We’ve had an action-packed year in telemedicine, but now it’s drawing to a close. Current estimates predict our market will hit $130.5 billion by 2025. That confirms our observations that virtual care is becoming an ingrained part of medicine – but with that growth inevitably comes change. Telehealth is the market that never stops moving, so let’s look back and review the dynamics, announcements and updates that shifted our world in 2019.
Reimbursement and Regulatory Changes
Let’s start with something that matters to many providers: reimbursement. Getting paid for telehealth services has long been an irritant, especially for overworked clinicians who are already struggling with burnout and don’t have time to deliver poorly compensated care. The good news is that reimbursement is on a steady upswing and 2019 was especially positive.
- The Center for Connected Health policy’s 50 State Telehealth Laws & Reimbursement Policies report noted the continuing differences in state reimbursement for store-and-forward, live video and remote patient monitoring services; Foley’s 50-State Survey of Telehealth Commercial Payer Statutes said that “while reimbursement remains a major frustration for telehealth, the landscape has significantly improved.” Their survey found that currently 42 states have a telehealth commercial payer statute, which they said “represents real progress over the past five years.”
- The Center for Medicare and Medicaid Services (CMS) announced in their CY 2020 Physicians Fee Schedule that three new codes for opioid use disorder treatment would be covered, including telepsych components; CMS also finalized new reimbursement rules for Remote Patient Monitoring. After receiving feedback that obtaining consent for every single virtual service is burdensome, CMS also revised this policy to only require consent once a year.
- The Federal Communications Commission(FCC) released a report that examined barriers to telehealth and made official recommendations for software interoperability, more generous reimbursement rules, greater access to broadband Internet and more efficient licensing pathways. Will these changes unroll overnight? No, but it’s clear that government and business leaders are committed to their implementation.
- The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 gained significant support from more than 100 organizations, including the American Medical Association. The CONNECT Act is aimed at removing what AMA President Patrice A. Harris, MD, MA called “antiquated restrictions in the Medicare program” while addressing alternative payment models and the reimbursement approval process.
Tech Visionaries Reinvent Telehealth
Technology captains of industry have long talked about disrupting healthcare through telemedicine; this year we got a clearer look at what that looked like. These forays into virtual health share the same goals of traditional healthcare systems, such as improving patient outcomes and lowering the cost of care. But the tech industry’s innovative “fail faster” model means that these visionaries are using new methodologies, designing new best practices and forging new partnership opportunities.
2019 kicked off with Microsoft and Walgreens announcing their partnership in creating a connected health platform. Telehealth stations and digital AI health tools are aimed at helping consumers engage intelligently with their care from preventative screenings to chronic disease management.
But no one grabbed more telemedicine headlines than Amazon. This year the retail giant announced the launch of Amazon Care, a virtual primary care clinic catering to some of the company’s employees by offering video provider visits and home delivery of prescriptions. The company has also acquired PillPack and Health Navigator and launched Haven, its joint venture with JP Morgan and Berkshire-Hathaway
Many industry leaders believe Amazon will eventually extend these programs to its millions of Prime subscribers. To that end, they’re watching closely to see how these tech leaders use their business muscle to dissolve or work around regulatory barriers. The healthcare industry has slowly but doggedly chipped away at licensing, cybersecurity and interoperability challenges; many observers are hoping Big Tech can blast a faster path through the regulatory wilderness and accelerate telemedicine adoption across the world.
2019 Trends and Markets
While telemedicine has been growing steadily over the years, 2019 made it clear that video calls to rural patients are now just a tiny piece of the pie. Here are a few trends that dominated the market this year.
Virtual care goes international. A massive virtual health deployment in Latin America, TeleMeditar, is on track to hit one million appointments in the first six months; across the ocean in Zimbabwe, a massive United Nation-funded deployment has not only brought care to remote African villages but also provided urgent disaster response emergency care after Tropical Cyclone Idai left thousands dead, missing and injured. (If you’re attending HIMSS 2020, don’t miss our Thursday presentation on Transforming the African Health Crisis with Telemedicine.) From China to Pakistan to Finland, new telemedicine companies are cropping up. Europe is especially active in virtual health adoption as government and healthcare leaders turn cross-border collaboration into medical breakthroughs.
Telemedicine leaves the healthcare world. Academic medical centers have been a key player in bringing telehealth outside the clinical walls. This year they expanded their reach in prisons and school-based health centers, which are bringing consistent care to disadvantaged children. Workplaces are also creating virtual kiosks and clinics to offer onsite care to their employees and efficiently address workman’s compensation issues.
Leaders address specific healthcare crises. The U.S. Department of Veterans Affairs’s telehealth app hit almost a million patients in 2019, with app usage up 235 percent this year. Two-thirds of appointments were for telepsych visits. 2019 also saw concerted efforts to harness telemedicine to manage chronic disease costs, control the spread of infectious disease and address the opioid crisis.
Telehealth specialty apps keep growing. While most bigger telehealth companies provide services across the care spectrum, many startups are focusing on specific clinical issues. Cohero Health offers virtual respiratory disease management; YouThisMe specializes in remote patient monitoring for chronic conditions. Maven addresses women’s health needs, Apostrophe provides dermatological care, Ria Health offers personalized mobile alcoholism treatment and BreakThrough, WellPsyche and TalkSpace focus on telepsych. Even pets have their own telemedicine app: Modern Animal. While these companies show that the public, particularly Millennials and Generation Z, want digital care, they also indicate the potential for an increasingly fragmented healthcare journey for patients.
A New Decade of Smarter Healthcare
And that’s 2019. If you’re curious about where telemedicine is headed, you’ll need to tune in come January for our reimbursement forecast and our prediction for 2020 trends. But there’s one prediction we can safely make now. Virtual care will only become more popular, more clinically sophisticated and more essential. It’s just too good at solving healthcare’s biggest challenges.
See you in the next decade.