The telehealth services we all relied on during COVID are fading away — but telemedicine may be entering a new era as providers look to bring the clinic home

 

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• Telehealth's rise during COVID-19 has expanded access to care for many people.
• But it's exhausted the capabilities of asynchronous care, one healthcare expert told Insider.
• Remote-monitoring tech could help bridge the gap between virtual care and physical exams.
• This article is part of "Big Trends in Healthcare," a series exploring the top trends shaping the future of the industry.

The telehealth boom of the last several years has been a benefit to many, like disability-rights activist Alana Saltz. She credits telehealth with keeping her safe, especially during the COVID-19 pandemic.

"As a chronically ill, disabled, and neurodivergent person, it's always been a challenge to attend in-person appointments," Saltz told Insider, adding that telehealth offered protection and limited unnecessary exposure to COVID-19 and other diseases.

But as we stride ahead in a post-pandemic world, those beefier, COVID-era telehealth services that millions relied on during lockdown are getting left behind as doctors increasingly prefer to see patients in person. Plus, changes to federal regulations may soon make it harder to provide virtual care at all.

So how to bridge the divide between doctors who want to provide high-quality, in-person care to patients and those, like Saltz, who would prefer telemedicine? The answer may lie in in-home monitoring technology, healthcare experts told Insider, which could be the next phase of telemedicine. 

Telehealth as we know it faces limitations

While some telehealth startups have found success, they face limitations.

Dr. Ateev Mehrotra, a professor of healthcare policy at Harvard University who researches telemedicine, argued that these startup models had exhausted the capabilities of asynchronous care.

"They're really convenient, and they're cheap, but they flip the clinical model," he said. "Instead of a provider's approach being 'I see what the patient's needs are, I diagnose them and prescribe a medication,' now the model is 'The patient wants this, I look for contraindications, and then I prescribe it.'"

That works well and carries little risk if, for example, a woman wants a prescription for birth control, he said. But "when you start talking about other medications, like propranolol for performance anxiety or antibiotics, all of a sudden you start seeing overuse of that care," Mehrotra added.

These models aren't always the most effective in diagnosing, since diagnosis often requires eyes on the patient or testing. But Mehrotra said that could change with remote-patient-monitoring technology. "What's needed is really to try to bring the clinic to the patient's home," he added.

Technology to monitor a patient's health could help pave the way for better telehealth

Some services that once required an office visit are becoming easier to access. There are devices on the market designed to, for example, allow parents to examine their children's ears at home and send the videos to a pediatrician. And pharmacies like CVS's MinuteClinic say they offer a quick, convenient way for people to take vital measurements like blood pressure without needing an in-office visit. 

Another example of a telemedicine model that uses in-home monitoring to expand access to care is the startup Bicycle Health. It has developed a protocol that allows people with opioid-use disorders to do drug screens from home (or elsewhere), check in with their providers virtually, and pick up suboxone or buprenorphine prescriptions the same day.

"A lot of my patients say, 'I wouldn't have sought treatment if this option wasn't here,'" Dr. Danny Nieves-Kim, an addiction-medicine specialist with Bicycle Health, told Insider.

Nieves-Kim said about 50% of his appointments involved patients sitting in their cars, adding that "sometimes there are urine drug screens being submitted on their dashboards." He described it as an indication of how telehealth could help more people access addiction treatment — and a contrast to a framing of in-person treatment as "quasi-carceral." Added Nieves-Kim, "In the winter, people are lined up at clinics before the sun has risen."

The company said a study it conducted suggested that telehealth accompanied by monitoring could help people in treatment for opioid addiction make and keep appointments and assist in getting them medications.

Telehealth's next phase will need to be speedy — but it faces challenges

Mehrotra said that because many Americans have come to expect quick service in other areas of their lives, it made sense that they'd expect that in their healthcare too.

"Anything that allows you to get care instantaneously is helpful, and some of these virtual primary-care practices make that front door and access so much easier than typical primary care," Mehrotra said.

But there are obstacles to getting this kind of care to patients, including doctors' resistance to telemedicine and federal and state regulation. 

The federal government has extended the COVID-era option for telehealth to be practiced across state lines, but only through 2024, and it's up to states and providers to waive the requirement for patients to see telehealth providers licensed in their state. Despite bipartisan support for broader availability of telemedicine — and federal legislation to that effect reintroduced in a fifth attempt in June — there are major hurdles. 

"For one-quarter century, this has been the domain of states," Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, told Insider. "There are legitimate concerns of patient safety, and states get to determine what the standard of care is within their borders — plus they get licensing dues."  

Efforts to codify interstate licensing confront "some of the diciest political issues in the country," Zebley said. 

At the same time, doctors are becoming less and less interested in providing telehealth services, according to a McKinsey report, believing that the best care is provided in person. This may be where in-home testing and monitoring can play an important role: If a patient is able to have a quick visit with a provider via telehealth that's informed by data from in-home tools, the quality of care will rise. But that's if the telehealth visit is available.

Telemedicine's expediency will only be sustained if there is a sufficient supply of doctors, therapists, and nurses providing care on par with in-person appointments, for the right patients. 

Pairing these fast, convenient front-door technologies with home monitoring has the potential to bridge that gap — but for now, everything hangs in the balance of policy limbo. 

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