3 Predictions for Virtual Care in 2019

Readers tell us what trends will have the greatest impact on telehealth in the year ahead.  

What changes will 2019 bring to the realm of virtual care? We asked our readers to peer into the future and predict which trends will have the greatest impact on telehealth in the coming year.

Despite the fact that they work for a broad array of organizations, including health systems and companies that provide telehealth services, the input provided was surprisingly similar. Nearly all feedback fell under three distinctive banners that will spur growth: reimbursement, expansion beyond direct-to-consumer models, and technological advancements.

Regardless of the reason, everyone expects the next 12 months to bring accelerated growth.

"There will be increasing attention on adoption and engagement of telehealth by providers and consumers," says Ann Mond Johnson, CEO, American Telemedicine Association. "At the ATA we believe this is critical for the expansion of telehealth. There’s a lot of technology available. The uptake needs to accelerate in order for telehealth to deliver on all it can do in terms of the quadruple aim."

Other readers agree. "In 2019, we will continue to see health systems turn to telehealth as a way to help improve access," says Carey Officer, operational vice president, Nemours CareConnect. "While there is plenty of investment in direct-to-consumer options, I am watching the growth in the number specialties offering care through this channel. Providers prefer to use clinic-to-clinic telehealth for first time visits, but for follow-up visits, there is great potential to use the technology to connect the specialists and the patient in a home setting."

Consumerism is one of the greatest driving forces behind the growing popularity of this practice and Officer says that families of the pediatric patients his health system serves are no exception. "Parents who try telehealth, especially millennials, love the convenience and quality, and when they share their experience with friends and family, it inspires others to test it out," says the Nemours executive. "This growing acceptance is not lost on payors and regulators, so we are hopeful that we will continue to see licensing and reimbursement challenges diminish."

As the year progresses, here are the three trends readers expect will matter most:

1.  Changes in Reimbursement Will Spur Growth
 

The leading prediction for the coming year is that changes in reimbursement will spur growth in virtual care. The seeds were planted in 2018 with passage of the CHRONIC Care Act and new billing codes from the Centers for Medicare & Medicaid Services (CMS). Opportunities also will be created by Medicare Advantage plans and new penalties for readmissions from skilled nursing facilities. One sticking point continues to be parity legislation from some state legislatures.

• Medical University of South Carolina: ""2019 will see continued and likely accelerated growth in telehealth activities as patients, providers, and health systems continue to embrace technology as one way to improve effectiveness and/or efficiency of care. The new CMS billing codes that allow reimbursement for services previously not supported by CMS will inspire more systems and providers to embark on telehealth projects." —Dee W. Ford, MD, MSCR, professor of medicine at Medical University of South Carolina (MUSC) and Program Director, MUSC Telehealth Center of Excellence
   
• Northwell Health:"The two most interesting areas to watch, in my opinion, are Medicare Advantage plans, which we may see actively partnering with provider organizations for more routine applications of telehealth in longitudinal care now that they are allowed to cover it, and the skilled nursing facilities (SNFs) space where the new penalties for readmissions are going to substantially change the ROI for SNFs to partner with provider organizations to address off-hours medical issues." —Martin E. Doerfler, MD, senior vice president, clinical strategy and development, Northwell Health
   
• InSync: “In 2019, the biggest trend in telehealth will be the expansion of telehealth reimbursement—and adoption—thanks to 2018 legislation such as the CHRONIC Care Act. More opportunities will present themselves for doctors and other healthcare providers to finally leverage telehealth technology for higher-quality, whole-patient care. Telehealth platforms and applications that are interoperable with EHR systems will be especially valuable to providers across multiple specialties (e.g., primary care and behavioral health), given the increase in insight and communication telehealth will provide about a specific patient. With resources spread thin in many medical practices—due to financial constraints and regulatory compliance—enhanced clinical efficiency from telehealth tools will make it easier for providers to do their jobs well." —Charles Hutchinson, chief financial officer, InSync Healthcare Solutions
   
• Telehealth Suite: "Members of state legislatures are still slow to pass legislation providing payment parity for telehealth services delivered by healthcare providers. Many telehealth services are being delivered because [health system executives feel] 'it is the right thing to do for our patients;' however, reimbursement is either small or the services are being delivered for free. Not having stable payment models in the states is a significant impediment. … Other areas of opportunity are reconciling the Medicare Section 1834(m) restrictions in the Social Security Act, which have posed a significant barrier to access and payment." —Matthew Rumbaugh, executive director, Telehealth Suite

2.  Focus Will Expand Beyond Direct-To-Consumer Models
 

How will virtual care be used in 2019? With more health systems moving toward value-based care, there seem to be few methods of healthcare delivery that won't be touched by this trend, which can help improve care while reducing costs. Management of chronic illness is one of the key areas for growth, an idea echoed by multiple readers. Expansion of behavioral health and specialty medicine also will continue. Some readers predict telehealth will become part of the solution to address needs ranging from annual wellness exams to the opioid crisis.

• Doctor On Demand:"Payers will become much more strategic in how they view virtual care. They will leverage telehealth more than ever to provide consumers with better access to high-quality primary care, and to cope with the growing crisis of chronic disease in the U.S; 60% of Americans have at least one chronic disease, which accounts for 81% of hospital admissions. We will see much more innovative plan designs from payers that will put virtual care at the front door for patients." —Hill Ferguson, CEO, Doctor On Demand
   
• Barrow Neurological Institute: "2019 will be the year of telehealth, not because of technological changes, but rather a more transparent business model. This is being led by (finally) a recognition by the federal government that telehealth is not a risk, not revenue neutral, but rather a tool to get better care, better access, and ultimately a lower cost for care. Much of the confusion has been related to the direct-to-consumer market (DTC) that has dominated investment in the space. Yes, customer service via online access is great, but the real opportunity is leveraging telehealth to deal with chronic illness, mental health and the opiate crisis." —Alan Pitt, MD, professor, Barrow Neurological Institute; former chief medical officer, Avizia
   
• Nemours CareConnect: "As health systems increase their focus on value-based care and population health, this technology provides convenient, lower-cost opportunities to access care." —Carey Officer, operational vice president, Nemours CareConnect
   
• MDLIVE:"We will see telehealth services expanding into areas like annual wellness exams, chronic condition management, behavioral health needs, and Medicare benefits." —Rich Berner, CEO, MDLIVE
   
• Teladoc Health: "Virtual care now has successfully expanded to include support for a wide range of conditions across the spectrum of care, from behavioral health to cancer, heart conditions, and a multitude of other complex care conditions. We’ll see a transition from what we have today of a confusing sea of virtual care point solutions evolve to an even more comprehensive range of solutions available via a single app/access point. In the modern digital era, consumer experiences in other industry sectors are no longer restricted to physical location, so it’s natural that healthcare follows suit." —Lewis Levy, MD, FACP, chief medical officer, Teladoc Health

3.  Technological Advancements Will Enhance Capabilities
 

Artificial intelligence (AI) and machine learning have already made inroads into the practice of virtual care. As more data feeds into these systems, expect further advances in the move toward seamless care and the ability to more rapidly scale solutions across an enterprise. Readers also suggest that 5G cellular mobile communications and progress toward resolution of incompatibilities between technological platforms will contribute to more streamlined services.  

• Ochsner Health System: "We expect greater shifts towards utilization of connected devices to facilitate the patient experience. This includes home-based diagnostic standalone and wearable kits that easily transmit high-level health data between patients and healthcare providers. Similarly, we anticipate the advent of 5G cellular mobile communications to rapidly expand the speed and size of that data available to be shared to keep all of us healthy." —David Houghton, MD, medical director, Ochsner CareConnect 360, Ochsner Health System
   
• Carbon Health: "In 2019, telemedicine will go from the superficial to the deep. Rather than caring for simple medical problems where the patients have limited options, we see telemedicine becoming the doorway to everyone’s healthcare needs-even complex ones. Through AI and machine learning, patients will go from virtual care to physical clinics without losing a step, since these systems will all be integrated to coordinate the care. Patients will be able to get the right care at the right time and at the right price." —Caesar Djavaherian, chief medical officer, Carbon Health
   
• MDLIVE: "Automation and AI will be paired with telehealth to allow for better quality, quicker care and the ability to scale." —Rich Berner, CEO, MDLIVE
   
• Zipnosis: "To date, the telehealth landscape has been characterized by a large number of small vendors offering very specific technology, services, and expertise. 2019 will mark a turn from this, driven by the need of healthcare organizations to streamline disparate technologies and consolidate vendor relationships. I anticipate seeing individual companies offering a greater breadth of technologies and services along with significant work being done to eliminate data silos and technology platform incompatibilities." —Jon Pearce, CEO and co-founder, Zipnosis