The Future of Virtual Care

The COVID pandemic rapidly shifted care from in-person to virtual. It is unclear what the future will hold for virtual care and remote monitoring. We sat down with Harvard Medical School Professor and Black Opal Ventures Advisor, Ateev Mehrotra, to get his thoughts.



Tara Bishop: You’ve been writing and studying about disruptive innovation in healthcare for a long time. What was it like when you first started exploring this area?


Ateev Mehrotra: When we started looking at the area of telemedicine, it was always — this is the future of healthcare. It’s five years from now or ten years from now. And those five-to-ten-year goalposts kept on moving. The traction was never as fast as people expected. And then, the pandemic happened and everything changed overnight.


Tara Bishop: When did you start working in this area?


Ateev Mehrotra: It’s been over a decade that we’ve been doing various projects on delivery innovations. But it was a very niche area.


I remember a piece I wrote in the Harvard Business Review, highlighting the promise of one delivery innovation and why it hasn’t really come to fruition.


It’s really hard in healthcare to take a great idea and bring it to real impact and change in the healthcare system.


Tara Bishop: You mentioned COVID — do you think we would have had such a transformation toward virtual or telemedicine without COVID?


Ateev Mehrotra: I think [as with] many aspects of our life, we were moving in this direction, the pandemic just accelerated the change. For example, the shift to zoom, for example, or Teams or whatever other product people are using for work meetings.


In the same way, year over year, there was growth in telemedicine across a variety of dimensions. The [change] to telemedicine would have happened. It just happened in the span of a month — a decade of change was compressed into a month.


As someone who’s always been frustrated by the slow rate of change, it’s exciting to see the healthcare system move rapidly. And so that’s obviously a positive.


I think where it has been a negative is that we don’t know what we’re doing exactly. All the clinicians, all the companies, all of our patients made the change very rapidly because of the desperate need. But it didn’t involve the iterative process which is the norm where we slowly learn what works.


So we face a situation in 2022, where we’ve made all these changes, but still lack a lot of answers. A very basic question that I’m often asked by policymakers is: “Quantify for me, what was the benefit?” And we don’t have those answers for people. Or in my work on mental illness, people ask: “What’s the right model for tele mental health?” I don’t know. We shrug — we’re still figuring that out.


Tara Bishop: That’s an interesting point. What do you think when someone says: “What’s the benefit?” What are the things that you look for when you think about all these new models? Or are there particular outcomes that you think matter the most?


Ateev Mehrotra: No, when I think of telehealth, I try to bring us back to basics, [whether] it’s another technology related to devices, pharmaceuticals, or new types of surgeries. We always come back to the same value equation, which is: “What is the improvement in health that we observe [and] at what cost?” And that’s the same lens by which we should be looking at telehealth.


There [are] two important points related to that. First is, policymakers say: “What do you think about telehealth?” And I always have to remind them (and myself), that it’s not going to be a single answer, just as a drug or device. There’s some patients and some clinical scenarios that it works and is high value — in other scenarios, it’s not. And so we’re not going to get a single answer on telehealth. We’re going to have a very nuanced answer, which is: these are the patients and the type of telehealth application that’s going to be useful. And then these other patients were not seeing much of the benefit.


I think the only other thing I would emphasize, maybe somewhat unique to telehealth, is that because of its main advantage, which is its convenience, people are looking more broadly when we measure its impact. [This goes] beyond just morbidity and mortality to look at patient time and access.


Tara Bishop: You mentioned that the regulatory environment or policymakers asked you about this, and they want to get your opinion on the value. Can you talk a little bit about what’s happening right now in health policy from a national or state level?


Ateev Mehrotra: There’s a long list of temporary changes that were made to facilitate telehealth during the pandemic. And there has been a big debate on which of those should be made permanent in policy at the federal level at the state level. Last year, in the setting of the vaccines coming out, people said: “The pandemic is over, we need to have this answer right away,” because providers and patients were understandably asking: “We’ve been doing this for a while — what should we do, what’s going to happen next?” There was a lot of uncertainty.

Now that cases [are falling] again, there’s going to be an increased push to try and figure out what’s permanent. Right now, the debate centers largely on what is the spending impact of telehealth and the different rules and regulations?


Organizations like Medpac, and many others, have argued that what we should do is keep the temporary expansions for another couple of years, collect more data and then make final decisions. So unfortunately, I think for people in this space, this uncertainty about what the permanent payment and regulatory framework is, is going to continue for some time, even post pandemic.


Tara Bishop: Can you describe expansion a little more? Do you mean payment for telemedicine or remote monitoring?


Ateev Mehrotra: Yes. So to give some examples, in the Medicare program in the United States, phone visits were never covered before. No one ever thought of a phone visit as a telemedicine visit — it was just a phone call. Remote patient monitoring was expanded and which technology you can use was also expanded.


Another example would be the DEA making temporary regulatory changes on which medications you could prescribe via telemedicine. And that’s just on the federal side. State Medicaid plans and private insurers echoed many of those changes, but most of those changes were only temporary.


Tara Bishop: Going back to where we started. You started exploring telemedicine and virtual care almost a decade ago, and there was a vision of what the future would look like. Could you tell us, what that vision was? And fast forward to a time where everything accelerated, is that the same future?


Ateev Mehrotra: My instinct is that the form of telehealth that we currently see in 2022, which is predominantly video visits and phone calls, will be a very small sliver of what we think of as telehealth. And that many other models of telehealth which incorporate monitoring apps, asynchronous communication, all into one thing are going to be the more common way that telehealth is used.


And so one of the things that I emphasize, is that there’s a lot of things that can be done via technology to provide patient care remotely. Video visits and phone calls are probably just the starting place. And so really, we’re not there yet, by any means.


Tara Bishop: Just a follow up to that, what do you think needs to change either from the policy perspective or the technology perspective?


Ateev Mehrotra: I think one place [where] there’s a lot of uncertainty is how we are going to regulate this. The way we typically ensure a level of quality is [through] licensure. We say that if a nurse, a doctor, or a psychologist is licensed, they provide a certain [level] of quality. And that’s good. But now when we’re starting to offer combinations of providers, technology platforms, and AI, we’re providing a package of information. How do we regulate that? Just ensuring that providers are licensed doesn’t cut it.


One of my main messages to companies that are starting [out], is that this is coming down the pike. There [will] be oversight and approval processes to ensure that we’re not harming people. Companies need to start taking the mindset of: how do I develop the evidence base [for my solution]? [This] mindset is part of the DNA of pharmaceutical companies. [For] a lot telehealth companies, that’s not part of their DNA, but it will have to be as we move forward.


This article was originally published on Medium