Telehealth Success Varies by Setting, According to AHRQ

Dive Brief:

• Telehealth can improve healthcare quality, but success varies depending on where and how it’s used, according to a report prepared by the Agency for Healthcare Research and Quality.
• The report found positives in some areas, such as remote intensive care unit consultations, which likely reduce ICU mortality and length of stay. Specialty telehealth probably reduces the time patients spend in the emergency department and remote consultations for outpatient care likely improve access and a range of clinical outcomes.
• However, the report found there is less evidence that telehealth reduces inpatient length of stay and costs. There’s also no evidence that remote ICUs reduce hospital length of stay, that inpatient telehealth specialty consultations improve clinical outcomes and reduce mortality or that outpatient telehealth improves patient satisfaction.

Dive Insight:

Healthcare organizations are investing more in telehealth. Foley & Lardner’s 2017 Telemedicine and Digital Health Survey found three-fourths of healthcare organizations said they plan to offer telehealth services this year. Only four years ago, the same survey found that the vast majority of organizations said they didn’t expect patients would use virtual care by now.

Another 2017 survey found that 30% said telehealth was a high priority in their organization. The North American telehealth market is expected to reach $16.8 billion by 2020, fueled by chronic diseases and rising healthcare costs.

However, there are still challenges. Determining telehealth’s ROI remains elusive in some cases. There are also concerns about reimbursement, including overpayments.

The AHRQ review looked at 145 studies to evaluate the effectiveness of telehealth consultations for inpatient, emergency and outpatient care. Researchers found overall results generally showed telehealth was either better or showed no difference then comparators on some outcomes. However, more research is needed to dig into costs and outcomes in telehealth. Also, there were few studies focused on telemedicine’s potential harms.

“In general, the evidence supports the effectiveness of telehealth consultations; however, the evidence is stronger for some applications, and less strong or insufficient for others… Future research should focus on better measuring harms or unintended consequences and collecting data on the costs and economic impacts from different perspectives (e.g., healthcare systems, payers, patients or society),” they wrote.

Virtual care is one subset of telehealth that’s growing. Kaiser Permanente and UnitedHealthcare have both been using virtual care for primary care and other visits.

David Harlow, principal at a healthcare law and consulting company and author of HealthBlawg, recently told Healthcare Dive that virtual care has “great promise,” but said it won’t solve all of healthcare’s problems. “It is not a panacea. We need a different system-level mindset to achieve long-term improvements in outcome and reductions in cost,” Harlow said.