Using Telemedicine Interventions During COVID-19 to Expand Care Post COVID-19

Am J Manag Care. 2023;29(1):e31-e35. https://doi.org/10.37765/ajmc.2023.89311 _____ Takeaway Points The Patient-Centered Rheumatology Collaborative identified several critical areas for further intervention to improve the delivery of high-quality, patient-centered care during the COVID-19 pandemic and beyond. * Telemedicine stood out as an underutilized intervention in the US health care system, with the capacity to facilitate access to care, potentiate the delivery of mental health services, and mitigate costs for all stakeholders. * The COVID-19 pandemic revealed a myriad of specific competencies and inefficiencies in delivering health care within the United States, and attendees of the roundtable noted that telemedicine could address many of the latter. * The value derived from telemedicine during the height of the pandemic placed precedence on seeking means by which to cement its place in the provision of care in the future. _____ Before COVID-19 besieged the US health care system, rheumatology services were scarce in some regions, while demand for those services increased.1 Now, as COVID-19 leaves an indelible mark on the US economy and society, the traditional approaches to care delivery are facing unprecedented challenges. Overall, the evidence base for telehealth is robust for the remote management of chronic health conditions.8 In rheumatology, the necessity has long existed for a novel means by which to expand access to care, owing in part to a growing deficit of providers in tandem with rural and elderly populations of patients, many of whom have limited mobility.1 The feasibility of telemedicine in this specialty practice has likewise been confirmed, as some rheumatology follow-up visits do not require a physical exam.9 Furthermore, in one systematic review of 20 independent studies, telerheumatology was determined to be effective even in the diagnosis of autoimmune/inflammatory rheumatic disease.10 Additional studies have shown high levels of patient satisfaction concerning remote interventions.10,11 In fact, the effectiveness of telemedicine has been established to be at least comparable with standard face-to-face approaches across several controlled trials, exemplifying the utility of digital health initiatives for delivering consultation and treatment and for monitoring disease activity in rheumatology.12 The American College of Rheumatology (ACR) issued a position statement in support of expanding telemedicine adoption and has coordinated guidance on the implementation, in remote settings, of measures of rheumatoid arthritis disease activity and of functional status assessment.13,14 A subsequent expert panel convened by ACR determined that these measures can be adequately adapted for use in telerheumatology to support high-quality clinical care.12 Challenges exist in ensuring equitable access to digital health, particularly in underserved populations in which internet connectivity, devices, and technology literacy may be limited. Telemedicine Adoption Post Pandemic After social distancing and stay-at-home orders were enacted across the United States in March 2020, telemedicine provided an immediate opportunity to maintain access and continuity of care while reducing the potential for community and nosocomial viral spread.2 Telemedicine is ideally suited to meet the demands of patient care while at the same time reducing virus transmission, stretching human and technical resources and protecting patients and health care practitioners (HCPs) alike.2 Recognizing an immediate need and a readily available solution, the health care community, including rheumatology professionals, quickly mobilized resources. [...]its adoption has been beset by resistance in a system founded on face-to-face contact and in which patient-provider rapport is deemed important. [...]with limited interest on the part of providers, minimal effort has been expended

Using telemedicine interventions during COVID-19 to expand care post COVID-19.

Despite available technology and supportive evidence in the literature, the integration of telemedicine interventions in the US health care system has remained sluggish for decades. The COVID-19 pandemic catalyzed widespread utilization of virtual visits and remote monitoring in urgent, primary, and specialist care settings out of sheer necessity. Specifically, in the rheumatology subspecialty, a lack of available providers and a patient community hindered by mobility and access issues have underscored the value of telemedicine. For these reasons, a solutions-focused, multistakeholder virtual roundtable meeting convened by the Frances Hamburger Institute for Community Rheumatology (FHI) identified telemedicine as a critical area for intervention to improve the quality and cost-effectiveness of patient-centered care. Building upon stakeholder experience and published findings, the Patient-Centered Rheumatology Collaborative identified the continued deregulation of policy barriers and the facilitation of sustainable coverage and reimbursement as critical steps toward establishing a robust infrastructure for telemedicine post pandemic. FHI roundtable attendees acknowledged several remaining telemedicine access barriers concerning traditionally underserved patient populations that will need to be addressed to realize the full potential of telemedicine. These recommendations are in concordance with those of other recent consensus groups, and they legitimize the formation of collaborative frameworks among payers, providers, and other key stakeholders to advance care in rheumatology.