COVID Drove Telehealth Forward in High Gear: Now What?

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Before the pandemic hit in 2019, Pooja Aysola, MD, considered herself lucky because she could tap into telehealth for neurology consults in her work as an emergency department physician.

"We would wheel in a computer screen with a neurologist on board every time we had a suspected stroke patient. And I was able to talk directly to the neurologist about my patient's symptoms. And it was great," Aysola said.

The pandemic, however, prompted the need for telehealth in many situations beyond specialty care. As such, investment exploded over the past few years.

"We're seeing telehealth across all specialties...more than half of clinicians are now saying that they do believe that virtual visits will surpass in-person visits for primary care needs," said Aysola, who also serves as senior director, clinical operations at Wheel, a Texas-based telehealth company.

Aysola spoke during an American Telemedicine Association conference panel addressing how COVID prompted an uptick in telehealth investment and utilization and how such virtual care is likely to evolve moving forward.

Nathaniel Lacktman

Nathaniel Lacktman, a partner at law firm Foley & Lardner LLP, agreed with Aysola's assessment of the market.

"The appetite for virtual care has become voracious," said Lacktman, who chairs the firm's telemedicine and digital health team. "It reminds me in some ways of taking my kids out to dinner and saying, 'Try this new food.' They're like, 'No, I won't like it.' They finally get a little taste and they're like, 'This is amazing.'"

While there is no doubt that stakeholders — from innovators to investors to providers to patients — will want more than just a taste of telehealth in the future, panelists addressed if this undeniable demand for virtual care was simply a short-term response to the pandemic or if there is a long-term desire to fundamentally change how care is delivered.

Expanding on the Pandemic-Driven 'Sandbox'

While the uptick in telehealth investment and utilization is not expected to continue at such jarring rates in the future, the panelists pointed out that innovation will proceed, but perhaps at a different pace.

"The last 3 years have been a sandbox during which the industry was able to experiment," said Lacktman. "What we're going to see more of even post-pandemic is building upon that experimental sandbox and creating models that aren't just high growth and really quick, but that are sustainable and meaningful."

As such, patients and providers won't be looking for telehealth to simply provide access to care, but to provide a full scope of services while also improving quality.

Rachel Stillman, vice president of 7wireVentures, a Chicago-based venture capital firm, also expects interest in telehealth to continue but at a less frenetic pace. In 2021, the industry witnessed nearly $31 billion of venture financing directed towards digital health companies, she said.

"Now, Q1 2022 has had a little bit of a slower start. But with that said, we still have invested $6 billion in early stage companies. So while...we're seeing some initial signs perhaps of — I don't want to call it a slowdown — but increased discipline," Stillman said.

Start-up companies will need to carefully position themselves for success in this post-pandemic environment. "Ultimately, it really goes down to making sure your fundamentals are strong...and having a really compelling [return on investment] case for your health plan, your self-insured employer, your health system, or your ultimate buyer," Stillman said.

Two models are coming into play as innovation continues, she added. One, is a traditional care delivery model whereby a start-up organization is building their own provider network specialized for the conditions or patient populations they are serving.

"Conversely, there are new entrants that are thinking about how they can leverage their insightful and strong technology foundations and platforms for existing provider networks that could benefit from a telemedicine partner," Stillman pointed out.

Aysola added that companies are moving forward strategically to achieve post-pandemic success. Some telehealth start-ups, for instance, are "capturing some of the low-hanging fruit, the simple UTIs, the really easy things to treat," Aysola said.

Others are addressing the clinician's experience. "Over 50% of clinicians have thought about leaving their jobs at some point during the pandemic. And so it's becoming really clear that focusing on the clinician and the clinician's needs are just imperative to [creating a] winning model post-pandemic," Aysola said.

Adapting to the New Normal

Healthcare provider organizations also need to adjust to post-pandemic realities. "We work with a number of hospital systems and it's astounding how slow they are compared to the start-ups because there's a lot more constituents; there's bureaucracy," Lacktman said. As a result, "the hospitals are in a more uncomfortable position post-pandemic than the start-ups."

To move forward successfully, these organizations, which are typically risk averse, need to create alignment among legal, compliance, and clinical leaders, Lacktman advised.

One of the first decisions that these teams need to make is whether they should proceed on their own or enter into a partnership with a start-up or pursue a merger and acquisition. In addition, some health systems, hospitals, and health plans are even opting to establish their own venture funds.

"Building your own venture fund or even investing...in companies directly or in other venture funds [are strategies] that health systems might be able to leverage both to accelerate partnerships and also really be on top of key trends," Stillman said.

No matter how healthcare systems invest in and implement telemedicine technologies, though, the need to move quickly is paramount.

Traditional healthcare systems "don't always have the luxury of time. Things have to be done pretty quickly in order to remain competitive," Aysola concluded. "We've found that companies can launch a virtual care offering in a matter of weeks. When in reality, if a traditional healthcare system were to try to launch it on their own, it could take upwards of 15 months."

John McCormack is a Riverside, Illinois–based freelance writer covering healthcare information technology, policy, and clinical care issues.

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