Sindi Daci: Telehealth—A Sustainable System Attempting to Address Issues in the Healthcare Industry
The COVID-19 pandemic disrupted the normal performance of our healthcare system. Problems that were always present in the healthcare system such as high healthcare costs and low quality of care, were further exacerbated by this pandemic. In response, many solutions to pandemic related challenges emerged including the transition to the telehealth system. Telehealth refers to the distribution of healthcare services using telecommunication technologies without any in-person visits (Mayo Clinic). Telehealth existed prior to COVID-19, but was amplified by the pandemic due to concerns over virus transmission during in-person meetings. In addition to solving pandemic related challenges, telehealth also addressed the persistent problems present in the healthcare system. As a result, telehealth has gained prominence over the past few years.
In order to fully understand why telehealth is necessary, this article will first introduce two current public health issues which are the rising cost of healthcare and the low quality of care. After understanding the problem, the article will analyze how telehealth is an appropriate solution by examining three benefits of the system. Finally, the article will acknowledge the challenges associated with telehealth which consists of privacy and accessibility concerns. To solidify these ideas, this article also reports on economic data, responses from patients and providers, and the projected trajectory of the industry. The reports, studies, and analysis will be relevant towards identifying telehealth as a sustainable and dependable system that provides long term quality care for patients. Telehealth has the potential to lower healthcare costs, increase productivity, and improve health outcomes, but before it is fully implemented in the healthcare system, privacy and accessibility concerns must be addressed to ensure telehealth is an equitable system.
Current Public Health Issues
Two current public health problems that experts are attempting to address are the rising cost of healthcare and the low performance in terms of quality of care. In 2020, healthcare spending accounted for 19.7% of the nation’s GDP (CMS). The Centers for Medicare & Medicaid Services (CMS) predicts that by 2025 healthcare spending will rise to 20.1% of GDP (Branning). Healthcare costs have always been rapidly increasing over the past few years, but the pandemic expedited the rising costs due to government involvement in the dissemination of vaccines and public health information to combat the spread of the COVID-19 virus. Rising costs in healthcare and treatment lead to an increase in insurance premiums causing many low-income individuals to remove their private insurance coverage (Cutler). This “makes society more unequal”, so lowering healthcare costs is a priority for combatting the inequality (Cutler). Another issue surrounding the healthcare system is the significantly low quality of care. Improving the quality of healthcare is necessary to ensure a sustainable system where patients receive the best care and promising results from treatment (Jennett). One solution has been to transition to value-based healthcare which pays providers based on patient health outcomes. This model can work well with the telehealth system to ensure a more effective performance of the industry. This paper will closely examine how telehealth addresses these two issues by lowering healthcare costs, increasing productivity gains, and improving health outcomes.
Telehealth Benefit 1: Lowering Healthcare Spending and Costs
In order to identify if telehealth truly reduces spending on healthcare, researchers have analyzed various healthcare economics studies. In one particular study, researchers examine 17 cost-minimization reports on the industry (Snoswell). Approximately 53% of the reports find telehealth to be less expensive than traditional care (Snoswell). If the study continues, these results can be extrapolated to conclude that more reports find telehealth cost saving. In the second part of the study, researchers met with a focus group and noticed that telehealth “offsets patient or clinician travel funded or subsidized by the health system”, so transportation and travel costs are significantly reduced (Snoswell). Since telehealth services are almost entirely remote, this eliminates the need for both patients and providers to go to a specific location for appointments. As a result, the health system does not need to maintain this intermediate cost. It also makes both parties more interconnected. For instance, telehealth mitigates supply and demand issues by allowing existing providers to work from home and meet with patients (Mahtta). Therefore, telehealth makes meetings more convenient and significantly reduces travel costs.
However, the challenge of implementing telehealth services is that the economic benefits and results are not immediate. Data shows, “the payback period ranged from near immediate to 9 years after implementation” (Snoswell). Transitioning to telehealth is a long-term investment, so it requires incurring some initial costs with the anticipation that they will be paid in the future with the profits eventually outweighing the costs. The study reports healthcare costs and spending are reduced by using telehealth services, but it involves efficiently implementing the program nationwide, so that everyone has access to the same resources.
Remote monitoring through telehealth services is also productive in terms of reducing hospitalizations. One particular study focuses on the effects of telemedicine on the readmission rates of people with heart failure. The research concludes that telehealth prevents the progression of serious conditions since the evidence shows “early telemedicine and in‐person follow‐up are both associated with lower rates of 30‐day readmission…” (Xu). By tracking food intake and vital signs, remote monitoring allows early detection of complications. Similar to the way early diagnosis is best for treatment, early identification of the problem is ideal for preventing a more serious situation. This all adds to reducing costs in the healthcare system by avoiding hospitalization and procedures that are both more risky and costly for the patient. Furthermore, data shows that when emergency department visits decrease by 1%, net savings are over $100 million per year which directly counters the problem of rising healthcare spending (Mahtta). Therefore, lower costs and other economic benefits are possible with the telehealth system, but it requires patience and long-term monitoring of the system.
Telehealth Benefit 2: Increase in Productivity
In all businesses, productivity is a key component for operating efficiently. During the pandemic, patients could not pause seeking care and treatment. Telehealth was a solution to continue serving communities with the same level of care while also preventing the spread of COVID-19. Initially, productivity in the industry decreased due to the unprecedented situation. However, the telehealth system provided an organized and structured plan with some researchers predicting telehealth acting “as a turning point for the utilization of telemedicine services in the USA moving forward” (Kichloo). These types of realizations show society adjusting its expectations in regards to what healthcare entails. They view telehealth as a long-term plan and not a temporary solution. Society interpreting telehealth as a sustainable and effective way to deliver services adds to productivity by building common trust and support for the system.
In addition to providers finding telehealth services helpful, after interviewing patients following their telemedicine visits, a majority claim to prefer this service more than in-person visits. They find it “satisfactory for their primary care needs” (Kichloo). Telehealth includes a wide variety of services with one being telemedicine. The survey highlights the increase in productivity because receiving approval and positive responses from patients are crucial for identifying if telehealth would be a useful system given that patients are the consumers who will demand the service. Having individuals automatically opt-in to telemedicine removes any convincing efforts from the healthcare system to encourage patients to use this resource. Furthermore, telehealth services are useful for individuals that could not take time off of work to physically go to their appointments (Park). Time management regarding doctor’s appointments was always an issue present in the system. Telehealth services save a lot of time because there is no commute or wait time associated with the meetings. It also allows providers to manage their workload better by designating intervals for each patient. Having more structure, organization, and a plan are key business strategies for ensuring one delegates an appropriate amount of time to each activity or in this case patient.
Patients demanding telehealth services is one side, but the suppliers must also meet this demand. The CMS is actively working to ensure all beneficiaries receive the same services with the same cost as in-person appointments (Kichloo). However, despite all their efforts, telehealth “was used less by Medicaid beneficiaries and low-income and rural populations” (Park). The system will be most efficient when everyone has equal access to telehealth resources, so there could be a standard approach for providers to deliver their services that is applicable to all patients. However, implementing these services, which require internet access for virtual meetings and advanced technology such as pulse oximeters or blood pressure monitors, is challenging. A lot of these updates require policies that extend beyond healthcare. For instance, the Digital Equity Act aims to improve accessibility of online services for low-income individuals, people with disabilities, and rural communities (DOC). Telehealth policies collaborating with national policies will be necessary for providing equal access to services which will significantly increase productivity.
Telehealth Benefit 3: Improvement in Health Outcomes
Besides managing the economic aspects of the healthcare industry, telehealth prioritizes patient care to ensure they are healthy. Studies show telehealth videoconferencing “enhance the quality of life for children with life threatening illnesses” (Jennett). In terms of elderly patients with mobility issues, telehealth allows them to live independently and manage their care from home (Jennett). Telehealth provides lifesaving treatments from the comfort of the patient’s home for every age group. In some instances, it simply acts as a supportive way to make patients feel less alone and more interconnected (Jennett). Telehealth also provides a level of freedom and independence for the patient because they do not have to reside or be dependent on providers and primary care facilities. This is crucial for boosting their morale and allowing patients to feel more in control of the situation. In addition, another example of a telehealth service is telemental health which uses communication technologies to remotely deliver mental health care despite the shortages of mental health professionals (Whaibeh). Mental health services are essential year-round beyond the pandemic. These services build an encouraging and supportive system for the patient (Kumar). Therefore, the benefits of telehealth services range from providing independence to support which all contribute to better physical and mental health.
Legal Challenges of the Telehealth System
After listing all the current benefits of telehealth services and the projected long-term results, it may seem like the ideal system. However, upon a closer review of telehealth, there are issues surrounding privacy and accessibility concerns. Research shows that “telehealth rules and regulations vary greatly by state and are constantly emerging and evolving” (Gajarawala). Patients have trouble understanding the various terms and conditions for different services and providers (Gajarawala). The issue becomes communicating with the patient that the service is safe and secure without overloading them with a lot of information regarding privacy protection. Furthermore, researchers are more often encountering privacy and security risks in telehealth causing patients to lose trust in the system (Hale). Building trust in providers is a priority. Telehealth may negate any trust that is built with providers because individuals feel their privacy cannot be protected through the increasing use of technology to remotely monitor their health and videoconferencing to meet with providers. A potential solution includes creating standard regulations for the system where these rules apply to all telehealth services. Creating a more uniform system avoids the confusion caused by different versions of the same regulation and it addresses the privacy concerns surrounding the technology. Another issue with telehealth includes accessibility concerns. The transition to remote working highlighted society’s lack of access to technology and internet across states (Gajarawala). In terms of older adults, modern technology may be too advanced and require these individuals to receive instructions or lessons regarding using the technology. Since access to internet services and appropriate technology are necessary for telehealth, society must implement policies and legislation which extend beyond the healthcare system. This includes providing, “Internet bandwidth speeds in rural or underserved areas” (Gajarawala). There will also be initial costs of setting up this technology, but it will provide patients access to telehealth services leading to future benefits.
Conclusion
Evidence from studies and surveys indicates that there is a lot of potential in the telehealth industry. Telehealth services combat high healthcare costs and improve the quality of care by providing access to services that closely monitor patients. Researchers have already encountered many economic and health benefits due to the use of telehealth services. However, initial costs, privacy, and accessibility concerns due to the use of advanced technology appear to weaken the positive effects of telehealth services. Nevertheless, to identify if telehealth improves care, researchers must examine the long-term results. Society must also adapt standard rules and legislation regarding privacy protection, internet access, and technology for all patients. With all these policies and the benefits consisting of a reduction in healthcare costs, an increase in productivity, and better health outcomes, telehealth can serve as a sustainable long-term system providing quality and equal care to all patients.
Sindi Daci is a junior at Yale University in Davenport College
Citations
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