We have seen a lot around the uptick of telehealth adoption during the pandemic and the subsequent reversal as some patients revert to traditional ways of engaging with providers and care networks. During the height of the COVID lockdowns, a virtual visit might have been the only way for patients to access any care. Health plans and provider networks have invested, adapted, and tried to leverage the gains in digital health transformation, and now the question is how they make the patient/member behavior stick.
The statistics for adoption and the implications for the future are all over the map. Early in the pandemic there was tremendous optimism that trends of patients embracing virtual health would continue to grow once COVID was behind us. But a recent mhealthintelligence article cited a Peterson-KFF Health System Tracker reporting an actual drop of 8% in 2021 in overall outpatient visits conducted via telehealth.
Headlines like this are often tough to translate to what they really mean in practical application. The article goes on to give the statistics contextual meaning:
“Although telehealth use has decreased since the peak of the COVID-19 pandemic, it is sustaining a relatively high utilization rate compared to 2019. Before the pandemic, telehealth comprised less than 1 percent of outpatient visits. But, during the early stages of the pandemic, this rose to 13 percent, followed by a drop to 8 percent in 2021.”
So overall, telehealth is….growing? But there are clearly barriers --what are they and how do we address them?
While they are not interchangeable, we see terms like virtual care, remote patient monitoring, the “digital front door” . . . all pointing towards the same objective: technology enabled programs that deliver efficiency, cost savings, increased patient/member satisfaction, and ultimately better health outcomes.
To realize the actual potential of these components and their ability to enable a true digital health transformation, payers, providers, managed care organizations and technology platforms all need to understand precisely how to encourage both patient/member adoption and the continued use of the services to enable their health and wellbeing. In other words, stakeholders must understand the person as well as, or better than, the tools.
In a Fortune article as far back as 2018, digital health innovator and advocate, Dr. Brennan Spiegel of Cedars-Sinai Medical Center distilled the challenge down to this:
“Digital Health is not a computer science or an engineering science. It is a behavioral science. Creating the tech isn’t the hard part. The hard part is using the tech to change patient behavior.”
At Simply Strategy we see this as an opportunity for stakeholders if they have a deeper understanding of the mindsets, lived experience, technical realities, and social determinants of the populations they serve. When it comes to solving the Rubik’s Cube of digital transformation, we recommend a few things to our clients:
Dig deep for the Root Causes. Some of the attrition in adoption of digital health can naturally be chalked up to user experience. Glitchy systems, spotty network connections, patients or providers who are less than comfortable with the technology all could result in a sub-par visit. Digging deeper though is the lack of cultural competency in design or rollout of tech that may be based in user assumptions, as well as deep-seeded structural and social determinant issues, such as a complete lack of broadband in a given neighborhood or community, otherwise referred to as the digital divide. You can’t fix what you don’t know is broken. Engage the patients/members who tried digital options and stayed, but more importantly those who returned to traditional solutions, to get a 360-degree view of the motivations for their decisions. Additionally, being intentional about asking the right questions that surface what’s on the ground, instead of questions that confirm an anticipated outcome. mitigates confirmation bias. What we find is that the results of well-designed research can sometimes reveal surprisingly complicated barriers that extend well beyond the issue being studied, but also some surprisingly simple fixes to address.
Don’t make broad brush assumptions. The Peterson KFF Health Tracker cites that there was little difference in the urban versus rural statistics of adoption and attrition of digital health options. This tends to mask the more critical question of “why,” because we assume that certain demographics in these populations are very different. Yet many demographics—namely socio-economic status, education level, and uninsured rates—are remarkably similar among very rural areas and very under-resourced urban cores. Many reports suggest that age or social circumstances are the key factors impacting access or preference for healthcare technology. Don’t make your decisions based on overly general assumptions. Develop more accurate and granular segmentations of your specific patient populations by applying fundamental psychographic principles around attitudes, values, and beliefs as much as you do age, income, education, and social circumstances. Then design research accordingly that will uncover what the resulting segments value in the adoption decision for digital solutions.
Never underestimate the importance of ease and clarity. It is broadly acknowledged that stable behavioral change is much more predictable if the paths to adoption are easy and clear. This extends to patients but also for providers for whom digital systems must ease, rather than add to, their burden of care. Understanding the language and health literacy of your patient populations is critical to engagement, education, and the likelihood of impacting health outcomes positively. Identify tech preferences of your specific patient populations (and your providers) and where possible give choices for the format of communication (e-mail, SMS text messaging, portals, apps messaging, automated phone messaging) so patients can choose what is best for them. Once adoption takes place, survey early and often to understand the “whys” behind the statistics.
Nothing is simple in healthcare and the digital transformation is no different. The adoption of innovations in digital health transformation by all stakeholders will reap huge benefits in efficiency and potentially better outcomes. Solving the puzzle of sustainable adoption of virtual health solutions depends on our ability to dig deeper in understanding the communities of patients and members we all serve.
If this is something you think about too, please accept our offer to have a conversation.