The COVID-19 pandemic has dramatically changed the delivery of and access to healthcare across the US. Fear of exposure and evolving local and state restrictions caused cancellation or deferral of many in-person healthcare encounters. Because of this, as well as temporary flexibilities allowed by Centers for Medicare & Medicaid Services, many Alliance Health providers have expanded telemedicine visits to serve our members.
To better understand the impact of these changes on services, Alliance conducted member and provider surveys to identify barriers, benefits, and gaps related to telehealth services. Overall, the satisfaction reported with telehealth services was near the level of reported satisfaction with In-person services.
“Our providers deserve a lot of credit for the amazing, almost overnight pivot that they made to provide telehealth,” said Sean Schreiber, Alliance Executive Vice President—Network and Community Health. “Our ability to support providers in their transition to telehealth has allowed us to maintain our members’ access to the services they need despite the difficulties imposed by the pandemic.”
The survey, conducted in June and July 2020, sampled Alliance providers via an online form, and members via telephone interviews by Alliance staff. Of the respondents, 64 providers reported providing and 202 members reported receiving telehealth services between March and July 2020. The number of members served via telehealth increased significantly during the COVID-19 pandemic. Of members that received telehealth eligible services between March and August, 62% received at least one telehealth service.
Of the member respondents that received telehealth services, 88% rated their service good or very good, which is only slightly below the 91% favorable rating for in-person services. Member satisfaction data was compared across demographic subgroups, including race, age, county, ethnicity, disability group, language, funding, service, provider, telehealth platform, provider training, and provider experience and were found to be proportional across all subgroups with at least 40 responses.
From the providers’ perspective, 78% believe their members are satisfied, 58% report improved show rates, and 66% report the same or increased member engagement as compared to in-person visits.
Some services appear to be better suited for telehealth than others. More than half of providers rated enhanced services (which include Multisystemic Therapy, Intensive In-Home, Family Centered Treatment, Community Support Team, Psychosocial Rehabilitation, Day Treatment, Substance Abuse Intensive Outpatient Program, Substance Abuse Comprehensive Outpatient Treatment, and Assertive Community Treatment Team) as more difficult to deliver via telehealth. Only 34% of providers rated outpatient services as harder to provide via telehealth than in person.
In addition to the ability to safely serve members during the pandemic, telehealth presents other benefits over in-person services. Members ad providers reported reduced transportation difficulties and travel expenses, which are known to be significant barriers to in-person appointments. Telehealth also provides flexibility and engagement advantages, reduces the need for childcare, and may allow providers some insight into a members’ home environment.
There are some disadvantages, however. One barrier may be lack of technology or the knowledge to use it. Providers may need to invest in upgraded equipment or broadband access, and some members may not have a computer, smart phone, or tablet with internet access. Despite this hurdle, 80% of providers reported that most members had no challenges with platform. Telehealth may not be suitable for all ages or diagnoses. Members’ home environments may not provide privacy from family members or present distractions from children in the household. And many members may have difficulties completing paperwork or co-payments electronically.
One survey limitation is that members without valid phone numbers in the system were excluded from the sample. In addition, there were low numbers of responses within subpopulations and claims lag may have meant several weeks passed between the members’ service and survey.
“This survey provides a starting point for continued examination of how telehealth may serve members going forward,” said Wes Knepper, Alliance Senior Director of Quality Management. Ideas for future inquiry include:
- Leveraging stakeholder insight and digging deeper into claims data to identify populations whose needs are not being met.
- Continuing to assess ongoing and long-term outcomes of the shift to telehealth for members and providers.
- Developing strategy to support providers with transitioning to HIPAA compliant telehealth platforms
- Assessing provider training needs, best practices, and training options.
The survey summary presentation may be found here.