COVID-19 Telehealth Expansion Can Help Solve the Health Care Underutilization Challenge

ABSTRACT

Am J Manag Care. 2021;27(1)9-11. https//doi.org/10.37765/ajmc.2021.88571 _____ Takeaway Points * The policy response to the coronavirus disease 2019 (COVID-19) pandemic has removed barriers inhibiting the delivery of remote health care, serving as an opportunity to directly address the gap in health care underutilization. * Policies that encourage telehealth and remote patient monitoring can directly lead to improved chronic disease management, an area of underutilization and high cost to the health care system. * Prior studies demonstrate the efficacy of telehealth, remote patient monitoring, and community health workers. In 2018, only 18% of doctors practiced medicine with some component of telehealth, compared with nearly 50% now.15 To exemplify the profoundness of this point, at Mount Sinai Faculty Practice in New York, New York, more telehealth visits occurred per average day in April 2020 during the height of COVID-19 than in all of 2019.16 In light of the boom in telehealth use, current evidence suggests a cost-reduction potential for the health care system and insurance providers, not to mention the financial incentives that accompany an increased ability to care for chronic diseases.17 Furthermore, of the 4 areas of spending on chronic disease management that account for two-thirds of all health care costs, both high volume and administration would be directly affected by sustained telehealth expansion.18 The increase in telehealth as a result of the COVID-19 pandemic is a prime opportunity to improve the effectiveness of health care expenditures by filling the void in chronic disease management and increasing access to care overall. Remote patient monitoring (RPM) is another disease management strategy that utilizes and builds upon the expansiveness of telehealth to reach underserved populations and fill an unmet need in American health care.19 RPM is a cost-effective method of engaging patients and promoting continuity in care that can integrate care teams and target high-risk groups through multiple channels.20-22 Effective RPM can improve access to chronic care management and help reduce unnecessary admissions, thereby reducing nonessential expenditures and cost burden from more acutely sick, hospitalized patients.23 CMS has issued a number of changes that tear down prior barriers to RPM as a means of providing care during the pandemic. Prior to COVID-19, CHWs, who served their respective communities through culturally appropriate health promotion and patient education, had demonstrated vast improvements in access for patients by improving care efficiency and reducing the need for emergency and specialty services.28,29 Moreover, incorporation of CHWs—as well as, similarly, care managers and navigators—has been associated with overall cost savings in addition to improved management of chronic disease and successful outreach attempts through multimodal communication efforts such as cell phone messaging.30-33 In light of the COVID-19 pandemic, a response effort that uses established CHW networks for short-term pandemic suppression with text messaging and virtual health outreach programming will also enable long-term amelioration by strengthening established care avenues.34-36 Although national policies promoting CHW telehealth strategies to combat the pandemic have not yet occurred, some states are upregulating CHW involvement as a short-term pandemic suppression strategy.