Did COVID-19 Create a False Telehealth Market?

This many months into COVID-19 and I think we all have to look at what all the changes are going to mean for healthcare. I know that so many telehealth advocates are saying the genie is out of the bottle and related phrases, but I think there’s still a lot more to be said about the future of telehealth.

While I still have Stacy Hurt’s recent comments on this webinar ringing in my ears about how she’s not going to allow her doctors to go back to in-person visits, I wonder if patients can really exert that much influence over doctors.  I hope they can, but if the doctors aren’t getting paid as much for telehealth as an in-person visit, it’s going to be a real battle for patients to keep demanding telehealth.

The reality I see is that COVID-19 created a false market for telehealth.  I call it a false market because the number of telehealth visits we saw during COVID-19 weren’t driven by natural forces that are going to persist forever.  I know about these false markets because we saw the same thing happen with EHR software.  $36 Billion in EHR stimulus money created a false market where people went crazy chasing government money.  EHR adoption was high, but we knew it wouldn’t last forever.  The same is true today with telehealth video visits.

False markets are not necessarily a bad thing unless you drink the Kool-Aid that the false market is going to last forever.  I’m not sure even the most ardent telehealth supporters thinks that 50-60% of visits should all be telehealth visits like was happening at the height of stay at home orders under COVID.  In many of those cases, both patient and doctor would have rather been in the office, but COVID prevented that.  However, the false telehealth market did expose telehealth to both doctors and patients that may have previously been skeptical.  Now, we’re going to see how many have become converts and how many revert back to old habits.  Never underestimate the gravitational pull of the status quo.

We’ve already seen the pullback of telehealth happening as we shared before.  The real question is how far are we going to pull back.  In other words, what does a rational telehealth market look like.  It’s clearly far above the 0.1% telehealth adoption (or something close to that number) we had prior to COVID-19, but it’s also likely much less than the 50-60% adoption we saw at the height.

My gut tells me that the real telehealth market is closer to 10-15% of office visits and the best health systems will push that to 20%.

Of course, there’s one big determining factor in all of this and that’s reimbursement.  If telehealth reimbursement doesn’t figure out the payments so that the same service provided through telehealth is reimbursed at the same rate as in-person, then we could see an even bigger fall off of telehealth.  If reimbursement is wrong, I could see us falling into the low single digit office visits.  That would be sad to see and would no doubt anger many patients who grew fond of telehealth during COVID.

Yes, I’m sure we’ll see some direct to consumer (DTC) telehealth options that are successful as well.  We already are seeing those and they work in affluent areas where patients can pay for those types of services.  The problem I see with those is that they don’t scale to the entire health system.

I’m also fond of a lot of what’s happening in the chronic care management (CCM) and remote patient monitoring (RPM) space.  Although, I see those as a remake of the health system as we know it with telehealth as one piece of their solution.  So, I classify them separate from the live video telehealth visit market.  I do think they’ll grow larger over time, but those are going to be a slow burn evolution and not a dramatic replacement of what healthcare does today.

What do you think the real telehealth market will look like?  Where will we land when it comes to telehealth video visits?  Do you see other drivers that will determine the future of telehealth beyond reimbursement?  Let us know in the comments or on Twitter with @hcittoday.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

2 Comments

  • John, thanks for this thought-provoking article.

    I have had several conversations recently about this
    topic and questions like, “Do you think we will ever get back
    to normal?”, are common. Back to normal is impossible, in my opinion..
    The genie is out of the bottle and much like the EHR market,
    where no-one is trying to go back to paper charting,
    I believe the next couple of iterations of telehealth
    will make telehealth the go-to standard for routine checkups,
    cough, cold, minor injury, etc.
    Now mix in remote connected devices that can populate a
    digital patient diary, vital signs, EKG, weight, etc. into my chart
    at my doctor’s office (connecting to my actual chart is coming),
    I expect we will see the healthcare market (patients) demand a
    shift in healthcare from the current break / fix model
    to an integrated pro-active patient base with trend driven alerts that
    allow my provider to understand deteriorating trends in my health,
    before I even notice it.
    Related to Reimbursement, If you think about it like this, physicians’ services are concierge by nature already, except they do not receive recurrent revenue per patient.
    The only time the payors pay is when we present to the office for care.
    What if they paid a concierge payment each month per patient regardless of the office visit for example $40.00 per patient per month X 2194 patients = $1,053,120.00/year per provider?

    Providers would be more engaged in ongoing care and working within POP Health models to keep their patients healthy, and out of the hospital or clinic.

  • Scott,
    Thanks for chiming in and I always appreciate your insights. I hope you’re right, but I think that’s a big vision with a lot of hurdles to still overcome before I’m a believer. I think what you describe is how it should be which is the most unfortunate part.

    And just to be clear, the false market is the 60% telehealth adoption for live video visits. I think that will probably drop to 10-15 as I say in the article. We’ll see.

    The RPM and concierge stuff is really interesting. I think that’s still going to be a slow growth thing. Your description of the concierge model works great for patients and even doctors. I haven’t talked to enough payers about it to know if it works for them or not. I’ll dig into it more.

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