October 27, 2020

Does mainstreaming telehealth mean the decline of doctor’s offices?

By Accolade

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According to a recent study conducted by the Pew Research Center, 51% of Americans expect their lives will remain changed in major ways after the pandemic is over. That’s a lot of people, but it’s not surprising. Behavioral inertia is real. We do what we have always done – until something shakes us up.

Well, COVID has shaken us up, though there are options that can help us navigate the pandemic more effectively.

These days, many of us are doing things we never thought we’d do before, many of which will stick. One of these things is accessing our healthcare via telemedicine. According to findings from research I conducted with Accolade, nearly half of Americans (48%) say they use telemedicine more now than before the pandemic began. And slightly more than half (52%) said they will use telemedicine more in the future than they did before COVID.

These numbers have risen dramatically since the KFF started polling these pandemic questions in March, when 32% of adults reported a negative impact on their mental health. In early April, it jumped to 45%, and was at 53% by July

This mainstream use of telemedicine raises questions about what the future holds for good old-fashioned doctor office visits.

Is telehealth substituting traditional care?

About ten years ago, I ran a research study to understand how people shop for groceries online. At the time, the idea of buying fruit without first seeing it, touching it, smelling it, knocking on it, or doing any number of things a person might do to determine the freshness of fruit, was a weird idea.

Back then, our question was whether grocery retailers could sell their items online without killing their brick and mortar stores. Ten years later, we know the answer would have been yes.

Until COVID, though people were buying some grocery items online (think dog food and toilet paper), most preferred to buy food at a store.

In a COVID world, though? In-store grocery shopping has declined dramatically and more people are adapting to buying groceries online.

Which begs the question: will COVID force people to adapt to telehealth in the same way that they’re adapting to online grocery shopping? Will the normalization of telehealth mean fewer people will go to the doctor’s office?

Maybe, but maybe not. According to our research, the proportion of Americans who say they’ll use telemedicine more in the future than before the pandemic began has declined since June, from 58% to 52%. Meanwhile, fewer now compared to June say they’d delay going to the doctor for check-ups (down from 56% to 46%). If these trends continue, then maybe Americans won’t see telehealth as a permanent substitute for the doctor’s office. After all, a medical diagnosis isn’t like fruit; if you get it online, and it’s not quite right, the consequences are much more serious than eating a mealy pear.

Perhaps the right question isn’t whether telehealth will replace the doctor’s office. The right question is: under what conditions? will it do so?

Can telehealth complement traditional care?

An apple is an apple, whether you buy it online or in person. Medical care, however, is much more complex. It can include regular check-ups with your PCP, follow-up visits to discuss lab results, visits to refill a prescription, and more. On top of that, specialists provide a range of services, from colonoscopies to knee surgery to kidney transplants. And then there’s mental health services.

Some things doctors do can be easily handled through a phone or video call – think providing a prescription refill or getting a second opinion on MRI imaging. Handling these sorts of engagements via telehealth has many benefits, like freeing patients up from needing to commute and to making it easier for people in rural areas to get the care they need.

But some things aren’t possible virtually – like biopsies or blood tests. Maybe one day we’ll be able to prick our finger, smear our blood on a microscope slide, and run it through a home diagnostic machine, but I’m not holding my breath that it’ll happen in my lifetime.

Telehealth can work with traditional care to best meet patients’ needs.

Making sure Americans get the proper health care involves knowing when telemedicine is a good replacement for a trip to the doctor’s office, not if it is. There is a time and place for telemedicine, and there’s a time and place for the doctor’s office. Patient advocates can optimize health care by getting clear on which offers the most benefit when, and then communicating that knowledge to patients and employers.

This way of framing a question – in terms of conditions rather than black-and-white – is a Decision Science hack that opens us up to seeking the information we need to make the right choices. It forces us to think through what is and isn’t possible, as well as what challenges we need to overcome to ensure the best outcome.

Telehealth doesn’t need to compete with traditional care, they can work together. When it comes to providing Americans with high-quality health care, that will drive good outcomes, it is up to all of us to advocate for what is right for the patient.