Impact of the COVID-19 pandemic on the telehealth industry

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Consultation by a doctor through telehealth Telemedicine Consult.jpg
Consultation by a doctor through telehealth

Telehealth refers to the delivery of healthcare services through electronic communication methods, facilitating interactions between healthcare practitioners and patients using devices such as telephones, smartphones, tablets, and computers. It enables patients to engage with healthcare professionals through various means, including telephone calls, secure email, video conferencing, and secure messaging. Additionally, telehealth systems can be utilized by physicians for remote monitoring of patients in their homes. [1]

Contents

Initially, telehealth emerged as a means to provide healthcare services to underserved and rural populations, bridging geographical gaps and connecting patients with specialists who were not locally available. [2] It was predominantly employed in specialized fields such as cardiology, neurology, mental health, and dermatology. [2] Over time, telehealth has evolved to encompass a broader range of applications, including digital monitoring tools for physical therapy and remote surgeries performed using robotic technology. [3] Notably, one of the pioneering telehealth companies, Teladoc, was established in 2002.

COVID-19's impact on telehealth

Early stages of the pandemic

Before the COVID-19 pandemic, telehealth adoption was gradually increasing. Some patients preferred in-person consultations and expressed concerns about privacy during video calls. However, with the outbreak of COVID-19 in early 2020, healthcare professionals reduced in-person visits to minimize exposure. As a result, telehealth usage surged dramatically, experiencing a 5,000% increase from February to March 2020. Telehealth has since remained widely utilized in healthcare services. [4]

Growth in the industry

Telehealth companies have witnessed substantial growth in their business operations since the onset of the pandemic, evident in the significant rise in both patient volume and financial prosperity. For instance, within a short span between February and March 2020, telehealth claims at the Blue Cross Blue Shield of Massachusetts escalated by an astounding 3,500%. NYU Langone Health's telehealth platform swiftly expanded by integrating over 1,300 new healthcare providers during the pandemic, highlighting the industry's meteoric surge. The COVID-19 outbreak facilitated an unprecedented reach for telehealth companies, enabling access to millions of patients that might not have been attainable outside the pandemic-influenced healthcare landscape.

The burgeoning influx of new clientele has notably propelled companies such as Teladoc, which has successfully capitalized on this burgeoning market potential. Evidently, Teladoc's stock valuation in 2020 soared year to date by an impressive 168%, while the industry's second-largest player, Amwell, went public on September 17, 2020. Collectively, the top 60 virtual health companies experienced a substantial surge in total revenue, elevating from $3 billion in 2019–2020 to $5.5 billion in 2020–2021, marking an impressive 83% increase. This growth has notably attracted significant interest from venture capitalists and other investors seeking to partake in the burgeoning telehealth industry's expansion during the pandemic. Venture capital funding for telehealth companies in the initial quarter of 2020 surged to $788 million, a figure more than threefold compared to the funds raised in the corresponding period of 2019. Additionally, telehealth startups experienced a staggering year-over-year increase of 1,818% in funding during 2020.

Logo of the second largest telehealth firm, Amwell Amwell logo RGB ColorGradient.png
Logo of the second largest telehealth firm, Amwell

Growth in usage rate

In 2020, over 50% of all outpatient care was being delivered completely virtually at its peak during the pandemic. [5] The number of patients using telehealth has grown from 11% in 2019 to around 46% in 2021. [6] Analysts believe that this growth will be somewhat sustained due to the pandemic allowing telehealth to overcome its biggest obstacle, which was its lack of awareness among patients and providers. [7] Millions of patients and providers have now used telehealth to fulfill part of their healthcare needs, and some evidence suggests telehealth contributes to similar outcomes and patient satisfaction. [8] [9] Not only has telehealth become known among the public, but providers have also had extremely positive interactions with these services. [10] 57% of providers view telehealth more favorably than before the pandemic and 64% of providers are more comfortable with using telehealth platforms. [10] Patients from various demographic locations have given positive reviews on telehealth services due to which telehealth/ telemedicine appears to paint a bright future for the industry.

Potential barriers to growth

Lower usage rate

The weekly average of daily telehealth visits has been declining since April 2020. [7] In April, the visits were peaking at around two thousand per week and they have dropped to around five hundred a week in June 2020. [7] Experts believe that the high peaks of telehealth usage during the pandemic will come down even more and that it is unrealistic to believe that this peak in usage will become the new norm. [7]

Cross-state practice

Most states require that the healthcare professional, that is using telehealth, have a form of license to practice in that state regardless of whether they are located in the state. [11] Cross-state practice issues can inhibit the growth of the telehealth market due to it affecting the staff composition at these companies. [11] These companies will have to make sure that they have professionals that are licensed in the states that the patients are from in order to service the patients. [11] This could inhibit the growth of the industry since these companies have to allocate a certain amount of workers to be in each region instead of just having certain types of healthcare professionals.

Coverage and reimbursement issues

Medicare, Medicaid, and commercial payers all have a unique set of rules and criteria for coverage and reimbursements for telehealth services. [11] Lawyers believe that these rules and criteria can be inconsistent at times and can be not fully comprehensive. [11] These unique rules and inconsistencies could potentially add another layer of complexity for providers to have to go through in order to get paid for their services. [11]

IT and security issues

Experts believe that telehealth services hinge upon the success of their IT services. [6] These services include software security, software compliance, and data interoperability. [6] Constructing and maintaining these IT services can be expensive and can be hard to fund due to competition. [6] With the growing number of potential patients, these startup companies could require funding to expand their IT services. [6] Without this expansion, these companies could have lower service quality and put at risk the data and privacy of their consumers. [6]

Another IT-related issue involves technicality, where patients or caregivers have problems accessing telehealth services due to various technical challenges. During the COVID-19 pandemic, one study found that 36% of cancellations or rescheduling of appointments was due to technical challenges before or during the appointment. [12]

Provider-patient relationships

States require that patients and healthcare professionals to establish a relationship. [11] This relationship was normally established when the patient met the provider in-person. [11] This requirement has evolved in some states to focus more on the existence of several factors such as the patient's medical history or the provider's affirmative acts. [11]

Remote prescribing

Some states require that an in-person examination happen before allowing for the remote prescribing of drugs. [11] Other states allow remote prescribing without an in-person visit, however there needs to be an interaction via a face-to-face video call. [11] All states do not allow for remote prescribing of drugs if the patient only submitted an online questionnaire. [11]

Telemental health

Due to lockdowns or ‘stay at home’ orders, at the start of the COVID-19 pandemic, mental health services in high-income countries were able to adapt existing service provision to telemental health care. Estimates suggest that between 48% and 100% of service users who were already receiving care at the start of the pandemic were able to continue their mental health care using remote methods. Some face-to-face appointments still took place if necessary. [13]

During the pandemic telemental health care (mostly phone and video calls) was effective and viewed as acceptable by the majority of clinicians and service users for use in an emergency situation. However both groups had concerns regarding the longer term use of telemental health care. For example, clinicians identified concerns including difficulties with medication appointments, concerns around engaging and assessing new patients, and finding it harder to assess some physical indicators of mental health status remotely. Service users identified barriers including a lack of private space at home to access during their sessions or access to technology. [13]

The rates of telemental health use seem to have declined as COVID-19 restrictions were loosened, indicating that face-to-face care might be preferable for some service users and clinicians. [13]

Future opportunities

Lower cost to patients and healthcare facilities

Telehealth often results in significantly lower costs and time commitments than traditional in-person meetings. [4] At the University of Michigan, a study found that on average patients travel a total of 110 miles to attend a clinic visit. [4] Many patients are forced to make a day out of this large time commitment and are forced to take time off work and incur child care costs. [4] By using telehealth, patients can meet with their doctors from anywhere without the need to take time off of work. [4] Telehealth can provide cost savings to hospitals and healthcare offices. [4] Since some portion of patients would be meeting online with their doctors, the need for large waiting rooms would be reduced. [4] This will allow healthcare facilities to be smaller which will result in cost savings due to less overhead being spent on rooms and facilities for patients that do not need to be seen in person. [4]

Substance abuse treatment

In July 2021, telehealth made up 30% of substance abuse treatment. [10] Experts believe that there could be substantial growth potential in substance abuse treatment for the telehealth industry. [14] Telehealth is convenient for patients and makes it easy for them to get the help that they need. [14] Telehealth has also been linked to higher treatment retention. [15] Studies have found that when telehealth video conferencing was incorporated into outpatient treatment programs, 88% of the patients kept their appointments as compared to only 77% that had solely in-person appointments. [15] Due to these benefits there is a potential for telehealth to increase their market share of the substance abuse segment of healthcare.

Tele rheumatology

In February 2021, 17% of outpatient and office visit claims relating to rheumatology were done through telehealth. [16] Clinicians believe that telehealth could play a role in the treatment of rheumatoid arthritis and other symptoms associated with arthritis. [17] Even though clinicians believe that telehealth does not improve diagnosing rheumatologic conditions, they believe that telehealth can help with managing the pain of rheumatoid arthritis. [17] Clinicians consider gout, rheumatoid arthritis, fibromyalgia, and osteoarthritis as the most appropriate to manage using telehealth. [17] Although clinicians believe that the use of tele rheumatology is dependent on the phase of care, they believe that it is vital to increasing the access of care for patients with arthritis. [17]

Present/future usage rate

As of July 2021, telehealth usage has stabilized at a level 38 times higher than before the pandemic. [16] Telehealth usage rate across all specialties has stabilized to around 13% to 17%. [16] While the usage rate has gone down since its peak during the pandemic, experts believe that telehealth will still play a major role in healthcare. [5] Experts predict that at least 20-30% of all healthcare will be provided through telehealth in 2021 and beyond. [5]

Future market size

Analysts are predicting a high amount of growth in the telehealth industry in the United States and globally. [18] In the United States, there are predictions that around $250 billion of Medicare, Medicaid, and Commercial OP could become virtualized, which would represent 20% of the total market share. [16] Research analysts believe that the global market size of the telehealth industry will grow from $62.45 billion in 2020 to over $475.50 billion by 2026. [18]

Related Research Articles

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health. Key components of eHealth include electronic health records (EHRs), telemedicine, health information exchange, mobile health applications, wearable devices, and online health information. These technologies enable healthcare providers, patients, and other stakeholders to access, manage, and exchange health information more effectively, leading to improved communication, decision-making, and overall healthcare outcomes.

<span class="mw-page-title-main">Telenursing</span>

Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, and telemonitoring. The field, however, is still being developed as the information on telenursing isn't comprehensive enough.

Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness.

<span class="mw-page-title-main">Telerehabilitation</span> Delivery of rehabilitation services over the internet

Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.

<span class="mw-page-title-main">American Telemedicine Association</span>

The American Telemedicine Association (ATA), established in 1993, is a non-profit organization whose goal is to promote access to medical care for consumers and health professionals via telecommunications technology. Membership in the American Telemedicine Association is open to individuals, companies, and other healthcare and technology organizations.

<span class="mw-page-title-main">Telepsychiatry</span> Mental-health care by telecommunication

Telepsychiatry or telemental health refers to the use of telecommunications technology to deliver psychiatric care remotely for people with mental health conditions. It is a branch of telemedicine.

Home automation for the elderly and disabled focuses on making it possible for older adults and people with disabilities to remain at home, safe and comfortable. Home automation is becoming a viable option for older adults and people with disabilities who would prefer to stay in the comfort of their homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards old people and people with disabilities.

Connected health is a socio-technical model for healthcare management and delivery by using technology to provide healthcare services remotely. Connected health, also known as technology enabled care (TEC) aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses readily available consumer technologies to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care and disease and lifestyle management, often leverages existing technologies such as connected devices using cellular networks and is associated with efforts to improve chronic care. However, there is an increasing blur between software capabilities and healthcare needs whereby technologists are now providing the solutions to support consumer wellness and provide the connectivity between patient data, information and decisions. This calls for new techniques to guide Connected Health solutions such as "design thinking" to support software developers in clearly identifying healthcare requirements, and extend and enrich traditional software requirements gathering techniques.

<span class="mw-page-title-main">Doctor's visit</span>

A doctor's visit, also known as a physician office visit or a consultation, or a ward round in an inpatient care context, is a meeting between a patient with a physician to get health advice or treatment plan for a symptom or condition, most often at a professional health facility such as a doctor's office, clinic or hospital. According to a survey in the United States, a physician typically sees between 50 and 100 patients per week, but it may vary with medical specialty, but differs only little by community size such as metropolitan versus rural areas.

<span class="mw-page-title-main">Zocdoc</span> Online medical care appointment booking service

Zocdoc is a New York City-based company offering an online service that allows people to find and book in-person or telemedicine appointments for medical or dental care. The platform also functions as a physician and dentist rating and comparison database. The service is free for patients, and doctors pay to advertise their appointment slots. Established in 2007, the private company had a $1.8 billion valuation by August 2015, the third-highest for a startup in New York at the time.

<span class="mw-page-title-main">Remote patient monitoring</span> Technology to monitor patients outside of conventional clinical settings

Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area, which may increase access to care and decrease healthcare delivery costs. RPM involves the constant remote care of patients by their physicians, often to track physical symptoms, chronic conditions, or post-hospitalization rehab.

Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise. It uses information and communication technologies to facilitate understanding of health problems and challenges faced by people receiving medical treatment and social prescribing in more personalised and precise ways. The definitions of digital health and its remits overlap in many ways with those of health and medical informatics.

Electronic consultation is an aspect of telemedicine which involves remote communication between patients and clinicians, or between clinicians and specialists.

American Well Corporation, doing business as Amwell, is a telemedicine company based in Boston, Massachusetts, that connects patients with doctors over secure video. Amwell sells its platform as a subscription service to healthcare providers to put their medical professionals online and its proprietary software development kits, APIs, and system integrations enable clients to embed telehealth into existing workflows utilized by providers and patients.

Teladoc Health, Inc. is a multinational telemedicine and virtual healthcare company headquartered in the United States. Primary services include telehealth, medical opinions, AI and analytics, telehealth devices and licensable platform services. In particular, Teladoc Health uses telephone and videoconferencing software as well as mobile apps to provide on-demand remote medical care.

Babylon Health was a digital-first health service provider that combined an artificial intelligence-powered platform with virtual clinical operations for patients. Patients are connected with health care professionals through their web and mobile application.

e-consult is a mechanism developed by the Department of Veterans Affairs that enables primary care providers to obtain specialists' inputs into a patient's care treatment without requiring the patient to go to a face-to-face visit.

This list of telemedicine services providers is for notable telemedicine, telehealth, and mobile health providers and services. This includes virtual care facilities for remote care, services or platforms used for specific steps within the healthcare industry, and clinical navigation.

Bicycle Health is a virtual medication assisted treatment provider for opioid use disorder (OUD). The Boston-based company was started in 2017 and was named a TIME 100 Most Influential Company in 2022.

References

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