Before the COVID-19 pandemic, two-thirds of consumers (66 percent) said they were willing to use telehealth,yet the 2019 American Well survey also found only 8 percent had tried it.
As you might expect, there are some generational differences. For Millennials, 74 percent are willing and 16 percent have tried telehealth as compared to seniors of whom 52 percent are willing and only one percent have used virtual care.
Some reluctance among patients to embrace telehealth may be due to awareness. A 2019 JD Power survey found nearly three-quarters of Americans (74.3 percent) said they either lack access or are unaware of telehealth options. Nearly 40 percent said their health plan or provider did not offer access to telehealth, and another 34 said they were unsure whether they have access to the technology.
Fast Forward to the COVID-19 Global Pandemic
The COVID-19 pandemic has improved patient sentiment toward telemedicine. A Sykes survey found nearly one in five (19 percent) have tried telehealth and almost three-quarters would consider using telehealth to be screened for COVID-19. One-quarter of survey respondents had not previously considered this option, and two-thirds said the pandemic has improved their willingness to try virtual care.
Contemporaneous with the improvement in consumer sentiment, physician practices have been adding telehealth capabilities. Since the start of the pandemic, the Primary Care Collaborative has conducted weekly surveys of clinicians. Seventy percent of primary care clinicians surveyed the week of March 25 said they work at practices with no e-visits. By the next week, the number of practices without e-visits was down to nearly half. That same week 55 percent of primary care practices said their practice is conducting 50 percent or more of patient visits by telephone.
The week six survey, April 17–20, shows primary care practice’s use of video telehealth is increasing, but the telephone remains the preferred method. For the majority of their virtual visits, 40 percent of clinicians use video, 13 percent depend on e-visits, and 16 percent rely on a patient portal. Forty-four percent are using the telephone for most of their visits.
Health plans have encouraged the use of telehealth during the pandemic. The Centers for Medicare & Medicaid Services (CMS) led the way. Pre-pandemic, Medicare could only pay for telehealth on a limited basis such as visits provided outside the home in a designated rural area. On March 6, CMS announced, “Medicare can pay for office, hospital and other visits furnished via telehealth across the country and including in patient’s places of residence.” Likewise, payers are making it easier for members to access telehealth, with some offering zero co-pay telemedicine visits for any reason.
Despite increased availability and payer reimbursement of telehealth, data showing a steep decline in healthcare usage is beginning to accumulate. A Commonwealth Fund study found “the number of visits to ambulatory practices declined nearly 60 percent in mid-March and has remained low through mid-April.” Some notable figures below show the decline from the baseline week of March 1 to April 5:
- Pediatric visits are down 62 percent
- Adult primary care declined 49 percent
- Oncology has decreased 47 percent
A survey of 1,000 independent pediatricians found dramatically lower vaccination levels in the past month. “The administration of measles, mumps and rubella shots dropped by 50 percent; diphtheria and whooping cough shots by 42 percent; and HPV vaccines by 73 percent,” according to The New York Times.
While delaying preventive care may be a reasonable choice for patients to make during a pandemic, especially if the disruptions are short-lived, there’s even evidence suggesting people are avoiding emergency care too. An early April survey of nine major hospitals showed the number of severe heart attacks being treated in hospitals had declined by nearly 40 percent since the onset of the pandemic. The Boston Globe reported hospitals in the Boston area and across the country are seeing a precipitous drop in emergency room cases — by 40 percent or more.
As the global pandemic continues indefinitely, chances are the healthcare system — that is, physician practices, hospitals, health plans and even employers — are going to need to do more to encourage patients to return to doctor’s offices for preventive and chronic care, whether that’s in person or for a virtual visit. That’s where the digital front door — a strategy to know and engage with patients at every major touchpoint of the patient journey — can help.
Imagine Lucy, a 40-something mother of two teenagers, is called by her health plan in late May to check in and remind her to schedule preventive care appointments for children and herself. Lucy’s health plan has already deployed a digital front door strategy so when Emily, a member services advocate, reaches Lucy, she’s immediately able to see that Lucy is overdue for preventive care related to her diabetes diagnosis.
Emily conveys the importance of regular care to prevent the debilitating complications many diabetics experience, and Lucy agrees to make an appointment with her primary care doctor. Emily goes one step further, and offers to arrange an appointment at a time that works with Lucy’s schedule. When Lucy relays her fear about returning to the doctor’s office, Emily shares all of the extra precautions the practice is taking including temperature checks in the parking lot, more time between appointments and less people in the waiting room, masks for all staff and patients and enhanced cleaning. Nevertheless, Lucy remains reluctant to schedule an in-person visit so Emily schedules a virtual visit with her doctor, arranges for her to have blood pressure checked at the pharmacy in her local grocery store, and ensures her doctor’s office is aware of Lucy’s fears.
That’s the digital front door, combined with telehealth, in action.