PART 1: TELEHEALTH… THE FUTURE IS NEAR

The outlook fortelehealthat beginning of2020was good with adoption trending in a positive direction. Asurveyof American College of Physicians(ACP)showedincreasedusage over the prior yearsuggesting continued steadyexpansion in 2020.The vast majority of ACP members surveyed were interested in learning more about telehealth technology as well as its effective and safe use in practice. Technologypenetration in threeprovider-focustelemedicine areasshowedthe strongestpotential:electronice-consults (42%),asynchronous evaluations (39%),and synchronousvirtualcare (33%). The expected short-term opportunity in adoption was video visit technology where it was alreadydeployed.Implementation ofthethreepatient-focusdigital telehealthareaswere less pervasive:Remote Care Management (28%),Remote Patient Monitoring(24%),andPatient Wearables(6%).The expected short-term opportunitywasincreasingavailability of these technologieswithin healthcarepractices. In general, thebarriers to adoption to date haslargelybeen financial and structural concerns, notalack of interestamongst providers.

ThisblogdetailshowtheCOVID-19public health emergency forcedthe healthcare ecosystem to addressmany of theseroadblocksto remote care.Itis the first in a three-part seriesexploringtheevolutionof telehealthand remote carein the post-COVID landscape.

Telehealth: Rise of COVID-19

WhentheCOVID-19pandemichitthe USinearlyMarch2020,thetechnologyimplementation of telehealthexploded overnight.As aleadindicator,submitted claimsfor telehealthservicesjumped83 timesnationallyin April 2020 overApril2019.TheOffice for Civil Rightsset the stagefor this growthby relaxingHIPAArequirementsaround the use ofthe commercial video conferencing solutions such as Zoom and Skype.State regulatorswerepushed to maintain a pool ofremoteprovidersby allowingtemporary licensingof healthcare professionalsacross state lines.FDArecentlyreleased as a series ofmedical device guidance documentsto increase availability of critical healthcare equipment andaddressthe need forsocial distancing and remote care.FCC allocated$200 millionto provide immediate support for funding healthcare providers telecommunication services.Most critically, CMS set the precedent for telehealth reimbursementduring the public health emergencyand the private payers followed suit.The ramp–upof the infrastructurefor practices and health networksin many instances tookbetween 48 and 72 hoursand leveraged makeshift staging areas.In some cases, parking lots were used for distributing laptops outfitted with camera to individual healthcare providers,whowereequallymotivated to continueworking.Even reluctant patients found themselveswelcomingthetelehealth visits and the feedback hasgenerally beenpositive. Telehealthwasdemonstrated as a serious alternative to in–person care for manytreatmentscenarios.In thekeynote addressat theAmerican Telemedicine Association(ATA)2020 conference,Dr. JosephKvedarproclaimed“Telehealth is now a household word.”

Telehealth: Industry in Turmoil

Thecurrentevidence suggeststhe telehealthindustry will continue to evolve as themarkethasnotreached a steady state.Giventhatthe impetus for thecurrentexpansionis the public health emergency, whatwill thefuture holdfor the industrywhen the pandemic subsides?Several privateinsurance companieshave alreadysignaled the potential end dates for supporting telehealth reimbursement.In response,United Statescongress is consideringlegislation to extendnationallythe current exemptions for180 dayspast the end of the public health emergency.In parallel,the statesRhode Island and Coloradoare looking to implement these changespermanentlyaround reimbursement.Telehealth usagedropped significantly in May 2020asPrimary Care Providers (PCP) restored operation by implementing protocols to manage COVID risk and keep both patients and staff safe.For platform vendors, the spike intelehealthimplementationsseen in March has been subsiding due to tempering ofdemand. In fact, an argument can be made that there may be consolidation amonghealthcare videoproviders giventhatso many solutions have been rapidly deployed in such a short period of time.As regulatory requirements tighten again, commercial toolsmaybe under renewedscrutinyin view ofnegative publicityfor platforms such asZoom.Healthcare regulators tend to demand a comprehensive approach tosecuringProtectedHealthcareInformation(PHI)as discussed inarecentcybersecurityblog.So, is the opportunityintelehealth industry alreadypast?Investment sageswill say thatnormalcareful due diligence is in play andstartups in this spaceneed tohave a novel approach to be competitive in the industry.

Telehealth:Wide OpenOpportunity

AFrost & Sullivan reportreleased in May2020predicts a tsunami of growthwith aone year increase of 64.3% over 2019. The compound five-year annual growth rate (CAGR)isestimated at 38.2%, whichissubstantially higher than previous pre-COVID era estimates.These projections may be fueled in part by continued favorable reimbursement landscape.A better explanationperhapsisthatthe dramatic shift in the industry has created a series of opportunities that will take time to realize.Due to Coronavirus,a decadeworth oftelehealth policyevolution happenedin just 2 weeks of time.Itmaytakea while for payers, providers, patients, vendorsand regulators to fully adapt to the new normal.There is now clinical evidence for changes in healthcare practices that normally would have taken multiple years torealize.With appropriate AI tools,thedata canbeused to create newmedical deviceopportunities in healthcare delivery.As anexample, the number and spacing of PCP visits during pregnancy has largely remained the same over the last several decades. Given the acute risks associated with COVID-19 exposure, providersarerethinkingcare plans and systematically replacingin–person visits with telehealth.Inanticipation of this trend, theFDA hasrelaxed regulatory requirementsfor medical devices supportingmaternal and fetal remote care. Inalot of ways,thestandard of care has been a barrier to innovation andthe newrisks introduced by thepandemic haveforcedthe risk–averse healthcare industry to make innovative changesout of necessity.This is just one example,buthow many morebarriersare out there thatmaydisappear over timeas the market adapts?

Telehealth:Remote Digital Health

The potential goldrush of opportunities in telehealth arebest understoodwithin thecontext ofemergingareasof digital health.Over 40% of the leading150 digital health companiesin 2020areincorporatingtheparadigmof remote delivery.Per the diagram below,thebase categoryofdigital health(white)encompassestechnologiesandplatforms thatengage consumers for health-related purposes; processes health-related data; and/or support(s)life science and clinical operations.This includes telehealth tools that enable the remote delivery of synchronous and asynchronous health evaluation and care,as well as consumer grade wearablesand wellness applications.The next levelin thedigital healthcontinuum(blue)entails platformsthat have beensubjected toclinicalvalidation andmay or may not beclassified asmedical devices.Digital Medicineiscomprisedofevidence-based software and/or hardware products thatperformhealth measurements and intervenesinthe service ofhuman health.Key example areas in telehealth include remote care managementand remote patient monitoring, including medical grade wearables. The final category in the digital health diagram(orange)contains what aregenerally software medical devicesthat requires rigorous clinical evaluation.Digital Therapeutics (DTx) productsdeliver evidence-based therapeutic interventions to prevent, manage or tread a medical disorder or disease.Thedelivery of thesedigital treatmentcommonlyoccursremote frommedical facilitiesandproviders by leveraging software applications on mobile smart devices.