It took American Family Care, an urgent care and primary care company headquartered in Birmingham, Alabama, just 36 hours to roll out its telemedicine service, AFC TeleCare, after the COVID-19 outbreak struck. “We had been thinking about it and deciding when we wanted to venture into it (telemedicine)” prior to the pandemic, says Benjamin Barlow, M.D., the company’s chief medical officer (CMO). “We met on a Monday, and the next day it was a go.” Since AFC TeleCare’s launch in March, many of the calls the company has received involve medication management for established patients, Barlow says.
If American healthcare does wind up getting divided into pre- and post-COVID-19 eras, the migration from in-person visits to telehealth ones will likely be one of the biggest developments on the right-hand side of the inflection. Population health experts and advocates have been eyeing telehealth for some time as a way to monitor patients, encourage healthy behaviors and increase adherence to medications.
“It’s recognized as an effective and often more efficient means to connect with patients to provide healthcare and chronic disease management,” says Mitchell Kaminski, M.D., MBA, a family physician and program director of population health at Jefferson College of Population in Philadelphia. The COVID-19 outbreak moved thought, research and pilot projects into full-on implementation mode.
“We’ve gone from incremental change in 10 years to very rapid, transformative change” because of COVID-19, Kaminski says, as virtual care gives providers the opportunity to offer much needed care during the pandemic while keeping patients safe by not making them come in person and wait in a doctor’s office.
As a family physician and leader in population health, Kaminski says he had long thought that he should provide virtual care for his own patients, but it languished on the to-do list. He envisioned a steep learning curve. And like many physicians, especially those who deliver primary care, he assumed that telehealth visits couldn’t measure up to the in-person ones in establishing a strong doctor-
But he has been pleasantly surprised. “I have been amazed at the connection I feel, even with patients I’ve never met before,” says Kaminski, who has been seeing patients remotely through JeffConnect, an app set up by the Thomas Jefferson University Hospitals system, as well as having telehealth visits with his own patients.
Before the COVID-19 outbreak, telehealth had been edging its way into American healthcare delivery. The convenience of being able to receive immediate care online via a mobile device has undeniable appeal for patients, especially compared with having to wait days, even weeks, to be seen. In many cases, the virtual visits had a lower copay. In some cases, the services were provided by hospital and healthcare systems. In others, they were the reason to be for so-called direct-to-consumer companies such as Teladoc Health and were offered as an add-on benefit to employer-based health insurance.
A 2019 J.D. Power survey found about 10% of respondents had used telemedicine in the previous 12 months. Two years ago, Michael Barnett, M.D., an assistant professor at the Harvard T.H. Chan School of Public Health, and his colleagues reported the results of a study of telehealth usage in an unnamed health plan in JAMA. (Although the plan is not named, the de-identified claims that Barnett and his co-authors used came from OptumLabs.)
From 2005 to 2017, those health plan members made almost 385,000 virtual visits, and usage climbed from 0.02 visits per 1,000 members in 2005 to 6.57 visits per 1,000 members in 2017. More than half the visits were for mental healthcare, and almost 40% were for primary care. Barnett’s report shows a steep increase in telehealth use starting in 2015.
Teladoc, which stakes a claim to being the country’s most experienced and largest telehealth provider, reported that its number of virtual visits reached 4.1 million in 2019, a 57% increase over the previous year. On March 13 of this year the company reported that virtual visits had increased by 50% in the previous seven days compared with the week before. Teladoc provided about 100,000 virtual visits during that time. Its stock price shot up from $128 per share on March 13 to $167 on March 23.
Maven Clinic, a digital health startup that focuses on women’s health, saw a 500% spike in virtual mental healthcare mid-March when pandemic hit the United States, says CEO Katherine Ryder. Virtual care is “dramatically reshaping” healthcare delivery, she says. [After that initial spike, Maven subsequently saw a 300% increase in virtual mental health visits over the past two and a half months, a company representative said at the end of May.]
Kaminski says that Jefferson emergency department physicians set up the JeffConnect app about three years ago. Patients were charged a relatively small copay. “They were providing about 50 telemedicine visits per day until the pandemic hit, and suddenly they found themselves dealing with over 3,000 visits a day, a 60-fold increase.”