Spectrum Health entered 2020 with a goal of having half of eligible primary care patient visits with its doctors occur virtually by the end of 2022.
Then came the COVID-19 pandemic that resulted in physician offices in Michigan being closed for three months in the spring, leading medical practices to redirect patients to telehealth platforms to connect with their doctors for low-acuity, routine care.
The result was exponential growth in virtual visits in 2020 after years of gradually gaining traction with consumers. At Spectrum Health, virtual primary care visits with doctors via the OnDemand telehealth service hit 35,000 in April 2020. That one-month total exceeded all of 2019.
Dr. Kristopher Brenner, a family physician and division chief for virtual medicine at Spectrum Health, describes the pandemic and 2020 as a year that “shot us out of a cannon” in using telehealth. The Grand Rapids health system has since exceeded its goal for virtual visits well ahead of schedule.
“We literally are 24 months ahead of where we ever dreamt we’d be,” Brenner said. “It’s moving faster than we ever anticipated.”
As of late December, Spectrum Health had recorded nearly 415,000 video visits in 2020, an experience that is typical of the massive growth in telehealth that began with the COVID-19 pandemic.
Kalamazoo-based Bronson Healthcare recorded more than 78,000 scheduled video visits through late December 2020 and 11,000 through its OnDemand Video Visit service. The health system completed just 248 video visits in 2019 and “we anticipate that telehealth volumes will grow and be expanded to support additional services in 2021 as more people and providers become accustomed to using this technology offering greater access to patients,” according to a spokesperson.
While telehealth visits flattened during the summer after physician offices reopened, care providers say they remain well above pre-pandemic levels.
Now that telehealth has broken far more into the public consciousness, care providers say it’s here to stay and will only become further embedded in health care as more consumers embrace the convenience the service offers.
“We don’t see telehealth going away once COVID is under control,” said Dr. Fred Reyelts, a family practitioner and medical director for innovation at Mercy Health Physician Partners.
“We also see this as a long-term piece of our repertoire of how we can take care of patients,” Reyelts said. “It allows us to practice in ways that we didn’t think we could in the past.”
Mercy Health began adopting telehealth in earnest early last year, before the pandemic hit.
In 2019, Mercy Health Physician Partners doctors completed “virtually zero” telehealth visits, Reyelts said. That changed with the events of 2020 and the resulting rapid rise of telehealth. Mercy Health now has a near-term goal of having 10 percent of primary care and some specialty physician visits occur virtually by the end of the first quarter of this year, according to Reyelts.
Having 25 percent to 30 percent of patient visits occur virtually within a year “is not unreasonable” for Mercy Health Physician Partners, said Reyelts, who in the last couple of months has completed half of his patient visits virtually after doing none in 2019.
According to industry experts, virtual doctor visits offer greater access to care, especially in rural markets, and are far more convenient for patients than in-person office visits. Care providers say telehealth is becoming commonplace for basic primary care, such as annual health checks or chronic disease management. They believe the platform will evolve to incorporate more care.
“I really believe that in the future of health care, your kids and my kids are probably going to be consuming care a little differently,” said Dr. Khan Nedd, CEO of Grand Rapids-based Answer Health LLC, an umbrella administrative organization for 200 independent medical practices with more than 1,000 care providers in the western Lower Peninsula. “That future is coming and we’re getting used to this telemedicine platform, but we can extend it to be much more of a complete, integrated form of how we care for patients.”
Freeing up capacity
Advances in medical technology enable doctors to do more virtually than ever before, according to Brenner at Spectrum Health. He cites internet-connected blood pressure cuffs and monitors, and hand-held devices with digital cameras that allow doctors in video visits to listen to patients’ heart and lungs, or to check their ears, nose and throat.
“We’re really almost starting to emulate in your home what we would listen to or look at (in the office) using these devices,” Brenner said.
Care providers use telehealth for routine primary care and also for consultations with medical specialists. Other uses include ongoing care for patients with chronic medical conditions or for patients after they’ve been discharged from a hospital.
In late November, Metro Health-University of Michigan Health launched a home monitoring telehealth service for recovering COVID-19 patients who otherwise met the criteria for discharge but remained hospitalized because they needed ongoing monitoring, said Dr. Lance Owens, the health system’s chief medical information officer.
Between Nov. 30 and late December, Metro Health had used the Hoboken, N.J.-based Health Recovery Solutions’ home monitoring platform for 29 COVID-19 patients after their discharge. The system uses tablets and internet-connected devices such as blood pressure cuffs, scales and pulse oxygen sensors to check and report a patient’s vital signs.
If a patient’s readings are outside of normal parameters, the system alerts a monitoring center that’s staffed by medical professionals who respond accordingly.
Through Dec. 23, the HRS system had saved 142 patient days at Metro Health Hospital, freeing up needed bed space as the health system was nearing capacity from the surge in COVID-19 patients, Owens said.
“We’re happy because we’re able to monitor them and we can open up a bed for someone else who may be sicker or someone who needs a crucial surgery,” Owens said. “Hospitals are bursting at the seams and freeing up one or two beds can make a big difference in the supply chain of hospital beds.”
Metro Health was already planning to use the Health Recovery Solutions system prior to the surge in COVID-19 cases this fall. The health system soon hopes to extend the home monitoring platform for patients with congestive heart failure or chronic obstructive pulmonary disease, Owens said.
High scores from patients
Mental health care and physical therapy providers also have made greater use of telehealth over the last year.
Among the top 10 diagnoses via telehealth for employees at self-funded companies that Grand Rapids-based benefits consultant Advantage Benefits Group Inc. works with, seven were for mental health issues ranging from anxiety and depression to alcohol abuse.
Overall, telehealth medical claims for Advantage Benefits Group’s self-funded clients have increased 2,600 percent in 2020 over the prior year, according to company President Bob Hughes.
Blue Cross Blue Shield of Michigan saw an “explosion” in behavioral health care through telehealth platforms in 2020, Chief Medical Director James Grant said. Half of Blue Cross Blue Shield members’ telehealth visits during 2020 were for behavioral health, Grant said.
Part of the driver in telehealth’s greater use has been consumer and patient satisfaction. In an October report by Troy-based J.D. Powers, telehealth received high satisfaction scores that were “among the highest of all healthcare, insurance and financial services industry studies conducted” by the firm.
Barriers to greater consumer adoption and the deployment of telehealth remain, namely through the lack of reliable high-speed internet access in some rural markers where telehealth can help to address provider shortages and improve access to care.
The new COVID-19 economic federal stimulus package Congress enacted includes $7 billion for broadband access, $300 million of which will go for rural broadband service and $250 million for telehealth.