Insights from

the COVID-19
telehealth roundtable
April 10, 2020

The use of telehealth services and connected care technologies has skyrocketed as a result of the
COVID-19 pandemic. Initially deployed by many provider organizations as a mechanism to keep
employees safe, telehealth has since been adopted in an accelerated manner, reaching a disruptive
level that begs the question whether we have crossed into a new era of truly virtual care. We
brought our network of industry leaders together in a virtual roundtable to learn more about their
telehealth journey amidst the COVID-19 crisis, its challenges and the lessons that can inform the
next generation of health care delivery.

Now Next Now: Changing and scaling in crisis

Figure 1 Figure 4 Telehealth has been an integral strategy for providers
Telehealth visits per day in effectively managing operations in response to the
COVID-19 pandemic. They rapidly deployed new services
5,000
2,000 and scaled existing ones in an effort to (1) enable social
distancing by keeping people at home, (2) expand the
current resource and asset base and (3) preserve personal
400 protective equipment (PPE) for staff through reduced face-
physicians to-face interaction. Telehealth capabilities across the entire
Pre-COVID-19 Post-COVID-19 trained in just two weeks care continuum and in virtually every setting were used to
achieve these objectives for both the COVID-19 and non-
Figure 2 Beyond
related patient population.
Figure 5
• V
 irtual triage: Providers who were quick to launch chat
84% bots and other virtual screening tools have received
40% to over 1,200 inquiries a day, diverting significant
volume from emergency department (ED) and urgent
60% care centers. Chat bots also have been leveraged
increase in virtual visit internally by providers to verify that employees are
volume in a single month not experiencing symptoms using data collected in
decompression of inpatient
beds through remote questionnaires prior to the start of each shift.
Figure 3
monitoring and hospital-at-
• R
 emote monitoring: Devices such as thermometers
home services
and pulse oximeters were used to monitor the
temperature and oxygen levels of individuals suspected
74% of or confirmed as being positive for COVID-19. This
was critical to keeping infected (or potentially infected)
patients at home while providing a lifeline to clinical
decrease in ambulatory clinic teams who could assess for worsening of symptoms
volume for in-person visits and quickly intervene as needed.
• V
 irtual visits: With many providers aligning to Centers for
Medicare & Medicaid Services guidance to cancel elective
services, in some instances there has been a 75%–80% decrease
in ambulatory clinic visits. Providers have been able to sustain
productivity of their workforce by transitioning to virtual
visits using secure video-teleconferencing capabilities with
varying levels of electronic health record integration. They
also reassigned those resources to supportCOVID-19-specific
telehealth services. In both instances, the use of telehealth
has significantly mitigated layoffs and reductions in workforce,
which have much broader economic impacts.
• H
 ospital at home: Remote monitoring technologies combined
with increased clinician interaction through virtual and in-
person visits are being used to manage low- to moderate-risk
patients at home, thereby reducing the need for observation
and inpatient admissions. Patients suspected of having
COVID-19 (e.g., those who have been tested) remain at home
with vigilant monitoring; symptoms are checked on a daily basis
using chat bot technology with a follow-up call from a nurse
at least once a day, if not more frequently. For those patients
with more acute needs, they receive daily in-person clinician
visits. By keeping suspected or confirmed COVID-19 patients at
home, these measures help minimize exposure for non-infected
patients and employees.
• Electronic ICUs: Intra-ICU use through two-way communication
technologies has contributed to the conservation of PPE by
reducing the number of times a clinician must enter a patient’s
room. This also decreased the level of exposure for clinical
teams as their well-being has been a major concern given the
experience of other countries who preceded the US in the
global pandemic.
Telehealth capabilities have also been critical in addressing the
psychosocial needs of multiple stakeholder groups during this crisis.
• Chat bots have been deployed both internally and externally
with questions to screen for mental health needs and check on
employee well-being.
• Social workers are conducting virtual visits for a patient
population who receives care for chronic conditions in one of
1,400 sites nationally; these visits focus on safety, access to
food and nutrition and overall mental health.
• B
 ehavioral health visits have increased by 12% for large
academic medical centers since the start of the COVID-19
pandemic.
• V
 irtual and in-person home visits have removed the need to
admit COVID-19 patients experiencing loss of smell to the
hospital as a result of dehydration and malnourishment.
In addition to connecting providers to patients, telehealth
capabilities have also been used to connect patients with their
families and loved ones for peace of mind and improved morale
given the restricted visitor policies in response to the COVID-19
pandemic. Virtual technologies have been used for spiritual needs
such as baptisms, last rites, prayers and chaplaincy involvement,
which supports the critical and basic need for human connection.
2
Patients and their support networks have responded positively to
this approach, and it has helped them to connect with care teams.
Next: Addressing financial concerns and
government relief programs
The rapid increase in telehealth services has not been without its
fair share of challenges. Roundtable participants shared some of
their lessons learned in rapidly scaling and deploying telehealth
during the COVID-19 crisis as well as initial thoughts about solutions
as they continue to evolve their services and capabilities.
Change management
Health systems are working with banking and financial institutions
to address mounting financial pressures from the crisis. Many
leaders are drawing on their lines of credit so that they have plenty
of capital in the near and long term. This will help them avoid
liquidity and payroll issues; hopefully helping to avoid furloughs and
layoffs of critical personnel.
Engage legal counsel to enforce insurance policies and
prepare for post-crisis litigation
Although telehealth is enabled by technology, the human factor
was a recurring theme in the discussion. The need for thoughtful
change management, to include training and education and a shift
in mindset, was identified as a critical success factor and area for
ongoing improvement.
•  onsumer adoption is often easier than provider adoption,
C
especially once consumers experience telehealth services. That
said, the COVID-19 pandemic has been an effective accelerant
to provider adoption, which was described as having been very
challenging in the past. It is estimated by one major health
system that over 80% of their ambulatory visits are now virtual
so they can continue to deliver care.
•  ealth systems across the country had to train thousands
H
of physicians in just a few short weeks to support expanded
telehealth services. While they have adapted and are
successfully using the technologies in the short term, there is
a need to revisit the level of guidelines and protocols, as well
as expectations, to formalize and potentially reinforce with
additional training and education.
•  any of these telehealth services support around-the-clock
M
care and monitoring and require a 24-hour support model for
all stakeholders.
Technology
Technology and devices are undeniably the backbone of telehealth.
The significant increase in use of telehealth and connected care
technologies through the COVID-19 crisis has provided insight into
the challenges of the current platforms, which largely focus on
workflow design and limitations with integration.
•  here is not a single platform that fit all needs, leaving
T
providers with no other choice but to implement multiple
technologies and vendors. This was further compounded by the
attempt to govern individual provider choice and the infiltration
of many vendors.
• M
 uch of the technology functions as though it was designed
for retail health settings; the waiting rooms and queues are
not intuitive or easy for providers to manage, especially when
they want to be able to initiate the outreach to the patient. It
also does not enable effective rounding, which is a necessity
for academic environments and graduate medical education
programs.
• F
 rom a patient perspective, if they are not able to verbally
communicate or access a device to turn it on, “auto-on” devices
are needed to support effective two-way interactions especially
in the inpatient environment (e.g., ICU). On an outpatient basis,
bandwidth and cell service challenges make it difficult for
patients who live in rural areas to use telehealth.
• A
 n important lesson learned is to lead with design thinking —
technology is an enabler to the interaction, and understanding
what the clinician and patient are trying to accomplish should
be the first step to informing technology selection. Telehealth is
not always just about connecting the patient to a physician — it
also can drive greater collaboration among the interdisciplinary
team which is integral to care coordination which has been
a persistent issue in our health care system. Subsequently,
implementation is most successful when there is a partnership
among technology, operations and telehealth teams.
Regulatory
The COVID-19 pandemic has obviated many of the regulatory
factors that limited the widespread adoption and use of telehealth.
Most notably, reimbursement at parity with in-person visits has
helped providers aggressively pursue telehealth services as part of
their crisis management strategy.
• M
 ultistate licensing remains the biggest regulatory challenge,
especially for providers that are located in border cities or
large, multistate health systems. For those providers that are
not a compact state, licensing their clinicians in multiple states
can be expensive and time consuming.
• A
 dditional support for cellular/wireless infrastructure is critical
in certain geographies to enable connection with those in rural
locations. Conversely, regulations that support telehealth
access for those living in urban areas are equally as important.
The relaxed regulation (i.e., waivers) as a result of the COVID-19
pandemic is conditional and temporary; providers need to
collaborate to protect the current provisions for reimbursement and
treatment in the longterm. This will involve establishing reasonable
guardrails that offer reassurance to regulators that clinical risk is
appropriate and there is sufficient mitigation for waste and abuse.
A longer-term strategy defined by a coalition of providers with
regulatory and clinical board approval is crucial to sustaining current
levels of telehealth adoption.
Beyond: Revolutionizing care delivery
Telehealth has made its mark on health care and propelled us into
a digital-first future as a result of the COVID-19 pandemic. While
there will be much to sort through on the other side of this crisis, it
3
is clear that telehealth is now a permanent fixture in the health care
landscape due to the multitude of use cases that demonstrate its
value.
•  rovider organizations that were in the process of five-year
P
implementation plans for telehealth managed to quickly
activate to mobilize a set of virtual services in a matter of
weeks. While it has been a heavy lift, it was necessary to protect
their workforce while safely caring for patients.
•  or programs that had prior experience, they have made
F
the leap to complete virtual care. As an example, a large
academic medical center that once had pockets of telehealth
for behavioral health has completely converted all services,
including partial hospitalizations, to virtual care. The
organization has noted greater efficiency for its providers in the
virtual model.
•  here have been opportunities to effectively collaborate across
T
the ecosystem to manage regional capacity in innovative ways.
Telehealth allowed hospitals to provide support and additional
resourcing to post-acute and long-term care facilities that were
some of the hardest hit by the COVID-19 crisis. The ability
to plug critical staffing shortages and remotely monitor and
evaluate patients prevented ED visits and hospital admissions
from nursing homes. Hospital and long-term care teams were
also able to connect with families to discuss end-of-life planning
and create a support network in challenging times.
•  s we emerge from what most believe is the first wave of
A
COVID-19, telehealth front-runners are strategizing about how
to use virtual care to effectively manage the backlog of demand
from deferred and postponed elective services.
Consumer expectations also will cement telehealth as a viable care
delivery model. The COVID-19 pandemic is unlike anything we
have ever experienced as a nation and it remains to be seen how
comfortable consumers will be with seeking care in health care
facilities as we surface from this public health crisis — it is highly
plausible that virtual care will not only be preferred, but the default
approach to care. Although this introduces uncertainty about the
economics of health care, it also opens up possibilities to integrate
emerging technologies to deliver more personalized care that truly
empowers consumers and promotes better health outcomes.
The Ernst & Young LLP team would like to
thank all the executives who participated in
this discussion. We look forward to continued
interactions as we all navigate these difficult
times together. For more information about
how to lead through the COVID-19 crisis, please
visit ey.com/COVID-19 or reach out to your EY
account executive for our latest insights.
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