November 17, 2020
In spring of 2020, the Covid-19 pandemic precipitated an explosion in telehealth adoption, driven by safety concerns, patient demand, and better reimbursement rates. Pediatric health care providers were no exception to this trend. By the end of April 2020, Stanford Children’s Health saw telehealth visits increase from a daily average of 35 to up to 800 and Children’s Hospital of Philadelphia reported an increase from 5-10 virtual visits daily to over 1500.
What can we learn from the rapid expansion of pediatric telehealth? This is the question that Altarum will explore in a new engagement with the American Academy of Pediatrics.
The speed with which pediatric health care providers shifted to virtual services has been extraordinary but not without challenges. Many providers have not received additional training in telehealth since the crisis began, clinical workflows need to be rearranged, and investments in facilitative technologies must be weighed against the possibilities of decreased demand and reimbursement post-pandemic.
Moreover, vulnerable populations’ uneven access to telehealth due to limited high-speed internet access or language barriers could further magnify existing disparities. To support their network of over 67,000 providers and the families they serve, the American Academy of Pediatrics (AAP) has enlisted Altarum to evaluate their newly funded telehealth support program to determine needs, gaps, and emerging promising practices.
The AAP has long been a proponent of telehealth and distant-care—virtual consults that take place outside of a primary care provider’s office—to support the delivery of services, particularly in rural or underserved areas, where long travel times or a dearth of physician specialists have limited access.
The goal of the current initiative, funded by the Health Resources and Services Administration through the Coronavirus Aid, Relief and Economic Security (CARES) Act, is to support telehealth access and infrastructure for the provision of comprehensive care to children and adolescents utilizing a medical home approach during and after the Covid-19 pandemic. Because of the potential for disparities in access, efforts focus on increasing utilization by children and youth with special health care needs and other vulnerable pediatric populations, including those requiring behavioral health services and adolescents.
Altarum will conduct an environmental scan, beginning with a literature review of AAP’s existing pediatric telehealth resources and branching outward to measure the effectiveness of training and technical assistance provided—including practice changes—through a series of qualitative and quantitative data collection methods including focus groups, interviews, and surveys that include both clinical providers and caregiver families. The initiative also involves disseminating promising telehealth practices for pediatric clinicians, developing metrics to track effective telehealth delivery, and expanding educational resources for families.
The first results from our evaluation will be available in the next few weeks. While the rapid adoption of telehealth has proven challenging, there may be some bright spots. Behavioral and mental health care is perceived to be well-suited to virtual delivery —in terms of both increasing access and offering providers with a window into their patient’s home environment. In the case of children and youth with complex health needs, telehealth has the potential to pull together specialists and primary care doctors to function as the patient’s care team.
While the future of telehealth is difficult to predict, with only 20 percent of health systems committed to continuing their virtual care offerings if reimbursements drop to pre-pandemic rates, pediatric providers have been granted a preview of its possibilities.
Prior to the pandemic, much of the buzz around telehealth was market-driven, the purview of virtual providers in retail-based clinics or phone consultations provided by insurers. Now providers in community-based pediatric settings are employing it to build on established relationships, enhance care-coordination, and improve acute and chronic care. Recent studies have suggested that adult patients are benefiting from both the convenience and increased access to care—including improved coordination with specialists and closer management of chronic conditions. Additional data is needed to see if pediatric patients are experiencing similar benefits.
By evaluating emerging best practices from the Covid-19 rapid response period, we can learn more about what does and doesn’t work for providers and families, laying the groundwork for a more effective and sustainable model of pediatric telehealth in the future.