Telehealth or telemedicine and in-home primary care are not new concepts.  While the former was made possible by the digital transformation of healthcare and broadband internet, the latter has been around since the horse-and-buggy days of medicine. Back then, of course, it was known by the folksier and admittedly more nostalgic name of “house call.” And while both have been expanding and growing over the past several years, and especially with millennials, seniors, home-bound patients and patients in rural areas, the Covid-19 pandemic has arguably accelerated their acceptance and growth. 

Consider, for example, the recent investment of payor Humana to acquire a $100 million stake in the in-home primary care company Heal.  And, just before the pandemic, Sutter Health | Aetna announced that it was partnering with Heal and with telehealth app 98point6 to offer its members telehealth and in-home primary care.  Other payers, of course, have invested significant amounts to beef up their own medical provider services, but these new Humana and Sutter Health | Aetna relationships could be viewed as ushering in the next generation of this approach to healthcare given their focus on, and expanded availability of, the in-home primary care component.

These hybrid telehealth and in-home primary care models clearly meet the demands and needs of their original target group of seniors, home-bound or rural patients (where a two or three-hour round trip drive to a doctor is not unheard of).  But the social distancing and mobility limitations of the pandemic are clearly demonstrating that they can also meet the needs of people who probably would never have imagined themselves doing a doctor visit on Zoom, having their blood pressure or glucose levels monitored remotely, getting virtual psychotherapy, or accessing their medical files on their smartphones.  

It’s also worth noting that during the pandemic, the U.S. government has relaxed many of its previous restrictions on virtual doctor visits.  For example, a patient can now talk with a doctor through a commercial video chat platform or even their telephone.  This easier access is most likely making telehealth available to more people, many of whom will probably decide that they actually like it.  

Providers deciding to adopt some form of this model or expand their current telehealth and/or in-house primary care programs, probably will find that it also offers millennials (an important audience for the healthcare sector) many of the things they have been saying they want and need from doctors and hospitals. This, of course, will make these providers more competitive in their markets, which can help with both attracting new patients and increasing the retention rates of existing patients.  These include:

• Greater transparency in pricing – Many telehealth and in-home primary care companies tell patients what costs will be before services are provided
• Lower cost – Affordable membership plans and low OOP costs for a virtual consult (as low as one dollar depending on the company) and in-home primary care visits, along with not having to pay for travel or cover lost wages from taking time from work all reduce cost
• Minimal wait times – Patients can use their smartphone apps to request a consult and often have it confirmed for later the same day (or sooner depending on the situation); in-home primary care visits usually have minimal wait times as well
• Seamless access to other services – Via the various telehealth apps, doctors can, for example, prescribe prescriptions, send them to a local pharmacy and then hand-off pick-up notifications to the pharmacy via their app, or prescribe physical therapy, x-rays and blood work
• Referrals to healthcare specialties – Primary care physicians conducting the virtual consult can refer their patients to specialists, such as a psychologist, dermatologist or even physical therapist, for follow-up and virtual treatment when possible and appropriate
• Mobility and interconnectivity – With a tap on their smartphone, patients can access and manage their individual health records, which can save time and make consulting with multiple physicians easier and more efficient

The second element of the model, in-home primary care, usually complements and flows from the initial virtual consult.  For example, if the doctor or other health care provider cannot resolve or adequately address a patient situation virtually, then an appointment will be made for an in-home primary care visit.  

Proponents of this type of care mention that in addition to being more convenient (and often more comfortable and safer for patients), it also gives doctors insights that could enhance patient care that they otherwise may not have had, such as identifying fall risks, food insecurity and treatment plan compliance.  One doctor mentioned seeing all of a patient’s pills in a bowl on the kitchen table. When asked about it, the patient responded, “Some days, I take the blue ones and others, the red ones.”  This type of information is critical for improving patient care and treatment outcomes. 

Providers Benefit in Multiple Ways as Well

One of the key benefits for providers on expanding their telehealth and in-home primary care (also known as “hospital at home” depending on the patient and service offered) is cost savings, much of which can drop straight to the bottom line.  One operational area where these savings can most readily be seen is in the ED. Studies show that having access to telehealth tends to divert patients away from this type of costly care setting.  

One study at Jefferson Health in Philadelphia, for example, suggested that telehealth generated cost savings from $309 to more than $1,500 each time an ED visit was avoided.  And, since many patients reported to researchers that they probably would have “done nothing,” without access to telehealth, using it may have prevented more costly treatments down the road. 

Other benefits to providers, both from an operational and financial perspective, include fewer follow-up visits; expansion of “hospital at home” programs (which have been shown to be successful in reducing LOS [length of stay], among other metrics); reduction in readmission rates; and a reduction in admissions from SNFs.  These services have also been shown to improve patient and patient caregiver satisfaction, both of which can positively impact a provider’s balance sheet. 

The Way forward for Providers

It’s clear that providers are increasingly recognizing these benefits and expanding their capabilities and offerings to capitalize on them.  For example, recent studies suggest that the percentage of providers using digital technology to connect with patients and practitioners has more than doubled over the past decade.  In 2010, this percentage was around 35 percent and is now well over 76 percent.  Another approximately 62 percent reported using remote patient monitoring.  These numbers will only continue to increase as more providers realize the benefits of telehealth and in-home services and as patients increasingly demand – and expect – them.

But achieving more than an incremental increase in the use of telehealth and in-home primary care will require that providers, and the healthcare industry in general do the following:

• Increase investment in the technologies that enable telehealth and in-home primary care along with ongoing education on how to use them.  According to a report by Deloitte, some 35 percent of physicians report not having access to these technologies at their workplace while almost a quarter of patients say they either don’t have the technology or are not interested in it.  
• Review current payor payment agreements and reimbursement rates to confirm which telemedicine and in-home primary care (including “hospital at home”) services they do and do not include.  Make sure to negotiate these during the contract renewal cycle.  Also be open to partnering with a payer when and if appropriate to expand these types of services.
• Work with healthcare associations, patient groups and local community organizations to lobby for legislatures to make the Independence at Home Demonstration a permanent part of Medicare.  Also work to keep any current expanded Medicare and/or Medicaid payment provisions necessitated by the pandemic for these services in place once the pandemic ends.

Many employers in the private and government sectors are seeing that the various work-from-home schemes they developed in response to the pandemic are working and productivity has improved. Employee satisfaction is also higher. It is quite probable that healthcare providers – from individual doctors to smaller hospitals to larger institutions in urban areas – will also see the multiple benefits from further embracing telehealth and in-home care programs.  After all, reduced costs, enhanced patient treatment outcomes and satisfaction, and increased community goodwill are a powerful combination.