Northwestern Prof. Craig Garthwaite on the growing scope of larger payors.

Digital Health

Telehealth Linked to Quality as Extension Deadline Looms

Efforts to extend regulatory flexibilities for virtual care gained some wind in their sails from a new study in Health Affairs that linked telehealth use to significant quality improvements and a relatively modest bump in spending. 

Researchers assigned Medicare patients to health systems according to care patterns in 2019, then segmented the providers based on their telehealth adoption in 2020 (5.5M patients, 576 systems). They then analyzed outcomes for 2021 and 2022.

Patients at health systems in the highest quartile of telehealth use (27% of all visits) had an increase of 0.21 outpatient visits per patient per year, a relative increase of 2.2% compared to systems in the lowest quartile of telehealth use (9.5% of all visits).

• These patients also had 14.4 fewer non-COVID ED visits per 1,000 patients per year, a 2.7% relative decrease.

• Further, the patients at high-telehealth systems saw improved adherence to medications like metformin and statins, although there were no clear changes in hospitalizations.

Those improvements came at the cost of an additional $248 per patient per year at high-telehealth systems, a relative increase of 1.6% above the lowest quartile.

• The authors noted that this increase was largely driven by inpatient admissions and pharmaceuticals, but offset by decreases in outpatient spending.

Where do we go from here? With many virtual care flexibilities set to expire at the end of the year – like allowing Medicare patients to receive telehealth in their homes – regulators are on the clock to create more permanent policies.

• Policymakers have already proposed a bevy of bills to extend the flexibilities, but the debate carries on as the deadline looms.

The Takeaway

Given the access benefits, quality improvements, and modest increase in spending, this study only makes it harder to justify rolling back telehealth coverage for Medicare patients. The evidence is mounting, and it’s not too hard to picture a world where the arguments against telehealth only grow weaker as technology improves and providers optimize their virtual care services.

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The Wire

• Optum Shuts Down Virtual Care: Optum is throwing in the towel on its virtual care business, per an Endpoints News insider scoop that definitely drummed up more questions than answers. We’ll have to wait for Optum’s official announcement to hear the justification, but employees in the virtual care unit were notified about the shutdown last week, and apparently many of them were given last dates in July. Optum Virtual Care was a major part of the company’s push into telehealth in 2021, and it isn’t clear what the future strategy will be outside of commitment “to providing patients with a robust network of providers for virtual urgent, primary and specialty care options.”

• Banning Non-Competes: In a move that’s reverberating throughout the business and healthcare world, the FTC this week banned non-compete agreements. The move drew praise from physicians and nurses, who’s ability to switch employers has been hindered by non-competes, while the American Hospital Association (predictably) issued a statement panning the decision. Noting that up to 45% of physicians are involved in non-competes, the FTC estimates that this ban could reduce healthcare costs by up to $194B over the next 10 years based on the theory that non-competes drive consolidation.

• Physicians Warm Up to GenAI: A Wolters Kluwer survey showed that physicians are quickly warming up to generative AI, with 68% reporting they’ve changed their views over the last year and are now more likely to think the tech will be beneficial for healthcare. Of the 100 physicians surveyed, 81% say GenAI will improve interactions with patients, and over half believe it will reduce time spent not focused on patients by over 20%. A large majority of physicians (89%) also said that the deciding factor when looking at whether or not to use GenAI was transparency about where the training data came from, who created it, and how it was resourced.

• Headspace Rolls Out D2C Coaching: Headspace is boomeranging back to its consumer roots by rolling out mental health coaching services directly through its flagship wellness app, with D2C therapy slated for later this year. The therapy and coaching services will continue to be offered to the employer market, but the move into D2C seems like an all-around great play. It allows Headspace to offer additional services to its massive existing user base, while also presumably allowing it to sidestep many of the member acquisition costs that other virtual mental health providers struggle with.

• Are Payors Too Big to Fail?: A beautiful chart was making the rounds this week after Axios crunched the numbers on the six largest payors’ revenue as a share of total US health spending, which now stands at an impressive 30%. The size of these companies raises some big questions about whether payors being “too big to fail” is healthy for the industry, while also highlighting how quickly their scope is expanding. Of the top six payors, three processed nearly 80% of last year’s prescriptions, one is owned by the nation’s largest pharmacy chain, and one is the nation’s largest employer of physicians.

• Lumeris Raises $100M: VBC enabler Lumeris completed a $100M growth equity raise to support the recent expansion of its provider partnerships with some of the country’s largest health systems and provider groups. Lumeris integrates “all the necessary tools, capabilities, and know-how in an innovative shared risk model” to help its partners ensure VBC performance. It also happens to own and operate Essence Healthcare, the industry’s highest rated Medicare Advantage plan.

• Patient Review Volume Doubles: A new report from Reputation found that 86% of patients now read online reviews when seeking care, and that 73% demand a minimum 4 star rating to even consider engaging with a provider. The consumerism of care delivery is in full swing, and patient feedback volume has increased by 150% in just the last five years. Another interesting finding was that acute care hospitals that request reviews have an average star rating nearly one star higher on their online listings than those that don’t request reviews.

• DiMe Core Sleep Measures: DiMe and DATAcc debuted a new set of Core Measures for Sleep to advance the digital measurement of sleep and expand the role of sleep measurement in care delivery and research. The publicly available resources are designed to deliver accurate sleep measures for clinical researchers, clinicians, and digital therapeutic developers so that they can accelerate their path to helping patients.

• Summer Series A: Pediatric telehealth startup Summer Health closed $11.M in Series A funding to help parents tackle skyrocketing family healthcare costs and deteriorating youth mental health. The Summer platform is offered either directly to parents for $45/mo or through some employers, providing text-based answers from its providers to questions about primary and developmental care for topics like ear infections, rashes, or lactation.

• Gamification + Financial Incentives: The BE-ACTIVE study (n= 1,062) showed how home-based gamification tools and “loss framed” financial incentives can motivate people with high cardiovascular risks to be more active. An intervention combining points-based gamification plus financial incentives drove the greatest activity increases versus basic text reminders (+868 steps), followed by gamification alone (+538), and financial incentives alone (+492). Improvement in the gamification + financial incentives arm lasted another six months without further intervention.

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