Reports of telehealth’s death have been greatly exaggerated

By Owen Tripp and Robin Glass

“Telehealth is collapsing.” “Telehealth is going through a contraction.” “There is a dark cloud hovering over virtual care.”

These are just a few of the doomsday views sparked by the news that Optum and Walmart are shutting down their virtual care businesses. Many industry observers, connecting the dots to the current struggles of legacy telehealth providers, have concluded that virtual care is in trouble.

As the leaders of Included Health, a company that provides virtual care to a good chunk of the Fortune 100 companies, we’ve been baffled and bemused — more than usual, that is — by the headlines and hot takes.

Virtual care isn’t in trouble. What is in trouble are the aftermarket telehealth solutions that largely function as a virtual extension of our siloed, fragmented health care system. This specific application of virtual care, which we call Telehealth 1.0, has consistently failed to bring meaningful value to patients, clinicians, and purchasers.In that sense, its collapse is a welcome development. It’s a sign that the market discerns where the real value lies in virtual care, and it validates the evolution from transactional, one-off care to more sophisticated virtual-first models.

Through that lens, we’ll take a closer look at some of the questionable narratives that have been resurfacing.

Patients aren’t sold on telehealth

Claiming that patients haven’t embraced telehealth because the volume of visits leveled off after the pandemic is like saying people haven’t embraced remote work because some of us are commuting again. In fact, much like remote work, most people had their first taste of virtual care during lockdowns — and many don’t want to go back to the (doctor’s) office unless they really need to.

Users are highly satisfied with virtual care and often prefer it — when it’s available. A recent analysis of patients who didn’t have a virtual visit in 2022 found that the most common reason, by far, was that their provider didn’t offer it. Only 17% of people opted not to use telehealth.

This suggests a post-pandemic decline in access, not demand.

Private insurers began rolling back telehealth coverage as early as the fall of 2020 (often by reinstituting cost-sharing) and have continued to curtail access.

Brick-and-mortar providers have predictably followed suit. Facing an uncertain reimbursement landscape and the prospect that Covid-era telehealth mandates — including payment parity for Medicare visits — may expire, many hospitals and health systems are steering patients back toward in-person care to protect their practices and margins.

In the fee-for-service model, foot traffic matters more than ever.

Telehealth can’t replace in-person care

A common rationale for this brick-and-mortar backsliding is the notion that virtual care can’t match the experience of seeing a doctor in person. To be sure, many health care interactions (surgery, MRIs, giving birth) can’t be done virtually, but the list is getting shorter by the day.

Roughly 80% of primary care physicians and medical specialists say the quality of virtual care they provided during the pandemic was comparable to in-person care, and a growing number are discovering the value of virtual visits for chronic condition check-ins, medication management, and other routine yet high-touch care. According to an April report from the American Medical Association, specialties such as cardiology, oncology, OB-GYN, and neurology are leading the way.

But the AMA report drives home the tension between evolving clinical practice — what’s best for patients and doctors — and what’s best for the bottom line. Longitudinal specialty care that blends in-person and virtual care is the wave of the future, say the physicians surveyed in the report, but they also identified reimbursement as a major blocker.

Telehealth drives overuse and increased costs

Private insurers have long voiced concern that widespread adoption of telehealth would lead to overuse and higher costs. Our experience has been the exact opposite: Virtual care tends to reduce health care costs by improving access to essential care and by guiding people to the right care at the right time.

This was the clear takeaway of a three-year study Included Health conducted with Walmart — one of our oldest and closest strategic clients — to test whether virtual primary care could fill a gap for the 50% of their workforce who did not have a primary care provider.

Walmart associates who accessed virtual primary care — for managing chronic conditions, mental health screenings and referrals, preventive care, and more — saw improvements in their physical and mental health and had fewer emergency visits and inpatient admissions than a cohort of their peers. The total cost of care was 11% lower in the virtual primary care group.

These findings add to the large body of evidence that virtual care removes access barriers, closes gaps in care, and addresses health disparities among high-need populations including people of color, the LGBTQ+ community, and those with chronic conditions. Far from encouraging overuse or misuse, virtual care is key to equitable and efficient health care.

Moving beyond Telehealth 1.0

When we connect the dots, we get a very different picture than the telehealth doomsayers.

The common culprit in the telehealth closures making recent headlines isn’t virtual care. It’s the entrenched interests and the antiquated payment and care delivery models that have soft-pedaled and disincentivized health care’s overdue digital evolution.

The good news is, forward-looking care delivery companies and health care purchasers aren’t abandoning virtual care; they’re reimagining and rearchitecting it to be less of a siloed service and more of the connective tissue across all of health care.

The Telehealth 1.0 era that’s being left behind was an important stepping stone on the way to the modern infrastructure and experience that people need and deserve from health care. That is much bigger than a one-off virtual connection to a doctor; it’s a single place, designed around people’s needs, that serves the full range of physical and mental health and is fully connected to all of health care’s highest-quality resources and settings, both virtual and in-person.

Dark cloud? From our vantage point, the forecast is quite bright.

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