During the pandemic, the use of telehealth and other digital health solutions skyrocketed as people looked to virtual options to get their care. Where’s the U.S. now with digital health, and what can be done to deliver digital health solutions to more people?
To answer these questions, host Ashley Bach spoke on this episode of HealthChangers with Dr. Daniel Meltzer, executive medical director at Regence. Dr. Meltzer is based in Idaho, a state with a large rural population, and he’s passionate about the power of digital health to make underserved communities healthier.
Listen to the full podcast episode on the player above. Below are some highlights, which have been edited for length and clarity.
AB: I wanted to start by asking, why is digital enablement of health care so important?
DM: There's not a quick answer to that one. What we’ve learned over the past decade-plus is that so much of a person's health outcomes are driven not necessarily by their “gene code,” but by their zip code. We call these things social determinants of health. These are the non-medical factors in a person's environment. These include things like nutrition - do you have access to food? Can you afford the food? Do you have secure housing? Do you have transportation? And some of the other pieces are affordability, literacy and access to digital technology.
The reality is that in less urban areas — of which there are many— virtual-first health care, whether it's behavioral health, for chronic conditions or even acute conditions, can be lifesaving. But it does require connectivity which can be provided by broadband. And what we've learned about digitally enabled health care is that for many people, it's just easier; it's swifter; it's more convenient.
It often can be accessed 24/7, it can be more affordable. It reduces sitting in a waiting room in winter where you may be exposed to other communicable diseases. It brings care into the home. It may allow for access to certain specialties which may not be otherwise available in the community. It can also reduce things like administrative costs and allow for more frequent touch-bases. So, it's another way for providers and patients, physicians and patients in particular, to connect in their home, and it's critically important in this day and age.
AB: Virtual doctor's appointments are probably what most people think of when they think of digital enablement of care. But that’s really just part of the story, right?
DM: People think of digital health care for a lot of reasons. One is third-party programs or companies. People may have heard of Teladoc, Doctor On Demand, MDLIVE, to name a few. Often they’re used for acute care. So, I'm at home at 7:00 at night. I just got done making dinner, and, you know, my kid is coughing or has a fever. Or I cut my finger while I was making that dinner, and I'm not sure if I need to come in to see a provider or not. So, these are types of situations, for example, where digital care can be very helpful.
In fact, the state of Idaho, where I'm based, convened a Telehealth Task Force that published some interesting hypothetical cases.
One of those cases: we know that teenagers are susceptible to significant behavioral health challenges. And let's imagine that there's a teenager at home who's threatening to harm himself. Maybe the police need to be called. Well, the police have the ability to use telehealth to access local behavioral health providers to perhaps de-escalate the situation so that the patient can be cared for and stay at home. He doesn't need to be pulled into the emergency department or dragged in by police officers, which we know can be traumatic.
Or think about a primary care provider who's trying to monitor a patient who's at home, and we can use digital devices that can send information to physicians, or we can monitor patients’ conditions and see if they're improving or when they may need to come in.
AB: Some people who live in rural areas may not have as much access to care because they live further away from a doctor’s office or hospitals. It feels like digital health can level the playing field.
DM: It can. I think of it as one of the many ways in which patients can access the health care system. However, there are challenges, and I think we need to be realistic, and I know I'm fortunate at Regence to work with colleagues who are thinking about this. The reality is that access and affordability and even literacy in terms of using devices and connecting to broadband, there's variance there. So not everyone has access, not everyone can afford it, and not everyone knows how to use it.
And we know that there are still disparities in who has access based on where they live. In Ada County, which is Idaho's largest county, broadband service is readily available. Over 97 percent of the county has it. But if you look at more rural counties in Idaho, places like Clark County, where there's less than a thousand people, there's no broadband access at all. And in my state, 80 percent of the counties are designated as rural. So there is a digital divide.
As we think about whole-person health and we think about social drivers, it's important that we consider access to broadband and not assume necessarily that people will have it. And work collectively with our legislators or our communities and our businesses to ensure that people, just like we want them to have access to brick-and-mortar health care and food and transportation, that they have access to broadband as well.
AB: Before the pandemic, we at Regence would talk a lot about telehealth but the utilization was pretty low. Where are things at now?
DM: Before the pandemic, telehealth was a nice to have, not a need to have. In many cases, health care was sort of a laggard digitally. That speaks back to the traditional or more intimate nature of health care; in most cases, people still want to have face-to-face experiences. Then the pandemic strikes, and that's just not an option for health and safety or access issues, right? We began to see the critical value that telehealth could play. Our claims for telehealth at Regence went up something like 5,000 percent in the first few months of the pandemic. In 2020, we were seeing 1,000 telehealth visits a week. Shortly thereafter, we were up to 50,000 visits a week. And, obviously that's waned down, but adoption still is certainly higher now than it was pre-pandemic, and there’s still room to improve it.
AB: It seems like we'll be able to better deliver solutions to folks if we understand the pitfalls, not just the benefits, of digital health going forward.
DM: We have to provide a variety of services. Regence, in particular, has taken a virtual-forward approach with our members. Regence members can use MDLIVE or Doctor On Demand, depending on their benefit design, for both physical needs like coughs, colds, maybe a potential urinary tract infection, a sprain, a strain or rash, as well as mental health care.
Most of our plans offer virtual mental health care from a variety of providers. We know that, just like physical care isn’t one-size-fits-all, there are lots of different things that we need for behavioral care, whether it's therapy or whether it's care for people with different disorders, such as eating disorder for which we have Equip, or obsessive compulsive disorder, for which we have NOCD; or teenagers that might need intensive outpatient care, we have Charlie Health.
So, we have a variety of partners that can help deliver these kinds of services. And people don't need a referral. People that are with Regence can look on the provider’s website, fill out their intake form and get rolling. The access is really quite easy for most of our virtual forward partners, as well. So, Regence is in pretty deep here.
AB: That's something I have heard time and again, that for a lot of these virtual providers Regence works with, the access is good. You can really contact them and get appointments in a relatively short time frame.
DM: Access is great. The vast majority of members can receive behavioral health services in under 48 hours. If you try to get an in-person appointment with a psychiatrist in some parts of our four-state footprint, it can be as long as six months. So, it's a massive difference in terms of people's ability to get access to the system.