Telehealth expanded during the pandemic because it offered access to medical care without requiring personal contact. Telehealth is poised to become an essential pillar of the U.S. healthcare system, offering innovative solutions to address workforce shortages, rising costs, and the unique needs of diverse patient populations. The shift comes as healthcare faces several challenges.
According to a recent Accenture report, a healthcare workforce deficit problem has worsened in recent years just as the industry faces greater demand, especially from heavy users in the 60- to 90-year-old age bracket; strained capacity because there aren’t enough clinicians to care for patients; costs that are rising because health systems have had to increase base pay and incentives; and a growing number of healthcare worker retirements. The National Council of Nurses expects more than six million nurses to retire during the next decade, and there could be a nurse shortage of 13 million by 2030. The shortage affects primary and specialty care.
The medical practitioner shortage is demographically driven—48% of the U.S. population will age into retirement by 2030, according to Kaveh Safavi, senior managing director of global health consulting at Accenture. “That’s important because people at retirement age consume healthcare three to five times the rate of younger people. However, this situation should become less severe in 20 years as Boomers, a large population cohort, pass away. Gex X is not as large, and that will ease demand.”
Meanwhile, high costs, especially for patients suffering from diseases such as cancer, can lead to so-called financial toxicity, which forces patients to forgo treatment or cut back on necessities to pay medical bills.
The Centers for Medicare and Medicaid Services (CMS) notes, “While primary care remains central to a high-functioning health system, Medicare beneficiaries and their care providers are facing greater clinical and health system complexity. To complement population-based models, fully achieving whole-person care requires the additional depth and scope of services offered by specialty care and the effective coordination of primary and specialty care providers.”
Telehealth, which continues to advance, may help the U.S. healthcare system achieve this level of care and overcome other challenges, including reaching underserved LGBQT+ patients who need culturally concordant doctors up to date on gender surgeries and changing regulations.
In the early days of telemedicine—dubbed Telehealth 1.0 by some industry observers—patient interactions with doctors were generally one-time appointments to treat a particular problem; the patient rarely saw the same doctor again. In Telehealth 2.0, patients can increasingly form lasting relationships with doctors, their healthcare universe is more closely integrated, and they have access to specialty care. Included Health, HealthTap, and Accolade are among the companies moving telehealth forward in this fashion.
“Telehealth was originally about access for people in underserved areas,” says Safavi. “But about 20 years ago, the medical profession realized it could be used for people already served because of the convenience. However, a shortage of clinical caregivers, which is everywhere and includes nurses and sometimes doctors, means the more pressing use case today has become one of access, not convenience. Most primary care practices have developed models that combine virtual and physical visits. Those that don’t will only be able to deal with certain conditions, which is problematic.”
“When thinking broadly about care delivery, location is an issue,” says Safavi. “Can greater access be achieved if it can be taken off the table? Maybe not for everything—doctors sometimes need to lay their hands on people—but certainly for some services. If I take the nurse’s job and break it into tasks, cognitive tasks could be handled by a competent nurse anywhere in the state or country. So, the labor pool becomes bigger. Shifting from offering convenience to increasing access improves telehealth platforms’ value proposition.”
That first wave of telehealth was not healthcare, says Included Health chief executive Owen Tripp. “It was not comprehensive, it was not sufficient, and ultimately not what people wanted in an ongoing medical relationship. The goal of Telehealth 2.0 is to have the same doctor, like the classic family physicians of the old days, who knew your entire history and had a comprehensive view of your health.”
As Safavi says, “People want a relationship in primary care, even if they don’t see that doctor in person all the time.”
Achieving this requires platforms such as Included Health that allow doctors to see lab results and images such as X-rays and MRIs and combine information from multiple specialties, all of which are possible with today’s technology. “In the broadest sense,” says Tripp, “we need a platform that can integrate not just everyday urgent care, but primary care that’s longitudinal, that sticks with a member’s specialty care, that brings an extra level of expertise and focus on a particular issue, and behavioral health that wraps the patient’s psychosocial needs alongside their pressing medical or physical needs.”
The next phase for Included Health, which serves 30% of FORTUNE 100 companies, is a newly launched Specialty Care Clinic, “a multicenter, virtual-first clinic that will provide rapid access to medical specialists and comprehensive support for the most prevalent and costly specialty care needs,” according to a company press release.
“There’s a great need to invest in this kind of care, which is more complicated and expensive,” says Tripp. The company will guarantee access to a doctor within seven days—which he says is “breaking the sound barrier”—in three specialty health centers: cancer care, metabolic health, and women’s health. The new platform will be a template for how the company will operate when it hopes to add further specialty care areas.
“You can think of telehealth like banking,” says Tripp. “I don’t care if my bank isn’t down the street because I do most of my banking online. But I don’t see it as online banking—just banking. Soon, we’ll stop talking about telehealth or virtual health. It will just be healthcare and medicine. Sometimes, you’re going to be in person, sometimes, you’re going to be on a video screen, and sometimes, you’ll be in your home or new care environments that are still being invented. I’m pretty optimistic about the future.”
