Patients Really Like Telehealth. Let’s Resolve to Make It Work.

By Barbra G. Rabson

(January 2022)

At the beginning of the pandemic, I penned a post I called “Now Is the Time to Get Telehealth Right” in which I suggested that something good might emerge from what I called our “grand telehealth experiment.” Well, my friends, the pandemic may not be over yet, but we certainly have been learning a lot.

Among the many useful pieces of feedback that MHQP and others have received about telehealth over the past year and a half, I’d like to focus on one high-level conclusion from our recently completed “Telehealth One Year Later” surveys: Patients liked the telehealth experience much more than clinicians did.

89% of patients said their overall satisfaction with telehealth was either “Excellent” or “Very Good.” Only 3% of patients reported having had an unfavorable (“Fair” or “Poor”) experience. In contrast, 43% of providers reported that their experience with video was either “Excellent” or “Very Good” and 30% said it was “Fair” or “Poor.”

The pandemic has created a new tension in our healthcare system. Patients have had a bite of the telehealth apple and will continue to demand its convenience. Providers have a lot of work to do to meet this demand.

MHQP recently hosted our annual meeting that brings together representatives from our Board and our three Councils (Clinician Council, Health Plan Council and Consumer Health Council). It’s my favorite meeting of the year because it embodies the true essence of MHQP – our unique ability to convene multistakeholder groups to tackle challenges none can solve alone. Each year, we prepare a special discussion topic for this unique group. This year, we posed this question to the group: “What are the ramifications of patient satisfaction with telehealth being much higher than clinician satisfaction with telehealth, and what can we do about it?”

The patient representatives in the group confirmed what our survey results already suggested: patients like telehealth primarily for one reason – convenience. While they understand some situations require a face-to-face visit, they appreciate being able to connect with their clinicians remotely because it allows them to avoid the hassles and safety concerns involved with getting to their provider’s office. Here, for example, are some quotes we captured from the meeting:

“We need to rethink the burden we place on patients to travel, pay for parking, wait in the office, and then spend 10 minutes seeing a provider.”
“Telehealth has highlighted the convenience for patients. When we ask patients to come for an in-person visit, it’s not just a 15-minute visit, sometimes it’s a day off of work.”
“Patients were already talking about this well before the pandemic. Convenience was already a question in access to care.”

Clinicians, on the other hand, seem less enthusiastic about the convenience factor. Having to shift to telehealth nearly overnight amid the stress of the pandemic, in some cases without adequate technology and support, led many to have experiences that were very challenging, especially for providers who simply prefer in-person visits and miss the “hands-on” aspects of their practice. Here, for example, are some quotes from clinicians in the meeting:

“For providers, it is a different paradigm of care. It’s a cultural shift. There is no laying hands on people. It’s a different experience. We didn’t train that way.”
“Doctors were thrown into telehealth. There is an enormous transitional process where young physicians that are adept at tech and see the benefits have a different perspective than older physicians.”
“The quality of telehealth is dependent on how much an organization embraces telehealth.”

What Can We Do to Optimize Effective and Equitable Telehealth Use?

It never ceases to amaze me what happens when we bring together patients, clinicians and administrators to discuss the challenges each faces from a different perspective. In this case, the participants collaborated to identify five categories of barriers that need to be addressed to optimize telehealth, as well as a variety of detrimental scenarios in which these barriers play out:

Barriers	Can Lead To…
Lack of system support for telehealth	Provider frustration and burnout Care not being cohesive
The “Digital Divide”	Inequities in patient access to telehealth with certain populations unable to navigate telehealth platforms
Confidentiality and privacy concerns	Creating barriers to engagement for patients with limited access to private spaces or confidentiality concerns
Quality concerns	Provider hesitancy Patients who are less likely to engage Plans that are less likely to pay for telehealth
Outdated reimbursement	A focus on visit-based care Hesitancy to invest in telehealth services Disagreement and debate around each new care modality

The group then offered a variety of action steps and specific ideas to address these issues:

Action Steps	Specific Ideas
Create guidelines to triage patients for mode-appropriate appointments	Work collaboratively across provider stakeholders to develop a visit type algorithm which incorporates the patient perspective Explore a hybrid model that evolves based on what the patient needs at the time and what is the appropriate mode of care
Measure both patient and clinician experiences of telehealth	Continue to monitor patient and clinician experience of telehealth, including comparing different care modalities Assess equity concerns by measuring telehealth experiences of populations with limited access
Improve patient and clinician support for conducting telehealth visits	Interview providers about their technical support needs to better inform workflows and resource allocation Support policies that address digital divide issues, including educational materials to help patients navigate telehealth Promote community and employer sites where patients can have confidential telehealth visits
Continue to monitor and address equity issues	Conduct qualitative and quantitative research to better understand and address barriers to accessing and using telehealth Develop patient education materials tailored to those who do not feel confident in their ability to use telehealth technology Support policies that subsidize telehealth-enabled devices, improve broadband infrastructure, and create public spaces with computers available for telehealth access
Educate around fair reimbursement for telehealth and telehealth products	Work with stakeholders to assess how to revise payment methods that encourage appropriate use of whichever visit type meets the patients’ needs Incorporate patient perspective into telehealth-only or telehealth-dominant products

Taking these steps and others will help ensure telehealth works for both patients and providers in the future. Telehealth is not optimal for all clinical circumstances, but there are many clinical situations where it is the perfect solution. Now that patients have had a taste of that solution, they will not have much patience for bureaucratic requirements that create inconvenience. Products and services that address these customer needs will rise; those that do not will fall. Just look at what happened to bookstores when Amazon came along.

As one participant in the meeting said, “There is a risk that if we do not get telehealth right, we may never get to more innovative delivery methods. 100% telehealth is an overcorrection which will fail. There is a right way for each situation; it is not all or nothing.”

MHQP is committed to finding ways to work collaboratively to move this agenda forward. One thing is clear: this tension is not going away soon. We need to take collective action now to ensure delivery and reimbursement systems support the care that meets the needs of both patients and clinicians, and provides the right care at the right time in the right place.

Please contact me at brabson@mhqp.org if you would like to discuss next steps.