Dr. Syed Hussain, Senior Vice President and Chief Clinical Officer, Trinity Health Of New England
November 30, 2020
Hartford-area doctors eye expanded use of telehealth, even as some payers balk
PHOTO | STEVE LASCHEVER
Hartford HealthCare sports neurologist Dr. Stephanie Allessi-LaRosa has adapted her examinations to videoconferencing technology.
By Liese Klein
Look up. Look down. Walk in a straight line. Can you tell me what day it is? Can you tell me who the president is?” (OK, that one might be tricky.)
Dr. Stephanie Allessi-LaRosa, a sports neurologist at Hartford HealthCare, asks a standard set of questions when she examines a patient who may be suffering a concussion. In her role as a physician for teen athletes as well as MMA fighters and boxers at Mohegan Sun, she treats many head injuries.
Lately, however, her questions and basic examinations often happen over Zoom, with her patient following along via phone or laptop.
“I can give them different commands, giving them a target on the left and right of the screen,” Allessi-LaRosa said of her new diagnostic routine. “It doesn't completely replace in-person assessments, but we definitely have made it work.”
Allessi-LaRosa is one of thousands of Hartford-area physicians who have pivoted quickly to videoconferencing technology for patient visits since the onset of the COVID-19 pandemic. So called “telehealth” or “virtual health” technology has been adopted by both patients and providers with astonishing speed since earlier this year, after decades of lagging in its acceptance.
Now, months into the pandemic, local healthcare providers say they are eyeing new and expanded uses of telehealth as it becomes a normal part of their operations. But that doesn’t necessarily guarantee the long-term growth of the service, as some insurers begin to balk at the higher-than-usual reimbursement rates they’ve been offering providers since March.
“The pandemic has served as a catalyst, ... one of the silver linings is virtual care,” said Dr. Syed Hussain, chief clinical officer for Trinity Health Of New England, which operates St. Francis Hospital in Hartford.
At the start of the pandemic, Trinity had only a basic virtual-care platform in place, which saw very little activity. When the first lockdown hit, the health system quickly deployed several videoconferencing software products for use by patients and providers. Virtual health visits peaked during the first COVID-19 surge in April at 32,454, and average monthly visits hovered around 26,700 from May to July.
“This is our phase 1.0 of virtual care, but we would like to take it to the next level, which is even more access and ease for the patients we serve,” Hussain said.
Primary care and mental health services have been at the forefront of deploying virtual tools at Trinity Health, Hussain added, due to high demand from patients and relative provider shortages. The service was then expanded to cardiology, with the help of biometric devices that patients can take home to help doctors remotely monitor their vital signs.
The next level for Trinity is hiring “virtualists,” physicians and other providers who specialize in using videoconferencing tools to diagnose and treat patients. St. Francis is the first hospital in the region to start hiring for this position, Hussain said.
“I think it’s here to stay,” Hussain said of virtual health. “We want to get ahead and leverage this tool to be able to provide those services to the community.”
Crisis innovation
Hartford HealthCare had been working with a virtual health program integrated with its Epic medical records system for several years when the pandemic hit. Virtual health visits went from a handful to 100,000 in a few months, now totaling more than 300,000 since COVID-19 arrived.
“This to me is sort of quintessentially about what a crisis does to accelerate innovation,” said Dr. Barry Stein, Hartford HealthCare’s vice president and chief clinical innovation officer.
Dr. Barry Stein
The quick surge in virtual health was made possible by interest from both patients and providers and the relaxation of state rules and insurer restrictions on reimbursement, Stein added.
“We had demand on both sides and the other constraints both regulatory and payer were relaxed,” Stein said. “That really unleashed this incredible transition from in-person to virtual, literally overnight in a blink of an eye.”
Virtual health has changed how providers do their jobs, Stein added.
“Very quickly what we used to believe was essential for a visit was challenged. Legacy thought processes about how to take care of patients were challenged, not because of anything other than out of necessity,” he said.
The upsides of the technology come with some downsides, including the potential to widen the digital divide between those with access to devices and those without, said Susan Marino, Hartford HealthCare’s vice president and chief nursing information officer.
“It's critical for us — we can’t leave out a huge component of our population of patients, especially here in Hartford,” Marino said.
Hartford HealthCare has implemented programs to get devices to needy patients and ensure that language barriers don’t restrict access to digital health.
Susan Marino
“We have a lot more to go,” Marino said. “But we definitely have strategies and plans under way.”
Payer caution
The enthusiasm for virtual health doesn’t necessarily extend to payers, who have expressed concern that the technology will balloon the costs of health care as “dialing a doctor” becomes nearly as easy as checking your Instagram feed. Claims to insurers for virtual-health visits have jumped 4,347% since last year, according to America’s Health Insurance Plans, a national association of insurers.
Insurers agreed to relax virtual-health rules on an emergency basis and have balked at extending “pay parity” for virtual visits, which were historically provided at a lower rate than in-person visits. The Connecticut Association of Health Plans has asked that the state undergo the usual negotiating process around reimbursement for virtual health once the pandemic crisis has passed.
Some insurers have already started changing their coverage around virtual health: UnitedHealth and Anthem were set to impose out-of-pocket charges on certain virtual visits starting in October. Lower rates could lead to eventual cutbacks in virtual-health offerings as hospitals struggle to deal with pandemic-related financial losses.
Stein of Hartford HealthCare said he expects insurers to adapt to the new landscape for virtual health, prompted by their customers.
“Their business models have to change, their infrastructure has to change,” Stein said. “But thankfully, the most powerful advocates for this are our patients.”
First virtual plan
One local insurer, Harvard Pilgrim Health Care, has embraced virtual health, announcing on Nov. 10 the launch of the state’s first “virtual primary care plan.”
The new plan, called SimplyVirtual, gives members access to virtual visits with primary care providers through Doctor On Demand, a growing platform co-founded by TV’s Dr. Phil. Larger employers with more than 51 subscribers have access to the new plan.
Harvard Pilgrim saw member use of virtual health services jump by 6,148% in Connecticut alone this year, and the company said patients were still interested in the technology despite a partial resumption of in-person services.
“The COVID-19 pandemic has shined a light on the need for insurers to provide members with innovative, convenient and high-quality options when it comes to their medical and behavioral health needs,” said Paul Bartosic, Harvard Pilgrim’s Connecticut market vice president.
Looking ahead
Even as reimbursement issues are sorted out, providers have big plans for the deployment of virtual health technology going forward.
At Trinity Health, Hussain envisions a time when a patient can see multiple doctors during a single virtual visit, allowing for consultation and collaboration to improve care. A patient with family members in three distant states can bring them all together in a meeting with doctors to figure out the best care options.
At Hartford HealthCare, Stein looks forward to an expanded range of biometric devices that can be used to give a patient near-hospital-quality monitoring at home.
Hartford HealthCare’s medical staff is already benefiting from the expansion of virtual health, Marino said. Trainee nurses in the intensive care unit at Charlotte Hungerford Hospital in Torrington are being supervised virtually by more experienced ICU nurses who coach and mentor them.
“This is not going away, this is not one of those fads that goes away,” Stein said. “We are anticipating this connectivity to really be with us for a very long time and get better and better and better.”
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