifying the paths to accredited providers – along with supporting frequently asked questions about when to use it, and what to expect – can go a long way to help patients. 

How to Respond to Consumer Telehealth FAQs

Here's a sampling of popular consumer FAQs you may receive or be receiving soon and what to consider to help find immediate solutions. And, here are some considerations on how to manage these questions while you simultaneously navigate through your own organization's traditional telehealth barriers.

FAQ: What are my telehealth options? A phone call? A video visit? With whom and for how much? 

Employers, payers, and providers must provide clear messaging and clarify when and how to use their telehealth services. 

FAQ: Do I need an app? Should I call my insurance company first? Will my doctor be angry?

The population is craving information and seamless solutions. Coupling this demand with step-by-step support can finally connect people to telehealth solutions. Expect peer-to-peer sharing to accelerate adoption and familiarity. 

FAQ: Does the person on the other end know how to treat what I need to be treated? Is the clinician on the other side qualified?

All major telehealth providers have put in place specific protocols recommended by the Centers for Disease Control and Prevention (CDC). They are well prepared and ready to respond to patients’ needs. 

FAQ: Are there enough clinicians? Are they local? Have they been vetted? 

Regarding licensing and regulations, many clinicians across the country have been doing telehealth and video visits for a long time. Undoubtedly, this capacity is about to meet with substantial demand, but it may still be the fastest, safest route to accurate clinical triage. 

FAQ: Is this really the time to try something new?

Regarding consumer uncertainty, consistent messaging from the CDC, the Centers for Medicare & Medicaid Services (CMS), employers, and insurers can drive adoption, and help the US start to truly turn the corner on needed behavior change.

FAQ: Are providers trained and ready to consistently deploy telehealth solutions?

Regarding provider readiness, provider organizations must rapidly develop and deploy training and support to clinicians. And when possible, improve ease of use and documentation to ensure protocol adherence.

A Final Key Takeaway

As the US healthcare system prepares for the demands of coronavirus and COVID-19, telehealth presents an essential medium to improve safety and efficiency when the system needs it most. It’s imperative all stakeholders embrace this medium and move quickly to maximize its impact.