Deep Dive Into Telehealth Adoption Covid 19 and Beyond | Doreen Amatelli Clark

November 2020
Telehealth for
COVID-19 and
Beyond
Doreen Amatelli-Clark
Way to Goal Business Insights
Copyright 2020 Way to Goal. All rights reserved.

Owner and CEO of Way To Goal Business Insights
Doreen Amatelli-Clark
Senior market researcher and moderator
with a strong qualitative and quantitative
background in various industries
Conducted more than 1,000 one-on-one
interviews and focus groups in a variety
of therapeutic areas and across every
stage of the product development cycle.
Over 25 years of market research
experience on the corporate side and
agency side of businesses.
Started my own market research consulting
firm in 2004 and has since worked with a
multitude of Fortune 100 Healthcare
companies.

Overview
• The role of telehealth
during the pandemic
• Physician’s attitudes,
perceptions, and initial
adoption
• How providers are using
telehealth today
• The role of telehealth in
the future
• Physicians’ predictions
• Impact of healthcare beyond
2020

Profile Of Physicians Interviewed
Practice Setting
Suburban 14
Urban 6
Years in Practice
5-10 years 6
11-19 years 4
20+ 10
Affiliation with HTC
Small Practice (10-30 staff; 500-1,000 3
Medium Practice (40-50 staff; 5,000-25,000 13
Large Practice (100+ Staff; 100,000+ Patients) 4
Primary Care Physicians
Practice Type
Hospital Network/ Health System 5
Integrated Delivery Network 0
Accountable Care Organization 2
Independent Practice (Group or Solo) 13
Specialty Physicians
Practice Setting
Suburban 23
Urban 12
Years in Practice
5-10 years 13
11-19 years 7
20+ 15
Affiliation with HTC
Small Practice (10-30 staff; 500-1,000 5
Medium Practice (40-50 staff; 5,000-25,000 25
Large Practice (100+ Staff; 100,000+ Patients) 5
Practice Type
Hospital Network/ Health System 10
Integrated Delivery Network 1
Accountable Care Organization 2
Independent Practice (Group or Solo) 22

Insight Into Our Methodology &
Sample Qualitative Research
Administration
and Setting
Method: Qualitative Interviews with 20 PCPs and 35 Specialists
Duration: 60 minutes tele-depth interviews (TDIs)
Fielding Dates: 4/16/20 – 5/5/20
Sample
Respondent Type: Sample Size:
Primary Care Physicians N=20
Cardiologists N=7
Psychiatrists/Clinical Psychologists N=7
OB/GYNs N=7
Dermatologists N=7
Oncologists N=7
Total N=55
Key Screening
Sample Parameters:
• Physicians who are currently actively using virtual video or telephone medical visits to manage
telehealth/telemedicine)
• Using virtual video or telephone medical visits to manage and/or treat patients in practice in
of patients
• Implemented and used telemedicine for at least 1 month; with subset/mix of practices that have
months

The forced adoption of
telehealth during the
COVID-19 pandemic is
creating a shift in
physicians' attitudes.

Evolution of Telehealth Perceptions Among Physicians
The widespread adoption of telehealth is
positively impacting attitudes about how to
provide healthcare
Patient care is largely
provided via in-person visits;
considered the only effective
way to provide care
Telehealth is considered a
temporary means to solve an
existing issue but not a long-
term viable option
After several weeks of
implementation, many physicians
are recognizing benefits of
incorporating telehealth
services and acknowledge
possible benefits as a
longer-term solution
Pre-COVID-19
Pandemic
First 3 to 4 weeks of COVID-19
Pandemic Announcement
Weeks 6 to 8 post-COVID-19
Pandemic Announcement

Pre-COVID-19 Pandemic
Before the COVID-19 pandemic announcement,
physicians had unfavorable perceptions of
telehealth
• Typically not used in vast
majority of brick and mortar
practices
• No experience in the use of
this method personally or
anecdotally from colleagues
• Awareness of its use in very
rural populations
• Believe telehealth is a sub-
optimal way to provide
healthcare; in-person visits
are considered a critical and
necessary element of patient
care
• Believe telehealth is not
practical for “my specialty”;
‘talk-therapy’ is most
feasible
Low Awareness of Use Lack of Relevance
• Low understanding of the true
definition of telehealth
(virtual visits? Emails/portal
patient communications?
remote monitoring?)
• Belief that technology will be
cumbersome and inefficient for
staff and patients
Lack of Tech Experience
It’s funny because I didn’t think it could be very accurate or easy. I
thought I would miss something and not be able to provide as good of
care to my patients.
- Primary Care Physician Copyright 2020 Way to Goal. All rights reserved.
“ “

It’s useful for patients who live several hours away, but it is still
very difficult for me to do exams and end of life discussions. It’s hard
to read body language and not be able to comfort them in person. But I
have to say, I didn’t think I could do all of this virtually.
- Oncologist
“ “
First 3 to 4 weeks of COVID-19 Pandemic Announcement
Immediately following the announcement of
the COVID pandemic, telehealth was
considered a possible, although difficult
option
• Early goal was to maintain
continuity of patient care
only as a temporary solution
allowing practices to keep
their virtual doors open, as
opposed to shutting
• Doubt and lack of clarity
about reimbursement (video vs.
telephone vs. in-person visit)
• Physicians were grateful to
have a virtual option, even
for physicians who expected
the reimbursement levels to be
lower than
in-person visits
Challenges in Patient
Care Expected
Uncertainty Around
Reimbursement
• Practices scrambled through
trial-and-error to select the
most efficient and medically
compliant technology platform
to facilitate virtual visits
• High skepticism regarding
technology and whether or not
users would be proficient in
its use
Steep Tech Learning
Curve Expected

Right now, I'm glad it's there. If we didn’t have it, then what would we
do? The whole world is affected, so it’s good that we have the
technology to be able to accommodate our patients.
- Psychiatrist
“ “
Weeks 6 to 8 post-COVID-19 Pandemic Announcement
Several weeks following the announcement of
the COVID pandemic, telehealth started to
be considered a viable option
• Medical Associations offered
best practices, resources
• Large practices/health systems
established
processes/protocols
• More reliable information from
CMS reduced anxiety
around reimbursement
• Practices were able to salvage
workflows
Increased Support from
Medical Community
Greater Clarity of
Reimbursement
• Early bugs and challenges were
rectified
• Surprising positive feedback
from patients as well as staff
was received on success of
technology
Trust in
Technology Increases

Practices without previous telehealth
capabilities are following a similar adoption
flow after the onset of the COVID-19 pandemic
Many practices
experienced a
significant
drop in patient
volume
Practices had to
find a solution to
continue
to provide care to
their patients
Some institutions already
had basic telehealth
capabilities in place;
others recognized it would
be the best option for
temporary solution
With the outbreak of
the COVID-19 pandemic,
states around the US
enacted a shelter-in-
place order
Late March 2020
(Within the 1st week
of shelter-in-place
orders)
(Within 1-2 weeks of shelter-in-place
orders)
n= 51 practices did not have telehealth capabilities already
established

Adoption flow continued...
Practices that are
part of large
hospital networks
have multiple
administrative layers
that determined and
approved the
telehealth platform
In smaller practices,
physicians/owners
along with office
managers and staff
made the decision of
the telehealth
platform
Practice staff
typically called
patients on an
individual basis
to inform them
that telehealth
was an option;
some also promoted
it on their
websites
Practices had to
choose which
telehealth
platform to adopt
based on various
criteria
Adoption process
involved training
physicians/staff,
purchasing necessary
equipment, and
contacting patients
n= 51 practices did not have telehealth capabilities already
established

Though telehealth has been available for many years, the COVID-19 pandemic has triggered a
nationwide uptake which has resulted in the following outcomes:
Overall, we are observing a shift in the
paradigm regarding the role that
telehealth is playing in healthcare
• Physicians are learning the ways in
which telehealth can be incorporated
into day-to-day care via trial-and-
error with various platforms
• Physicians have a greater understanding
of the limitations and best practices
of telehealth from being on the
frontlines
• Physicians are stepping out of
their comfort zones to redefine
traditional methods of practicing
medicine
• They are finding novel avenues to
empower patients virtually, i.e.
talking them through self-
examinations or educating them on
measuring vitals
• Many physicians have come to value
the positive impact that technology
has on the medial field and
recognize the importance of constant
advancements
• New technologies are emerging that
allow patients to track vital signs
and administer treatments from home
Increased knowledge of telehealth
practices and the range/limitations of
its use
Optimized creativity for
establishing new ways to provide
care
Streamlined traditional
healthcare with the use of
technology

The ultimate long-term impact of widespread
acceptance of telehealth is producing benefits to
patients, physicians, and the entire US healthcare
industry
• Reduces costs through
potential downsizing of staff
and facility
• Ability to maintain continuity
of care with patients
• Patients can better manage
their health needs through
more consistent medical visits
• Potentially more cost-
effective option for patients
• Expands healthcare reach to
patients who previously had
logistical, situational, and
lifestyle barriers
• Greater access to preventative
care ultimately reduces
healthcare
costs to the overall American
health system
• Improves efficiency in patient
flow (less wait time)
• Provides more flexibility for
providers (location,
availability)
• Larger responsibility of
patient care given to mid-
level providers reduces
physician burden
• Patients have greater options
to obtain care
• Less pressure on patient
schedule; substantial time
reduction (transportation,
office wait time, check-
in/check-out)
• Provides access to care during
time of crisis
• Strengthens physician/patient
relationship; patients feel
comfort and gratitude knowing
they can reach physician in a
new modality
• Forces changes to the current
coverage and legal policies
Benefits for
Physician/Practice
Benefits
for Patient
Impact of Telehealth on
the Healthcare Industry
Long-Term
Benefits
Immediate
Benefits

With proper implementation and
integration into the existing treatment
sphere, telehealth is now considered a
supplemental tool that is here to
stay.

How to ensure proper telehealth utilization
Physicians predict telehealth will
endure beyond the pandemic, assuming
the following conditions are met
Physicians/hospitals are being reimbursed properly for telehealth visits
Physician-patient confidentiality is secured
• Patients must feel they can relay information to their physician in confidence
via telehealth
• Telehealth platform must provide a secure log-in so patients know their session is
private
Telehealth is utilized for appropriate visit types
• Patients are visiting physicians virtually for follow-ups, medication refills, psych
evaluations, etc.
• Physician must be honest with patients and notify them when it is necessary to
come in-person
• i.e. for lab work, procedures, new patient visits, or pre-surgery visits
The appropriate platform is adopted
• IT departments and staff use trial-and-error process to find platform that is easy to use
for patients
• Platform is HIPAA compliant , does not lag, and integrates well with current EHR system
Patients feel like they are continuing to receive quality care via telehealth Copyright 2020 Way to Goal. All rights reserved.

“I think telehealth is here to stay and will be used across
all specialties, but it will be used more selectively in the
future. I imagine that a good portion of my patients will
request it in some occasions that make sense, maybe
about 30%”
-Oncologist
“I think it will continue. Now even as we are opening
back up slowly, we're finding patients continuing to call
us and want to be seen using telehealth. Patients like it,
so we will probably always offer that option when
applicable.”
-Primary Care Physician
“I think [COVID-19] is the catalyst to bring our industry to
the modern era of telemedicine, as long as insurance
companies continue to reimburse it. A lot of us have had
a surprising experience with it and see it
has a place in medicine.”
-Cardiologist
“I think this crisis…made it apparent that patients don't
have to be limited by location. Some aspects of
healthcare will continue on virtually…not all of course.
But the most revolutionary area that telemedicine is
likely to play a role in is the management of chronic
diseases and disorders.”
-Psychiatrist
“
“
Physicians are seizing this opportunity to standardize a
hybrid model for future patient care

How does the Telehealth
market look now?

As predicted by physicians in our study, Telehealth
utilization has dropped to ~20% since the start of
the pandemic, as more patients return to in-person
visits
• Telemedicine visits accounted
for just 21% of total
encounters by the middle of
July, down from 69% at the
early peak of the public
health crisis in April,
according to national data
from Epic, the electronic
health record company.
• Because of the major ramp up
in the peak of the pandemic,
healthcare practices will have
to work to find the right mix
between office and
telemedicine visits in the
coming months
https://www.ehrn.org/articles/telehealth-fad-or-the-future/ https://www.statnews.com/2020/09/01/telehealth-visits-decline-covid19-
hospitals/

The Telehealth market
continues to expand and is
investing heavily in future
growth
• By 2025, Telehealth is projected to exceed $64.1
billion in the US; Globally the market is
projected to surpass $130.5 billion
• From 2017-2023, the global Telehealth market is
projected to grow at a compound annual growth rate
of 16.8%
• Confidence in this industry is growing as we
continue to see companies filing for IPOs as well
as numerous mergers and acquisitions between
telehealth and digital health tech companies in
the upcoming months
https://www.gminsights.com/industry-analysis/telemedicinemarket
https://www.americantelemed.org/resource/why-telemedicine/
https://www.statnews.com/2020/09/01/telehealth-visits-decline-covid19-hospitals/

Continued use is dependent on several
factors
Patient Willingness
 Patients across all age groups have embraced telehealth since the pandemic and appreciate
the convenience it can provide
• According to a survey conducted by longtermcarepoll.org, 9 out 10 Americans over 40
years old are comfortable utilizing telehealth for themselves or a loved one,
debunking the myth that older generations are not as comfortable with Telehealth
technology
Proper Insurance Coverage
 National policymakers have still not confirmed whether they will establish permanent
coverage policies.
• Without permanent policy changes, it is unclear if telehealth services will represent
a significant proportion of U.S. health care visits in the long run
Technology
 Despite minor issues with utilizing the technology, access remains an issue for a portion
the US population.
• 23% of patients said they do not have the technology to support Telehealth visitshttps://www.fiercehealthcare.com/practices/rush-to-embrace-telehealth-many-physicians-still-have-concerns-about-
quality-care-survey
https://www.longtermcarepoll.org/many-older-americans-opento-using-technology-to-increase-access-to-care/
https://www2.deloitte.com/us/en/insights/industry/health-care/virtual-health-care-health-consumer-and-physician-

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