The role of telehealth during Covid-19 outbreak: a systematic review based on current evidence published in August 2020, found that: “Telehealth has the capability to incorporate several organisations and situations of healthcare into one virtual network, led by the central clinic. This network can contain physical locations in different region: central and remote clinics, prevention centres, private clinics, and, private offices of physicians, centres of rehab state and all registered patients within their locations.”

Almost without exception, governments around the world have embraced telehealth solutions and encouraged providers to offer them to patients during the pandemic, and Australia is no exception. In June, the Commonwealth Government extended its Medicare Benefits Schedule funding for telehealth until the end of 2021, demonstrating its commitment to the scheme. Health Minister Greg Hunt noted: “There’s not much good that’s come from Covid. But one good thing is the fact that we have skipped a decade and jumped from 2030 to 2020 for the delivery of telehealth for all Australians.”

While telemedicine has been around for many years now, its growth and acceptance among patients and healthcare providers has been patchy. Now, though, it’s all systems go. As Inake Ereno, CEO of health insurer Bupa Group, pointed out: “The rapid pace of change in digitalisation will be pivotal in shaping the future of healthcare. We have many digital solutions across the various Bupa Group businesses globally already, and are now planning for significantly more digital coverage in each of the countries we operate. This is bigger than just telehealth, with opportunities spanning across primary and specialist care, health coaching and chronic pain management.”

We all understand the importance of telehealth during Covid-19 – it freed up medical staff and equipment required for those who became seriously ill from coronavirus, and it kept people safe as they weren’t all waiting in crowded hospital corridors for their appointments. But the scale of the challenge in introducing telehealth services across a network of international hospitals is not to be underestimated, and it takes the buy-in of all stakeholders to make sure it is working as intended.

Many health insurers had to move fast to introduce – or boost existing – telehealth services for their members during the pandemic. Some members were stuck in the country in which they were working at the time of the global lockdown, unable to reach home shores for the care they would usually receive, and others were in need of follow-up treatment for a procedure they had undergone before March 2020. So, were the insurers, and their networked hospitals, prepared for the job they had to take on? From Australia, a nib spokesperson elaborated: “We introduced access to a range of telehealth consultations for our health insurance members as part of our more than $45-million Covid-19 support package. While varying state restrictions and lockdowns continued across the country, we wanted to ensure our members were able to continue to access the health services they needed, from the comfort and safety of home. Members could access services like psychology, occupational therapy, dietetics, speech therapy and podiatry with their provider via video or telephone consultations.”

Bupa Australia, meanwhile, quickly announced the temporary funding of video and phone consultations for its customers from April 2020. From then, until June 2021, the company has paid claims for more than 3,000 telehealth consultations for Australian customers, and over 165,000 claims for international citizens working in Australia. As overseas students and workers do not have access to the government-funded Medicare package, Bupa covers primary care (GP) consultations as part of their international health insurance package. Such appointments accounted for 85 per cent of telehealth consultations from this group.

Many health insurers had to move fast to introduce – or boost existing – telehealth services for their members during the pandemic.

Emily Amos, Bupa Health Insurance Managing Director, said that while the technology to enable digital delivery of health services from everything such as physiotherapy and telehealth had been around for several years, it took a global pandemic to move it into the mainstream: “The pandemic forced us to look differently at how we receive and deliver healthcare and adapt quickly to the changing situation. We estimate that it sped up digital adoption in healthcare by at least a decade both in Australia and around the globe.”

Working with hospital partners

Nib said: “For our health insurance members with hospital cover, rehabilitation and mental healthcare were available through telehealth appointments within our hospital network as part of our response to the Covid-19 pandemic. It was great to see our hospital partners embrace this opportunity and work with us to offer telehealth services.” To ensure that telehealth services for rehabilitation and mental healthcare were provided at the highest standard of care and value for members, nib established a number of requirements in line with clinical guidelines that hospitals were expected to follow in order for our members to remain covered. “In most cases,” added the spokesperson, “the implementation of our telehealth offering to nib health insurance members was straightforward as many of the hospitals within our network had already offered telehealth services. Our eligibility and funding criteria ensured our approach was consistent across our entire network and that the continuity and standard of care for our members was met at the highest level.”

Working with hospitals is only part of the overall telehealth offering, though, as Bupa pointed out in its recent White Paper, How the pandemic helped healthcare go digital. From the outset of its rollout of telehealth services in early 2020, the company worked with industry groups and associations to ensure guidelines were in place for healthcare providers to clarify exactly what was and wasn’t covered under policies. Transparency in working relationships with hospitals was absolutely essential to ensure smooth working practices and optimum patient experiences, while introducing digital platforms that work for payers, providers and patients.

A potential barrier to the adoption of digital health solutions could be regulatory. Practitioners working on behalf of national health services need to adopt technology that has been approved by the national government, and this can be an arduous and expensive process. However, it’s fair to say that most governments have been on the ball with speeding up what could have been a lengthy process in order to protect their health systems and workers.

A permanent arrangement

Is the adoption of telehealth initiatives a flash in the pandemic pan? While usage rates may fluctuate slightly, the overwhelming feeling from providers we spoke to was that telemedicine is now firmly embedded in the delivery of healthcare services. Nib said: “Due to the positive response from our members and our ongoing commitment to our members’ better health, we’ve made telehealth services permanent for ancillary with benefits available for eligible nib members.”

It might not be suitable for all types of care, though. Bupa points out that dental benefits were never included in telehealth deals, as there is little a dentist can do from simply seeing a person’s teeth! The top telehealth services it has seen engagement with from its customers and providers are psychology, physiotherapy, speech therapy and dietetics. But all these ebb and flow in terms of usage as well – at its peak in April and May 2020, mental health consultations via digital platforms accounted for 49 per cent of all Medicare appointments, but by March 2021, it had dropped to around 20 per cent, according to the Medicare Benefits Schedule, published by the Centre for Online Health at the University of Queensland in Australia.

Dr Zoe Wainer, Head of Public Health at Bupa, and Chair of the Board of Dental Health Services Victoria, commented on the fact healthcare providers and insurers should not just be limiting themselves to video calls when there is so much more that digital healthcare delivery can achieve. She explained: “The conversation now needs to be about when telehealth is the right mode to deliver the optimal health outcomes, so that it augments delivering the right care at the right place and at the right time. This may be video, phone, face-to-face, or bundling a combination of these settings together along the healthcare journey.”

Clinicians and insurers should be working closely with designers of digital health software and hardware, as the understanding and experience of all parties is needed to link doctors and patients around the world. And it is not just about connecting physicians and patients in the short term either, it’s about connecting the whole patient journey, so that when they are referred to a different specialist for a complaint or illness, that specialist is aware of the background of the case and can connect up the care pathway the patient has already experienced. Investment, then, is needed, as Dr Wainer pointed out: “Cutting costs does not deliver the best outcomes.”

Working with hospitals is only part of the overall telehealth offering

Proven results for patients and providers

Barbara Ioppi, Telehealth spokesperson at the Royal Melbourne Hospital, said that ITIJ that the transformation in the level of uptake and engagement with telehealth services proves that it works: “In the past, the most optimistic projections have considered that up to 50 per cent of consultations for rural patients could be delivered by telehealth by 2025. Now it has been demonstrated that more than 70 per cent of outpatient visits can be delivered remotely, including nearly 30 per cent using telehealth, and this can be achieved within a period of only six weeks.” From the number of telehealth video calls mostly from rural and remote areas of January and February of 2020 being in the low hundreds, the hospital quickly reached over 1,600 in March, over 5,000 in the next few months, and over 8,000 in September.

Investment in health tech pays off

Telemedicine used to be touted in the travel and health insurance sector as a way to cut costs of ER admissions, and while this may still be the case, investment is needed by hospitals and their insurance payers to ensure that telehealth experiences can also encourage take-up and engagement among customers. While there was no choice in going to see the doctor for a face-to-face appointment, digital appointments were accepted. What needs to happen now is that the industry must put on a good enough show to keep that engagement high.