The ‘New’ New Normal, Regulatory Changes & Healthcare Policy’s “Great Trajectory”

During the past two years, John Halamka, MD, has devoted quite a bit of time to studying the Covid-19 pandemic. In fact, thanks to countless hours spent building out the Covid-19 Healthcare Coalition and sifting through Medicare regulations, he has emerged as an authority on the topic.

And so, when he says he’s no longer using the term ‘post-Covid new normal,’ the industry should take notice. “Let’s just call it the new normal,” noted Halamka, who has served as President of Mayo Clinic Platform since December of 2019. “Over these 24 months, we’ve seen a fundamental change in cultural expectations for telehealth and virtual care” — one that has required a big lift from both a policy and a technical perspective.

During a recent webinar, Halamka and Jay Sultan (VP of Strategy, LexisNexis Risk Solutions), shared their thoughts on the “massive change in culture and the massive change in the deployment of technologies” that has taken place since March of 2020, and what it has meant for CIOs and other healthcare IT leaders.

Great(er) expectations

The most significant change, not surprisingly, is in patient preferences around care delivery. According to a McKinsey Report, between 40 and 60 percent of consumers want a broader set of virtual care solutions, such as a digital front door or lower-cost virtual health plan. “Patients want and expect their healthcare world to behave the same way as other digital worlds, and that speaks to convenience, security, and efficacy,” said Sultan. To make that a reality, “we have to rethink our pathways.”

One reason for that, according to Halamka, is that telehealth is actually “a whole collection of technologies and processes” that goes far beyond Zoom or FaceTime encounters. And although “it means many different things,” it usually falls into one of the following categories:

• Real-time communication
• Store-and-forward (the transmission of data, images, sound or video from one care site to another for evaluation)
• Remote patient monitoring
• Hybrid models

What’s been encouraging, he noted, is the fact that providers have become more comfortable with it. As of April 2021, 84 percent of physicians were offering virtual visits and 57 percent prefer to continue offering these services.

Changing behaviors

And while adoption has varied by specialty, the biggest uptakes have been in psychiatry and substance-use treatments. “The anxiety and depression that has occurred during this COVID era is an epidemic in the middle of a pandemic,” Halamka said, which means “the demand for behavioral health services is going to be increasing and unlikely to ameliorate in the next couple of quarters.”

Fortunately, those services don’t always have to happen in person — or even through synchronous virtual visits, thanks to tools like mindLAMP. Developed by John Torous, MD, Director of Digital Psychiatry Division, Beth Israel Deaconess Medical Center, the open-source app is designed to monitor changes in behavioral patterns that could predict an anxiety or depressive episode. “In this time where there’s a growing demand for mental health services, being able to do remote monitoring is key,” noted Halamka.

Regulatory landscape

What has made innovations like this possible are the regulatory relaxations put in place in the early days of Covid to provide coverage for virtual health services — in some cases, permanently. For example, Medicare beneficiaries can utilize telehealth for the diagnosis and evaluation of various mental health and behavioral disorders and substance abuse disorders, all while receiving reimbursement. “That’s a change that will be so important during this new normal,” said Halamka, adding that it can done synchronously or using audio only.

Rural health centers and federally qualified health centers are also being reimbursed for virtual visits, which helped enormously during disaster relief efforts in Kentucky, he noted.

Emerging technologies — including tools like remote patient monitoring that show promise but haven’t become standard of care — have been granted an extension through the end of 2023, after which they could earn permanent status in terms of reimbursement.

“High quality care” at a lower cost

In the meantime, having waivers in place opens the door to innovations like hospital-at-home, which Mayo Clinic is fully leveraging. According to Halamka, it offers “the same high-quality care” as patients receive at traditional brick-and-mortar facilities, but at a reduced cost.

And it’s not limited to physicians and nurses; paramedics are now able to provide care inside the home, which can help reduce the rate of hospital-acquired infections, while also improving the experience for both patients and family members. It has shown the effectiveness of removing site-of-service and scope of practice restrictions — and the criticality of continuing to evolve the reimbursement model. “We should be able to deliver high-quality, continuous care to anyone at any time,” he said. “My belief is that there will be such a high cultural demand that these services become permanent and become part of the fabric of care delivery regulations going forward.”

“It has to be strengthened”

Along with this rapid rise in digital health adoption, however, comes a new set of challenges for CIOs, according to Sultan, the first being infrastructure resiliency. “If we’re doing hospital-at-home and there’s telemetry coming from monitoring devices, it fundamentally changes the footprint of the technology infrastructure,” he noted. And that means leaders must have a solid disaster recovery plan in case the environment or communication pathway goes down. “It’s looking at the entirety of the infrastructure needed to deliver these services.”

Another hurdle is patient authentication. In the virtual setting, the risk of insurance fraud and identity theft are exponentially higher, Sultan said. “The more ports we have to open in the firewall and the more different types of telemetry we let into the system, the higher the threat vector.” He believes the way authentication is managed — which is focused mostly on inpatient encounters — has to be “rethought and significantly strengthened.”

Finally, there’s data access, which has played an increasingly important role in care delivery during the past two years. “As we’re doing more through digital methods, those diagnostic codes, complaints, patient notes and prescriptions need to become part of the patient’s record,” he said. “It’s going to require a different level of information sharing.”

These challenges, however, are surmountable, as long as the collaborative spirit that was present in the early days of the pandemic persists, according to Halamka. “There’s going to be a lot of learning. There’s going to be some risk, and we’re going to need to all work together.” But, all things considered, “we’re on a great trajectory.”

To view the archive of this webinar — Health IT Policy Update (Sponsored by LexisNexis Risk Solutions) — please click here.