Maneesh Goyal, Chief Operating Officer at the Mayo Clinic Platform

Telehealth

Measuring Telehealth Outcomes During the Pandemic

Since the beginning of the pandemic, few studies have investigated the association of telehealth with outcomes of care, including patterns of care use after the initial encounter. New research published in JAMA Network Open set out to do just that, using a cohort of 40.7M US adults with commercial health coverage to examine the difference in outcomes between telehealth versus in-person encounters.

The study assessed Blue Cross and Blue Shield members from July 1, 2019, to December 31, 2020. Outcomes of care were assessed 14 days after initial encounters and included follow-up encounters of any kind, ED visits, and hospitalizations.

The key finding of the study was that telehealth has the potential to result in duplicative care, depending largely on the patient’s condition type. Telehealth patients with acute conditions were more likely to have a follow-up encounter than in-person patients, while telehealth patients with chronic conditions were less likely to require follow-up. 

In the cohort with acute conditions, the odds ratios for patients with an initial telehealth encounter were 1.44 for a follow-up of any kind and 1.11 for an ED encounter.

• Ex: Patients with an acute upper respiratory tract infection episode were 65% more likely to have a follow-up if their initial encounter was a telehealth visit, compared to in-person.

The chronic condition cohort showed contrasting results, with odds ratios of 0.94 for follow-ups of any kind if the initial encounter was via telehealth.

• Ex: Patients with essential hypertension were 37% less likely to have a follow-up if their initial encounter was a telehealth visit, compared to in-person.

For those that like to dive into the data, this table breaks down patterns of subsequent care by the clinical condition.  

The Takeaway

The contrasting patterns of telehealth follow-up care for acute and chronic conditions are relevant to both policy makers and providers. Telehealth use for the management of chronic conditions appears comparable, or even more efficient, than in-person care, with the opposite looking true for acute conditions. This trend was strongest for acute respiratory infections, but that also feels like a pretty natural result for a study conducted during a respiratory-related pandemic.

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The Wire

• Patients’ AI Perspectives: A new JAMA study suggests that most patients (n = 926 in 2019) are optimistic about the impact of healthcare AI, although a lot of that depends on how AI is used. The majority of respondents believed that AI would make health care either “much” or “somewhat” better (10.9% & 44.5%), while 19% “did not know” how AI would impact care, and just 4.3% believed AI would make health care “somewhat” worse. Perhaps more notable, most patients were “very” or “somewhat” comfortable with AI reading a chest X-ray (12.3% & 42.7%), but far fewer felt that way about AI making cancer diagnoses (6% & 25.2%).

• Google Pixel Watch: One of the largest announcements from Google’s recent I/O developer conference was the unveiling of the long-awaited Pixel Watch, the company’s first in-house attempt at a smartwatch. While Google’s been in the smartwatch market for a while through its WearOS operating system and acquisition of Fitbit, many are carefully watching the new launch (coming this fall) to see where the company will position the watch in its healthcare story. Health features, and the data they collect, have become key components of a smartwatch’s value proposition, and Google is clearly aiming for the 800-pound gorilla in the space with its new watch that looks … pretty much like a circular Apple Watch.

• Employee Health Privacy: Although at-home health screenings are frequently requested employee benefits, many are concerned about how their data is shared, according to Quest Diagnostics’ 2022 Health at Work Survey. Quest surveyed over 800 office employees at companies with more than 100 employees, finding that 89% consider health screenings an essential benefit for an employer to be considered a top choice. While 90% would like to be able to perform at-home biometric tests, 67% would not want their employer to know the results of their health screenings, and 55% are concerned about employer overreach in healthcare.

• Accrete Launch: Bon Secours Mercy Health announced the launch of Accrete Health Partners, a holding company designed to expand the organization’s digital health services and partnerships. Accrete will form a coalition of health systems and technology companies to connect the data and people needed to bring innovative solutions to market. BSMH CDO Jason Szczuka will helm the new entity, which aims to build products that add value as standalone solutions, but are also “categorically aligned, unlocking even more value when leveraged together.”

• SDOH Readmission Predictions: Sepsis readmissions are notoriously difficult to predict, but a new UCSD study found that including social determinants of health significantly improves predictive models. After developing a 30-day readmission model for patients enrolled in the AllofUs Research Program, incorporating SDOH factors on top of clinical features improved the AUC from 0.75 to 0.80 (P<.001), with economic stability and care delays each carrying predictive value. The work represents one of the largest-ever studies of sepsis readmissions (8,935 septic index encounters), which could make this model more generalizable than prior attempts.

• Mahmee Series A: Maternal health startup Mahmee closed a $9.2M Series A funding round to help it address disparities in maternal care through its subscription-based app that lets parents build a team of obstetricians and care coordinators to proactively monitor health needs and assist with navigating social services. The funding will be used to expand the startup’s provider network and add more partnerships with health systems, which use the Mahmee platform to conduct telehealth appointments and manage patient care plans.

• Telehealth Slowdown: Fair Health’s Monthly Telehealth Regional Tracker showed that overall telehealth use fell to 4.9% of all medical claims in February (down 9.3% month-over-month) as January’s omicron wave began to subside and more patients returned to in-person healthcare. COVID-19 also fell out of the tracker’s top three telehealth diagnoses in February, which now consist of developmental disorders (2%), acute respiratory diseases (3%), and mental health conditions (64%).

• GE Invests in Pulsenmore: GE Healthcare will invest up to $50M in home maternity ultrasound startup Pulsenmore, bringing GE into the fast-growing home care segment and helping Pulsenmore expand globally. GE Healthcare will support Pulsenmore as it brings its maternity ultrasound system into the U.S. and Europe, while the companies will collaborate on future home ultrasound products (perhaps beyond maternity & fertility). Although Pulsenmore has already achieved solid early adoption in Israel and other vendors have been advancing their tele-ultrasound products/strategies, GE’s investment gives the home ultrasound segment a new level of credibility and influence.

• Traveling Nurses: Hospital labor expenses have risen by 37% from pre-pandemic levels, according to Kaufman Hall’s latest workforce dislocation report. Heightened traveling labor costs were a main driver of the trend, with contract labor accounting for 11% of total hospital labor expenses in 2022, versus 2% in 2019. Contract nurses’ median hourly wages climbed 106% since the beginning of the pandemic (from $64 to $132 per hour), while employed nurse wages increased 11% (from $35 to $39 per hour).