Ever since the first case of COVID-19 hit our shores, we have been hearing about the importance of “flattening the curve” through social distancing, stay-at-home orders, and other means.
The strategy is designed to keep from overwhelming the health care system by avoiding a single surge of patients requiring medical attention over a short period. After all, as we have seen, there are only so many hospital beds, ICU beds, ventilators, N95 masks, and, most importantly, health care professionals to go around.
When you look below the surface, however, you begin to see a disturbing truth. The flatten the curve approach isn’t intended to significantly reduce the expected number of people who acquire COVID-19. It merely stretches the same number of people across a longer timeline.
But what if there was a solution to reduce the onslaught of nervous patients converging the facility without compromising on delivering quality or care? That is what telehealth offers.
A Next-Level Approach
By increasing their use of telehealth, health care organizations can scale up quickly to manage thousands of patients effectively while reducing exposure for patients and staff. The ways telehealth can help the country redefine the COVID-19 curve include the following:
• Helping patients self-identify at home. While the Internet is a marvelous tool for sharing news and information and for keeping us all sane during shelter-in-place orders (thank you Netflix, Amazon Prime, Hulu), it is also a huge source of misinformation and conflicting “expert” opinions.
Patients who are not feeling 100% healthy may wonder whether—or assume—the symptoms they’re experiencing mean they have COVID-19. With a telehealth application in place, health care organizations can share pathways prepared by experts that help patients self-diagnose their symptoms and determine whether there is cause for concern.
If so, these same pathways can tell them what to do next, such as contacting the Centers for Disease Control and Prevention and/or requesting a formal test from their physician. Every healthy patient following these pathways is a patient who isn’t tying up the precious time of clinicians—something that is in short supply right now. And those who are aware of their condition before the symptoms become obvious can keep from unknowingly infecting others.
• Further reducing the chance of spreading the virus. This is probably one of the most critical contributions telehealth makes to redefining the curve. Patients with COVID-19 (or who are worried they have it) are converging on hospitals and physician offices like a magnet attracts metal shavings.
The result? Patients who do not currently have COVID-19 are now at risk of exposure that would not have occurred otherwise. If they do acquire it, everyone in their household—and everyone they come across while at the grocery store or other areas outside their homes—is now also exposed.
Telehealth enables these healthy patients to be examined without putting them at risk, helping reduce the overall numbers rather than just stretching them. It also eliminates the need for personal protective equipment during the examination, conserving those precious resources for actual cases, helping protect providers and their staff as well.
When patients are diagnosed via telehealth as likely having COVID-19, they can be sent for testing with confidence that our limited supply of tests isn’t being reduced unnecessarily.
• Helping health care professionals scale care. As the number of patients seeking care increases, the number of patients hospitals and physician offices see in a day is shrinking due to social distancing requirements.
For example, rather than sitting in waiting rooms, patients are either seen immediately or told to wait in the car or outside the office until they are called in. After each visit, extra time must be taken to thoroughly disinfect patient rooms, and, if there is a suspected or confirmed case of COVID-19, to ventilate the room before the next patient can be admitted. That’s a lot of downtime that slows the flow of patients through the facility.
None of that is required with telehealth. As soon as health care professionals have finished seeing one patient they can click over to the next, which is even more efficient than the typical rooming process.
Additionally, a recent relaxation of regulations regarding telehealth means health care professionals who have lower licenses (eg, medical assistants) can handle at least a portion of the patient load, with the option to bring in someone with a full license when needed. This further extends the ability of physicians and nurses to move patients through the system while delivering quality care.
• Ensuring care reaches patients in rural areas. As of now, COVID-19 has primarily been concentrated in more densely populated urban areas. That makes sense, as closer proximity means easier transmission. However, the disease is making its way into more rural areas, where its effects may be even more devastating, given the lack of nearby access to care—especially with 120 rural hospitals closing over the last 10 years and one in four still in jeopardy.
Additionally, while an urban hospital may have hundreds of beds, along with dozens of ICU beds and ventilators, a rural or critical access hospital may have 10 to 20 beds total, limited or nonexistent ICU capabilities, and one or two ventilators at best. Given that nearly 20% of the population and 95% of the land mass in the United States is in rural areas, stopping the spread there may be even more challenging.
Telehealth helps address these issues by bringing care to the patients, rather than requiring patients to travel long distances for care. If patients have mobile coverage—as nearly every area does from at least one carrier—they can use telehealth to establish not only voice but also video and data contact with their providers.
They can also use the devices for remote patient monitoring (RPM) of critical vital signs to help providers stay ahead of developing issues, either with COVID-19 or other chronic conditions. (Incidentally, through a partnership with Samsung, Vivify Health is addressing the issue of getting mobile phones and tablets into the hands of underserved populations who need them but do not currently own them.)
• Maintain care for other causes, especially chronic conditions. While much of the present focus is on eradicating COVID-19, addressing other chronic conditions through RPM is equally important and necessary.
Typically, this process would be part of an automated RPM program where parameters such as weight, blood pressure, and oxygen in the blood are measured and uploaded automatically to a central portal monitored by health care professionals. But in instances where Bluetooth-enabled devices aren’t available or affordable, patients can take their reading using inexpensive, consumer-grade products and send them to the portal manually.
The other reason it is important to stay on top of chronic conditions is that patients could deteriorate significantly if their entire focus is on COVID-19. When the pandemic subsides, providers and patients will be left with the aftermath. Healthy populations mean fewer post-COVID-19 complications and avoidable procedures down the road, and, therefore, a better quality of life.
• Avoid a rebound effect. With all of the isolation and social distancing associated with flattening the curve, there is a lot of pent-up demand for returning to normal. This means once we have passed the peak of COVID-19, there may be an unfounded belief that we are now safe. This will create a temptation to rush back into public spaces too soon, creating a rebound effect that leads to another, avoidable wave.
Data from telehealth can provide a better indicator of when it is safe for the public to return to normal social practices. Incidentally, based on their specific health conditions, the timing for individuals may be different than for the general public. It will be important to understand what is truly “safe” before we are all unleashed on one another again.
• Increase provider revenue during difficult times. In any other business, a sudden surge in customers would be a revenue bonanza. But the COVID-19 pandemic has meant stopping or seriously reducing the level of providers’ primary revenue streams—surgeries, elective procedures, and visits/inpatient stays covered by commercial health plans. This has led to providers (including hospitals) cutting salaries, closing offices, or reducing staff in areas not focused on immediate care because they can’t afford them at this time.
RPM helps them make up for some of this revenue shortfall while delivering better, safer care. Recent changes to telehealth reimbursement designed to encourage its expansion make it more profitable for providers to consistently monitor the health of patients in their homes—as part of a value-based approach to keeping them healthier and staying ahead of negative trends—before they result in an inpatient stay or emergency department visit.
By using analytics to examine their populations with chronic conditions, providers can identify more candidates for RPM so they can take advantage of these additional revenue streams while also improving care quality. Taking this action helps them keep the doors open, so when care is needed, it is available.
The Long View
What becomes apparent is that there is no need to settle for simply flattening the curve, ie, delaying the inevitable, when we can significantly redefine it. By expanding the use of telehealth, we can reduce the number of patients who acquire COVID-19, relieving pressure on the health care system while shortening the timeline.
Additionally, once the benefits are reviewed post-pandemic, we may just find it’s a way to improve care quality and reduce care costs substantially, even when we’re not in a crisis mode, which will be a plus for all of us.