Defining Quality in Telehealth: An Urgent Pandemic Priority
This blog was co-authored by Ami Parekh, M.D., J.D.; Tista Ghosh, M.D., M.P.H.; and Nate Freese.
Telemedicine is expanding rapidly as a result of the pandemic and, given its popularity, this trend will likely continue. Yet, standardized quality evaluations of telehealth providers are lacking; i.e. there is currently no simple way to measure the quality of care delivered by a telemedicine clinician. We are at the perfect moment in time to change that.
At Grand Rounds, we developed an algorithm that assesses provider quality based on condition and specialty-specific combinations of process, outcome and structural measures. These measures have been independently validated by Harvard-based researchers. Results from their two-phase study revealed that physicians identified as “high-quality” deliver quantifiably better health outcomes for patients. For example, primary care physicians (PCPs) in the top 10% of quality were:
- 30-40% more likely to conduct appropriate cancer screenings for colorectal, cervical and breast cancers
- 30-70% less likely to prescribe high-risk and addictive medications for back pain
- >90% less likely to be sanctioned in the future by their state medical board…compared to PCPs in the bottom 10% of quality.
Professor Niteesh K. Choudhry, M.D., Ph.D., a faculty member at Harvard Medical School and one of the study authors, found that “top 10% primary care physicians provided higher quality care than other physicians for all of the metrics we evaluated. The magnitude of these differences was clinically meaningful and statistically significant in all cases.”
We use these quality measures to make personalized recommendations to members based on providers’ performance in the clinical areas most relevant to them. Traditional navigation and network search tools lack the clinical and technical rigor to deliver these outcomes-oriented, quality-driven care recommendations. It’s why our provider quality measurement approach is at the forefront of innovation in the industry.
As telehealth adoption increases, it will be important to observe how predictors of in-person quality translate to telehealth, and what new quality measures might need to be developed for telehealth specifically. For example, accessibility and equity measures will be very important for telehealth as limited internet access (via a desktop or a mobile device) and low digital literacy may impact use among certain populations.
But if we don’t start implementing telehealth quality measures now that address issues related to access (among other barriers), we risk leaving these populations behind. Our preliminary analysis of telehealth usage pre and post-COVID-19 shows that virtual care utilization has been lowest for the very populations where it could offer the greatest benefit. For example, members who are based in rural areas, live in low-income zip codes or are seeing “low-quality” PCPs are at least 36% less likely to receive virtual care for major chronic diseases from their local providers.
You can read more about our thoughts on the need to define quality in telehealth and our call to actions for policy makers and other key stakeholders in our piece originally published in Managed Healthcare Executive.
In many ways, telehealth is still in its nascency, functioning as a carbon copy of our (still) fax-machine based healthcare system. We’re optimistic about the next phase of telehealth, however, and excited to play a pivotal role in how the industry measures telehealth provider quality. It will not only help as many patients as possible find the best quality care for them in the virtual setting, but also provide a feedback loop that allows healthcare workers and systems to continually improve their performance.