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Technological Breakthroughs and Emerging Trends: Modifying Public Plans for Tele-Virtual Health

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Candi Choi
April 16, 2020

According to Pew Research, 96% of all Americans own a mobile phone device, 81% own a smartphone, three-quarter adults own a laptop and one-half own a tablet.

Once essential for social interaction via texting, social media posting, and Googling, mobile devices now provide a path for swift implementation of various emergency responses to COVID-19. Many solutions previously considered out of bounds or trivial are currently commonplace, such as home and virtual schooling, teleworking, digital meetings and tele-virtual medical care. Mobile devices are useful for tracking COVID-19, disseminating health information and providing interface between patients and healthcare providers. There are some public concerns in regards to technology, such as quality of information, medical integrity, privacy and public property. Overall, mobile device accessibility provides the public continuity while decreasing travel and exposure during one of the world’s major crisis’ (COVID-19). This article provides a brief summary of the implementation of current public tele-virtual healthcare.

Tele, virtual and digital medical options address patient health while improving accessibility and affordability across the continuum of care. These models exchange medical information from one site to another through electronic communication, such as from a provider to a patient’s home. There are a variety of health related functions, such as mHealth applications and SMS alerts. The models provide healthcare workers access to resources, guidelines, diagnostic support and  a platform to collaborate with both colleagues and patients in real time. They also collect data remotely for evaluating and optimizing interventions, initiatives and policies. Thus, patients and practitioners can easily engage in tailored healthcare leading to efficient health and outcomes. With the caveat, that personal information is shared over the internet of things.

In 2019, tele-virtual healthcare check-ins and e-visits were implemented for limited Medicare beneficiaries, such as rural residences. Recently, the Centers for Medicare and Medicaid (CMS) have expanded tele-virtual health services to all beneficiaries. This is in part due to the Federal Government’s temporary emergency response to COVID-19, which helps reduce the spread of the virus and ensure benefits to all. Currently, Medicare beneficiaries can use telecommunication technology for services that would otherwise occur in-person. Patients can interact with a variety of distant state-licensed practitioners without leaving their homes. Thus, the recent expansion and flexibility for public tele-virtual health has helped provide care to vulnerable populations while minimizing travel and exposure.

Doctors provide virtual direct primary care services to patients without billing and processing claims through typical insurance plans. The patient and provider agree to a DPC where fees are paid directly to the provider via a monthly payment. Direct primary care plans provide preventive care to mitigate the cost of care, enhance the patient experience, improve provider engagement and increase overall population health via tele-virtual health providers. DPCs focus on preventive care, disease management and lab services. This doesn’t include specialist care or hospital visits. Ultimately, the DPC model opens the market for direct access between patient and provider. Direct primary care provides tailored preventive healthcare experiences at lower costs while mitigating the need to visit specialists and hospitals. However, it is important that the tele-virtual health provider has medical integrity and acumen that supports the science behind their practice.

Public employers are providing virtual direct primary care models as an option among traditional insurance plans. Union County, North Carolina implemented the DPC model in 2015. 44% of Union County’s 1000 employees are enrolled in the DPC plan. According to the John Locke Foundation the model has saved 40-60% of overhead costs, decreased medical claims by 23% and saved taxpayers over $1.28 million. Public-employer direct primary care options might limit out-of-pocket costs for its employees and reduce the burden on taxpayers, but its design disintegrates its purpose and it is redundant as an additional healthcare plan.

The purpose of direct primary care is for access to open markets and payments directly from patients to practitioners, rather than a third party. Governments incorporating the management of direct primary care models alongside traditional insurance plans prevent the free market, rather than enhance it. It is important for all patients to shop for providers with direct access to their prices and quality care. Therefore, the direct primary care model is better suited for patient-to-provider agreements.

Technology can help improve health outcomes for the whole population. It increases patient-provider access, expands the use of tailored care, provides efficient management of patient records and reduces the cost of healthcare and travel. However, fully relying on technology for healthcare has its limits. Most of the population uses cell phones and access information at the click of a button. Many depend on web-based information for health. It is important that the tacit knowledge of practitioners is developed and maintained with study, critical thinking and reflection rather than web-based information.

Medical care providers can incorporate tele-virtual health into their normal practices. Public services can be modified to provide beneficiaries healthcare that offers virtual services at lower costs with higher efficiency. DPC models can be updated to include local preventative healthcare that offers an option for tele-virtual services. State medical boards and state practice laws can maintain continuity evaluating and assessing licenses, prescriptions and management practices. Thus, the ideal tele-health model is for direct access to local providers that enhances their practices with digital resources when appropriate.

Policies and initiatives that improve the quality of life through technological formats require simultaneous protections for accuracy, privacy and property. Incorporating technology into a practical health model where and when possible can increase quality of life, conserve resources and maintain healthy lifestyles. However, technology usage has become a free-for all and at some point information sharing and medical integrity must be tamed. Thus, medical science and its integrity must be sustainable to technological advancements.


Author: Candi Choi holds an MPA with a specialization in local government management. She has experience with local budgeting, business planning and constituent affairs. Her contact email is [email protected] and her twitter handle is @MunicipalThink.

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