Telehealth: Steps for Sustaining Quality of Care (Part Two)

Telehealth is a cost-effective, convenient alternative to the traditional face-to-face practice of medical care and services. It allows providers to deliver care to a patient when they need it, where they need it, and with less disruption to the patient’s life. Although not a new concept, telehealth has surged in popularity during the COVID-19 pandemic, accelerated by the federal government’s $200 million in funding via the Coronavirus Aid, Relief, and Economic Security (CARES) Act. In fact, since the start of the pandemic, the Centers for Medicare and Medicaid Services (CMS) has added over 250 services to the list of telehealth services that Medicare Fee-for-Service will cover.

While substantial investments by new and existing players in the healthcare industry are contributing to telehealth’s rapid expansion, it’s critical to pause and consider the complex nature of healthcare requirements. In the second of this three-part blog series, we’ll look at the quality of care implications that are crucial for telehealth’s successful progression. We’ll also share what can be done to help sustain quality of care in telehealth programs as adoption rates increase.

Telehealth has the potential to improve the quality of healthcare and make it more efficient, seamless, and accessible to a greater number of patients. Between the rapid advancements in technology (think high-speed internet, videoconferencing solutions, and digital examination equipment) and the major uptick in telehealth utilization during the pandemic, there has been overwhelming optimism for this delivery modality and its impact on health outcomes.

As modern healthcare providers continue to embrace telehealth as a way to better service their patients, it’s critical to ensure these programs are delivering high-quality care.

Before looking at the main factors that impact the quality of care in telehealth, let’s explore three primary forms of telehealth currently available to patients:

  • Asynchronous (store-and-forward videoconferencing) – The Office of the National Coordinator for Health Information Technology (ONC) defines asynchronous telemedicine as the "transmission of a recorded health history to a health practitioner, usually a specialist."
  • Remote patient monitoring (RPM) – ONC defines RPM as the “use of connected electronic tools to record personal health and medical data in one location for review by a provider in another location, usually at a different time.” An example might be using RPM for continuous monitoring of patient-anchored medical devices or wearables.
  • Synchronous (live videoconferencing) – ONC defines synchronous telemedicine as "live video-conferencing," which is a "two-way audiovisual link between a patient and a care provider." For example, a mobile device may be used to video chat with a healthcare professional to screen for COVID-19 symptoms.

The asynchronous and RPM methods of telehealth have been around for much longer than the synchronous method. They are generally less complex to deliver and have proven to enhance health outcomes in patient populations. For example, studies have consistently shown patients participating in diabetes RPMs had lower A1C levels and improved glucose control, while those using heart failure telemonitoring experienced significantly lower readmission rates. Because of the outcomes demonstrated by both the asynchronous and RPM methods of telehealth, they’ve become widely accepted service standards in terms of quality of care and patient satisfaction.

More recently, the pandemic has rapidly expanded synchronous telehealth methods—those involving real-time interactions between patients and providers via computer or telephone.  Some providers have even begun to take a virtual-first approach—a paradigm shift that may continue post-pandemic. That’s largely because:

  • This type of virtual care is more accessible for people with limited mobility, time, or transportation options. Specifically, emerging data suggests virtual telehealth interactions have enabled significant advancements in the accessibility of quality healthcare to those living in rural or isolated communities.
  • It also offers patients an opportunity to be more proactive and engaged in their overall health, which, in turn, gives providers a better pulse on how their patients are doing.
  • It has created more timely and seamless communications between healthcare professionals and patients via expanded channels including voice, text, web portals, and video.  

So, what are the main factors that impact the quality of care in these three forms of telehealth? And what actions should healthcare providers take to ensure they sustain quality of care and patient satisfaction? Let’s take a look:

Provider expertise. While having the technology for healthcare presents major opportunities, it means nothing without the right expertise applied by those using it. That’s why healthcare provider expertise has likely the biggest impact on quality of telehealth care and patient satisfaction. It’s about the interactions between healthcare providers and patients, and is dependent on how those inputs are transformed into effective, evidence-based health outcomes. For example, poor technical or interpersonal performance could potentially lead to incorrect interpretation or inattention to a patient’s health and concerns. Healthcare Effectiveness Data and Information Set (HEDIS) measures, widely used in quality-improvement efforts, have been updated as more health plans, clinicians, and patients embrace telehealth services. A total of 40 HEDIS measures are part of the update to cover telehealth services and will serve as important indicators of short- and long-term trends in telehealth outcomes.

  • Take action: To ensure providers meet the level of expertise needed to maintain quality of care, we recommend establishing service level agreements (SLA) with providers. It’s also important to create professional standards for remote clinician workplace environments, informing program guidelines, protocols, success factors, and key performance indicators.

Regulations. To remain compliant in this fast-growing industry, providers must keep a close eye on evolving regulations designed to protect patients and maintain high-quality healthcare. For example, the volume of telehealth services significantly expanded during the pandemic, and a number of policies were amended in response to COVID-19, such as the loosening of security and privacy measures to enable easier access to remote communication products such as FaceTime and Zoom. But these could be rolled back in a post-COVID-19 environment, and regulatory requirements could potentially become even stricter.

  • Take action: Telehealth service providers should be prepared for regulatory changes. And, as policies evolve, it’s of the utmost importance that providers understand the intent and impact of new guidance. How can you prepare? In one state, for example, North Highland is working with the state’s agencies to interpret constantly evolving guidance from the federal government and oversight agencies regarding CARES Act funding and monitoring. Our team is helping the agencies understand the often-complex changes to federal and state guidelines, and determine next steps to remain compliant.

Patient circumstance. the synchronous type of healthcare delivery, in particular, patient satisfaction and quality of care are also dependent on factors such as severity of illness, convenience, access to in-person healthcare, cost savings, and provider relationship.

  • Take action: A patient’s personal circumstances must be considered to ensure the safety of telehealth systems. Providers should work with patients and encourage them to share their preferences and concerns regarding virtual care delivery. Consider addressing safety protocols and assessing patients' capacity to use telehealth in order to jointly agree on when virtual care is appropriate.

While there are still some limitations, the telehealth industry is continuing to find innovative ways to improve their patients’ access to quality healthcare, and we fully expect it is here to stay. As we continue to embrace telehealth solutions, quality must be paramount.

In the final installment of this series, we’ll consider what’s next in the near term and long term for the future of telehealth.