TeleHealth and COVID-19:

How COVID accelerated value optimization in comprehensive telehealth care delivery

4 Lessons learned to optimize telehealth in the workplace

Employers have been faced with a tremendous return-to-work challenge in COVID-19 pandemic America.  Billions of dollars have been lost in productivity while millions are being spent in return to work strategies.  Large employers have additional layers of liability and logistical issues in maintaining a safe and healthy workforce.  

National commercial laboratories and telemedicine providers have been overlooking a gap in streamlining employer testing solutions.  While testing may be easily scheduled for employees mass onsite testing remains a challenge.   Telemedicine evaluation of COVID-19 often outstrips the low-acuity care model, leading to inadequate “get tested” guidance.  This deficiency merely diverts risk without delivering value.  

Covid has highlighted the need for telehealth companies to step up the level of care integration and acuity of care delivered.  Cura TeleHealth and Wellness is one such telehealth company. Delivering higher acuity comprehensive care including laboratory services at a value, the bar has been raised, setting new standards of care while in the marketplace. 

COVID-19 optimized telehealth

One Friday evening, Cura’s CEO received an urgent call from a national trucking company with 1800 employees at the epicenter of the coronavirus outbreak.  Employee confidence was at an all-time low and absenteeism as viral as the virus itself.  “With our assessment, test, and safe to work strategy, all employees received a telemedicine risk assessment visit over the weekend,” said Dr. Clinton Baird, M.D, Chief of Clinical Operations at Cura TeleHealth. 

In this particular scenario dual testing with rapid antibody and viral testing before the evening that Monday occured.  Employees identified as high risk during the telemedicine visit were tested and quarantined along with positive IgM results found in asymptomatic individuals.   The remaining low risk employees continued in the workplace awaiting final testing results.  Subsequent visits were delivered as needed.  This quickly identified the value of integrating COVID testing methods with care delivery.    

Paradigm shift to provide comprehensive care delivery

COVID-19 has accelerated what many in telemedicine have been preparing for years in advance. “Presently we are only utilizing a fraction of the value telehealth has to offer” says Aymen Elfiky, M.D., MBA.  The pandemic has demonstrated that chronic conditions and acute exacerbations of chronic conditions can be managed over telemedicine visits for an extended period of time. 

Telehealth augments chronic care  by delivering basic diagnostic sets such as a lung flow meter, pulse oximeter and blood pressure cuff into the patients home.  “By deploying telehealth solutions and programs, people who are suffering from other medical ailments … can receive care from home, without entering medical facilities” says Dedi Gilad with Tyto Care.   The swift and broad adoption of telehealth has  created a tremendous opportunity to focus attention on the 20% of employees with chronic conditions that utilize 80% of the health care dollar.  

A smarter PEPM teleHealth model

Covid-19 has highlighted the missing value in PEPM models for telemedicine coverage as well as the need for a higher level of care.  Even with the higher utilizations we have seen companies spending $171 per visit when normalizing the PEPM across utilization.  TeleHealth has demonstrated value when integrating methods such as COVID testing, chronic care management and remote patient monitoring into the service offerings.  

Tremendous value in offering employers integrated delivery models with low acuity and specialist visits offered at a visit fee only can be realized.   Applying a portion of this savings for chronic care management to at risk employees with diabetes, heart disease, depression, and COPD improves worker productivity, reduces absenteeism, and lessons unexpected costly healthcare visits.   

Telehealth companies that share risk by applying a cap on spending such that it doesn’t go above traditional PEPM cost models support the value of this integrative model.  This model allows significant delivery of care in the home in mild to moderate cases of COVID infection that would otherwise end up with hospitalization. Employers take on financial risk in healthcare and the integrated telehealthcare company should also share in risk of quality care delivery.

Longitudinal Doctor Patient Relationships

Many components of the health of a patient revolve around a doctor patient relationship.  Pundits have argued telehealth can not provide this longitudinal relationship.  Telemedicine has often delivered episodic low acuity care without regard to maintaining the doctor patient relationship.  COVID supported proponents of this longitudinal relationship by proving the validity during the early and mid stages of the pandemic.  

Providing the best value to employee health offering must include the ability for employees to choose a single primary care, behavioral health or other provider in which they see regularly.  Utilizing the value of telemedicine visit fee only models of  longitudinal care  creates a cost effective solution as  compared to placeholder PEPM models.  In at risk patients this relationship fosters the value of the in person visit while maintaining the value of digital delivery.

The future of telehealth

One day we will differentiate far less between telehealth and other forms of healthcare delivery models.  Employers should seek this value now.  Telehealth companies should see themselves as caring for populations in all aspects of health – urgent care, chronic care, behavioral health, preventative medicine and more.  These relationships should offer what we expect from any brick and mortar solution at an improved cost and efficiency – a comprehensive care plan.  For example does your telehealth company offer onsite COVID testing and flu vaccinations, annual diabetic retinopathy screening, and at home  lab testing?   It’s time for a better telemedicine.