Most physicians are acutely aware of the support that women need during key transitional times in their life, such as puberty, pregnancy and menopause.
Yet while access to technology to help women, such as 3D breast imaging, is expanding, access to high-quality healthcare providers is shrinking. This is especially true for women in rural communities, where the patient-to-primary-care physician ratio is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. According to the American Congress of Obstetricians and Gynecologists, there will be a shortage of up to 8,800 OB-GYNs by 2020.
These two trends highlight the crucial role of telehealth, an increasingly prominent technology that can actually help mitigate the physician shortage and be a trusted resource for women who need access to reproductive guidance, pre- and post-natal care, and other services. In September, Congress introduced the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act to improve health for women covered by Medicaid, which accounts for about half of the nation’s pregnancies. Within the bill is a provision to study telemedicine and its effectiveness and potential to improve Medicaid beneficiaries’ access to maternity care.
The bill comes on the heels of the Chronic Care ACT, which passed earlier this year and is expected to break down barriers to telehealth use.
Simultaneously, in the digital health start-up space, we’re seeing an unprecedented rollout of telehealth applications geared toward women’s health. Today, women can use virtual care for everything from post-partum depression screenings to lactation assistance. Behavioral healthcare, in particular, can be crucial for a post-partum mom who feels overwhelmed and isolated as she struggles with her new role while experiencing hormonal fluctuations.
And we’re only beginning to scratch the surface. As virtual care grows, healthcare organizations, physicians and other providers have an immense opportunity to help women navigate their unique health issues.
A Frontier of Opportunities
When I think about the future of telemedicine, I recall my own maternity experience — the hours after giving birth when I was trying to adjust to nursing — which, until then, I’d never directly experienced. As a pediatrician, I am well-versed in answering parents’ questions about their babies’ weight, sleep and emotional distress, but as new parent, I felt overwhelmed (even with a medical degree). Most women have it much harder, navigating a range of emotions, from sadness to anxiety, and physical symptoms, as they embark on their new lives as mothers.
Yet it is my own experience that showed me why virtual care platforms are ideal for patients who would benefit from frequent engagement with their care providers.
Consider breastfeeding, a function that may seem easy but can be incredibly difficult for moms with latching issues. In the hospital setting, a mother may have nurses on call, who can offer one-to-one assistance on an hourly basis, if needed. But when the mother leaves the hospital two or three days later, she can’t take the hospital nurses with her. They’re often not accessible when she’s struggling to feed her baby at home.
In response to this need, some provider organizations and payers are launching their own telehealth applications to support lactation. One that comes to mind is Blue Cross Blue Shield (BCBS) of Georgia’s maternity telehealth platform, available for all members on the State Health Benefit Plan (SHBP), as part of their existing maternity support program. Through the LiveHealth Online platform, powered by American Well, expectant and new mothers have access to telehealth visits from home with a lactation consultant through private and secure video on any device.
Early studies suggest that new mothers who use such platforms to connect to lactation consultants had a similar or better experience than their non-virtual counterparts. They found that, in person, a consultant may feel more inclined to physically assist a mother who struggles with a latch; in the video setting, the consultant was able to instruct the mother on how to correctly position the baby herself, increasing the likelihood that she would be successful on her own later. An additional advantage of telehealth, is that you can have more frequent and convenient check ins, making sure that help is available whenever it is needed.
Beyond maternity, telehealth can also support women’s sexual and reproductive health needs throughout many phases of her life.
Planned Parenthood Care™ — currently available in Alaska, Arizona, California, Connecticut, Florida, Hawaii, Idaho, Illinois, Minnesota, Montana, North Dakota, Rhode Island, South Dakota, Utah, Virginia, and Washington state — offers secure on-demand video consultations with physicians to receive birth control advice, Urinary Tract Infection care, STD testing kits and other services. In addition to improving health outcomes, these types of services can potentially reduce emergency room utilization.
Regulatory Considerations
The regulatory environment for telehealth has become significantly more supportive over the past few years. With the recent passage of the CHRONIC Care Act of 2017, patients with chronic conditions will have increased virtual access to qualified healthcare professionals nationally, while individual states continue to support increasing reimbursement opportunities for virtual care.
However, the reimbursement environment is also considered by many to be very confusing, especially as we move toward value-based care, and seek to lower costs while improving quality.
As a recent Health Affairs report pointed out, excessive regulation can make it harder for physicians to practice true, patient-centered, care, because they lead to additional administrative burdens. For example, if physicians have to document telehealth visit notes in a separate EHR to meet regulatory requirements, that can add hours to their day. This is especially true if they’re documenting in an EHR that is separate from the telehealth platform.
This confusion has led some women’s health providers to delay exploring telmedicine. If they are uncertain whether they’ll get paid for virtual services at a competitive rate, if at all, then staying with the status quo seems the safest option.
Nevertheless, practicing telemedicine continues to become easier year over year, and trends continue to point to seeing many of these issues resolved in the near future. As technology continues to advance and new regulations call for greater support of women’s healthcare, I see telemedicine as a crucial piece of the puzzle to increase access to women’s health services, whether that care exists between tablets and touchscreens, or within the context of examination rooms or hospital beds.
Sylvia Romm MD, MPH, is the Vice President of Medical Affairs of American Well and works with health systems, employers, health plans, pharmaceutical companies, and other health care innovators to design and implement their digital health strategies. Dr. Romm worked first as a pediatric hospitalist before founding a company focused on telemedicine for new mothers, and then joining American Well full time. Through these experiences working both as a clinician and as an entrepreneur, Dr. Romm believes that the integration of digital health care delivery into the traditional health care ecosystem is a key component to the quadruple aim of enhancing patient experience, improving population health, reducing cost, and improving the work life of health care providers.