A Pandemic Silver Lining: Transformed Health Care Delivery

COVID-19 is transforming how Americans get health care.

Before the pandemic, when people felt sick, they went through a familiar drill -- make an appointment, drive to the doctor's, and all too often, wait. But as health-care providers reduced in-person visits this spring, all that changed. By May 2020, nearly 50% of patients sought care remotely via phone or video appointments with their doctors, up from just 11% in 2019. Almost 80% of Americans now say they're interested in virtual visits, according to a survey by McKinsey & Company.

The transformation goes beyond telehealth, though, to include more use of online portals, digital medical devices, and in-home treatment. Collectively, these changes are accelerating a shift towards "patient-directed care." Previously, doctors acted as the final arbiters of what patients needed -- but now doctors and patients collaborate to make decisions. Ultimately, everyone gains from this evolution. It's up to lawmakers, regulators, healthcare professionals, and patients themselves to ensure these positive changes last long after COVID-19 recedes.

The potential ramifications of this shift are enormous.

Telehealth appointments, for example, are quicker and more convenient than the alternative, significantly decreasing travel and wait times. In a 2018 survey published in JMIR Medical Informatics, 88% of patients said telehealth had saved them at least one hour per appointment, and 41% said it saved more than three hours. Another study found that for two out of three patients, telemedicine increased overall satisfaction with their care. Telehealth is also considerably less expensive. An in-person doctor's visit costs $146, on average, while the average phone or video consultation costs $79.

Meanwhile, COVID-19 has ramped up the use of digital monitoring technology, for instance, by using cell phone data on patient whereabouts, provided with permission, to better understand the disease. The need to stay home has also encouraged patients to use online portals for tasks like ordering prescriptions and reviewing their own lab results.

The idea of browsing our own medical data or tracking our own symptoms may take some getting used to, but the results are encouraging. For example, the University of Southern California's Keck Medicine ran a pilot study in which it provided lung transplant patients with a tablet and a bluetooth-enabled device that detects signs of organ rejection. The device measured stats on blood pressure, heart rate, and lung health, which were shared with doctors in real time. Patients with the monitoring kit had 44% fewer hospital readmissions than a control group, and spent 54 fewer days in the hospital when they were readmitted.

The success of the pilot program showed Keck Medicine how it could massively expand virtual care when the pandemic hit. For instance, one group at Keck is now exploring high-tech socks that use fiber optics and sensors to tell when diabetes patients begin to develop foot ulcers.

Covid-19 has also sped up a trend towards not just diagnosis, but actual treatment outside of traditional settings. Spurred on by the pandemic, the non-profit healthcare system Intermountain Healthcare is now launching an at-home bone marrow transplant program.

Patients can only benefit from these exciting developments if we make sure they last. When the pandemic first started, the Centers for Medicare and Medicaid Services relaxed restrictions on telehealth. As a result, doctors don't have to provide evidence of a prior relationship with patients when filling out virtual-appointment claims. And they don't necessarily have to be licensed in the same state as their remote patients.

These rule changes were originally only meant to last through the pandemic. But patients, providers, and advocacy organizations are asking officials to make them permanent.

And now that patients are in the driver's seat, we'll need to make sure they have the right directions. Because of hospital restrictions due to COVID-19, patients are struggling to meet the requirements for accessing treatment. Organizations such as the Children's Tumor Foundation would like to assist by telling patients exactly what they need to do before they can get a drug -- whether that's simply getting their blood pressure checked or undergoing more complicated exams, in-person or remotely.

The coronavirus has taken a terrible toll on our country. But it is also bringing the future closer, empowering patients to take greater control of their care. We are all ready to bid the virus farewell, but should embrace the positive change it has brought.

Annette Bakker, PhD., is president of the Children's Tumor Foundation