In March, as part of the federal response to the COVID pandemic, the Coronavirus Aid, Relief, and Economic Security (CARES) Act recognized the pending need for expanding telehealth capabilities and allocated $200 million to support technology initiatives for providers. By July 8th , the program was closed and over 500 providers were able to fund projects from the initial allocation. Because of the success of the program, and the ongoing need to provide remote access to healthcare resources during the ongoing pandemic, on July 21st forty members of Congress sent a formal request to the FCC Chairman for detailed program data, with the intent to propose additional telehealth funding. The letter mentions the recent trend that “more and more patients are seeking care from providers over telecommunications technology rather than in a brick and mortar office or clinic”, and goes on to say they “believe this shift has the potential to improve access to care for marginalized populations, reduce costs, and improve health outcomes by facilitating better monitoring of chronic health conditions.”
The Great Reset
COVID-19 has had an abrupt and extensive impact on our lives. The “great reset”, as it is referred to by McKinsey, applies to almost all businesses, and healthcare is no exception. The delivery of care to date has evolved slowly. There is a constant need to align thinking and interests between the physicians, health plans, and other involved stakeholders, creating an ongoing debate to status-quo. The onset of COVID-19 has forcibly accelerated changes, some that may be here to stay.
Lack of access has provided an opportunity for remote health delivery organizations:
Much like Amazon has benefitted from the lack of readiness by many traditional retailers to serve consumers during the pandemic, there are care delivery groups that are well-positioned to address the new environment. We could argue it was not because their service was better, but rather that the traditional provider model was ill-prepared to deliver its services in a COVID world. Consumers of health in need of care saw their usual place of care unable to serve them and had to find alternatives. Combined with more favorable laws to provide care remotely, the situation provided a boost for companies built on that model ready to capitalize. Telemedicine providers, or lifestyle medicine companies like Livongo have greatly benefited from that trend for now. It remains to be seen whether consumers will go back to their prior care providers once they are ready to serve them again, whether in person or via newly adopted telehealth platforms.
Physicians are finally adopting remote technology in order to survive:
The technology to deliver telehealth or monitor patients remotely has been available for years, but physicians have been slow to adopt. Low financial incentives from payers, implementation costs, additional physician burdens, lack of consumer demand, and resistance to change from both physicians and consumers have all contributed to low adoption rates. But physicians are eager to serve their patients in these times of need. As they feel more and more comfortable with the technology, and backed by financial incentives to deliver care remotely, this will become a standard way to interact with their patients. It remains to be seen whether patients will favor one-to-one interactions or enjoy the convenience of tele-medicine. It will also be interesting to see whether patients that sought alternative solutions for care during the pandemic will go back to those physicians. And finally, one wonders whether those patients will now become more sophisticated consumers with higher expectations or will just return to being grateful to what they get, happily fill out repetitive forms, and wait in line for service that may not reflect the context of their daily realities.
Accounting for the mental health component of whole person health in a remote world:
The awareness of the importance of mental health is the biggest potential catalyst for changes to the system. The changes described above are only challenging the deliveryof care, but not the actual model. Remote monitoring and lifestyle medicine is gaining ground and acceptance during the pandemic. However, the delivery of care still remains a one-size-fits-all defined by biometric readings and statistical models of care. A person’s blood glucose value or blood pressure might be good indicators of risk and trigger the need for intervention, but they do not define who a person is - it does not account for or accurately describe whole person health. One’s mental state, who they are, what matters to them, is what defines people and is perhaps even more important to the care model. As we experience a necessary focus on mental health it will open the door to better accept and understand the impact of who we are and how we feel on our overall health. I see the inclusion of context(social determinants initially, maybe situational determinants real-time in the future), and character(their persona initially, and their real-time emotional state in the future) as critical to serve the need of a more sophisticated consumer of health. I see consumers being more interested in having energy to play with their kids, feeling happier, feeling in control, and such things that matter to them, rather than trying to achieve the blood glucose or cholesterol level their physician or diabetes educator is looking for them to get. We are all in agreement that biometric markers are valid and necessary. How we deliver the message, create a more engaging experience and get people interested in developing healthier habits is where I see the potential for disruption and improvements to come.
These changes are welcome and long overdue. The onset of the COVID-19 pandemic has broken down the barriers and connected consumers to care providers under a different premise. We can do more than make short-term changes in the delivery of health services under the guise of convenience; we can improve the model of care as well. Eventually consumers will want and expect more. And I expect it to come sooner than later.