The Path to Optimizing Telehealth in a Post–COVID-19 World

Technology-driven innovations in care delivery grew rapidly in response to the pandemic, and none expanded faster than telehealth. As the need grew for new channels of safe, easily accessible care delivery, federal stimulus packages were enacted to support telehealth.¹

This legislation, passed in March 2020, enabled the Centers for Medicare & Medicaid Services (CMS) to make changes in telehealth policies, and many commercial payers instituted similar guidelines. Under the new regulations, providers can treat both existing and new patients virtually while being reimbursed at the same or close to the same rate as providers would be for in-office visits.²

With relaxed regulations, telehealth grew dramatically as more and more providers embraced the technology. In the second quarter of 2020, virtual encounters comprised 14% of all health care visits.²

Telehealth in oncology also grew. Prepandemic, only 8% of oncologists/hematologists in a recent survey reported using telehealth, but by May 2020, that number skyrocketed to 88%; 90% of oncologists/hematologists also indicated they plan to keep using telehealth postpandemic.³

Telehealth is clearly here to stay, but to realize its vast potential, key stakeholders must support this care delivery channel and recognize its benefits. A look at the telehealth care delivery model over time in the specialty pharmacy context, as well as what can be done to sustain the advances made in telehealth, will be instrumental in this regard.

Lastly, the divide between medical and pharmacy benefit plans must be addressed. Health care is delivered in a variety of silos, and it is often said clinical care is a combination of many silos—each standing alone, doing what it does best.⁴ A patient’s medical plan is a separate silo facilitating medical services, and another silo, a pharmacy plan, manages access to drugs.

This separation increases the challenge of aligning the plans to allow for telehealth visits and guaranteed telehealth access to centers of excellence. To advance technology-driven channels of care, medical and pharmacy plans must concur on all aspects of coverage for telehealth medicine.

Can Telehealth Deliver High Quality Care?

Obviously, telehealth encounters will never completely replace face-to-face visits, but in some circumstances, they can actually drive improved patient outcomes. For instance, recent research found patients with cancer who could report symptoms on a regular facilitated call to a nurse in a telehealth visit or to a digital symptom-reporting portal lived 5 months longer on average than patients in the control group who were only able to report symptoms in a face-to-face clinical visit.

Access to telehealth options allowed more responsive care in real time, resulting in improved symptom control that helped patients maintain mobility, a factor associated with better survival.⁵

Although telehealth might be an acceptable care delivery mechanism when in-office visits are unsafe, some wonder if it should still play a role in health care postpandemic. Assessments of available data have resulted in a resounding yes, and a quick look at specialty pharmacy will demonstrate why—as specialty pharmacies use telehealth to drive and support quality care every day.

Specialty pharmacies have been providing superior care via telehealth long before the pandemic. In fact, experience has shown specialty pharmacies are highly efficient.

Specialty pharmacies are experts in providing telehealth services because all their communication with patients is done by phone, text, and increasingly through online video channels. Consequently, specialty pharmacies have honed the ability to understand patients, communicate effectively with them, and efficiently manage their care without ever seeing them in person.

Specialty pharmacies position patients for success via telehealth encounters by creating and executing a personalized care path that supports adherence, reduces adverse events (AEs), enhances quality of life, and drives optimal outcomes.

Each patient is assigned a care team that is available by phone 24/7 and includes a board-certified pharmacist, a registered nurse, and, often, a certified pharmacy technician. With a dedicated team of experts, patients can request to talk to the same people every time, which helps build trust.

Members of the care team develop personalized assessments, adherence-risk evaluations, and ongoing counseling plans. Nurses constantly evaluate patients’ needs during regular check-ins over the phone, offering advice for AEs while coaching patients through any difficulties. Assessments are sent to the prescribing physician, indicating whether further action is needed or whether the patient was simply educated and assessed.

This care model—delivered entirely through telehealth mechanisms—is more scalable than in-office visits, allowing more patients to be seen and for longer visits. Specifically designed to enable frequent and consistent communication with patients, specialty pharmacy care models can serve to minimize logistical barriers, nonadherence, and unnecessary testing and medical services, which can result in reduced adversity and lower costs for all stakeholders.

Payer Guidelines Are Coming

Payers generally have accepted telehealth during the pandemic because they recognize it is a lower cost, highly effective form of care. Even Medicare has gotten on board with telehealth by waiving prior restrictions so more providers can deliver telehealth.

Currently, Medicare is assessing whether to reimburse clinical interactions via telehealth and electronic symptom-reporting portals. Payers have adopted telehealth much faster than anticipated due to the pandemic, but over time, they will likely also develop robust policies governing when telehealth visits are appropriate.

For specialty pharmacy, there are immense limitations on payer reimbursement, especially for patients with cancer or complex diseases needing interventions that were not previously possible with telehealth. Most payers have been slow to create guidelines that allow for reimbursement of telehealth services, often called medication therapy management. During the pandemic, many payers, especially CMS, relaxed the stringent requirements, although it is still quite challenging to qualify for and be paid for telehealth services.

However, there is great opportunity where specialty pharmacy excels, such as in monitoring AEs and providing adherence coaching between physician visits. Payers are recognizing how specialty pharmacy utilizes telehealth to help patients comply with treatment, reduce unnecessary care services, and optimize outcomes.

But there is more work to do. Specialty pharmacy needs to educate payers so that they better understand how these benefits provide value to patients and the plans that are paying for these services.

Ensuring Continued Success

Several obstacles must be overcome for telehealth to continue to thrive in the future. The pandemic highlighted the lack of digital infrastructure that plagues certain geographic regions; vast regional differences emerged among providers in relation to their ability to utilize technological platforms.²

To ensure the future of telehealth and other virtual channels, policymakers must support broadband investments in underserved areas. Even if providers can offer telehealth, many patients lack internet access and need reliable broadband internet, if not in their own home, then through a regional technology hub.

Policymakers must also recognize patients with cancer and other complex diseases who would benefit from access to academic medical centers via telehealth for diagnosis, treatment planning, and care coordination with local providers. Collaborating with these centers can make possible the best opportunity for an optimal outcome, as these facilities bring cutting-edge treatments to patients.

Quality care can be greatly advanced by requiring that access to centers of excellence through telehealth be written into coverage plans as a core benefit. Payers and policymakers must agree on these issues if real progress is to be made.

Telehealth Is Meeting the Challenge

Telehealth has grown tremendously during the pandemic, demonstrating it can efficiently provide safe, real-time access to specialized clinical care. Medical providers who converted to telehealth are realizing the value of this technological platform because they are still able to provide a high level of care in a very challenging environment.

It is rewarding for the specialty pharmacy industry—experts in telehealth—to see providers adopting a patient-engagement technique that specialty pharmacy has successfully used for decades. Providers are recognizing what specialty pharmacy has always known: Telehealth empowers superior, cost-effective care by highly trained clinicians, driving optimal outcomes and a better patient experience.

REFERENCES

1. Royce TJ, Sanoff HK, Rewari A. Telemedicine for cancer care in the time of COVID-19. JAMA Oncol. 2020;6(11):1698-1699. doi:10.1001/jamaoncol.2020.2684
2. Japinga M, Paff M, et al.How Telehealth Expansion Can Support Comprehensive Virtual Care. NEJM Catal Innov Care Deliv. 2021;2(7). doi:10.1056/CAT.21.0129
3. COVID-19 impact on oncology. Healthcare Research & Analytics. Accessed September 1, 2021. https://www.hraresearch.com/wp-content/uploads/2020/07/HRA_COVID-19_Infographic.pdf
4. Morency J. Coordination over silos: the new healthcare team. Hello Health. November 06, 2018. Accessed September 6, 2021. https://hellohealth.com/blog/coordination-over-silos-the-new-healthcare-team/
5. Goodman A. Online self-reporting of symptoms improves quality of life, extends survival. The ASCO Post. June 25, 2017. Accessed September 9, 2021. https://ascopost.com/issues/june-25-2017/online-self-reporting-of-symptoms-improves-quality-of-life-extends-survival/