Necessity is the mother of invention, and war is often a surrogate mom.
For centuries, war or the threat of war has propelled nations to seek technological solutions to end the battle, reduce the threat or minimize collateral damage. Very often these solutions, such as computers, penicillin, GPS, and canned food outlast the conflict and contribute significant advances to society.
Our nation is currently engulfed in a war against an invisible and unique enemy. The fight against COVID-19 is unlike any previous traditional conflict as it has attacked us at home and forced our doctors, nurses, and healthcare workers to be our new front-line soldiers. The unprecedented elements that surround the war against COVID-19 present our nation with an opportunity to accelerate innovative developments for the purpose of ending this conflict and advancing our society long after. The technological solution that I want to focus on is telehealth because it possesses the unique dual ability to significantly advance the current fight against COVID while providing long-term, perhaps monumental improvements to the quality of healthcare access our society will have long after the war ends.
The Demand For Telehealth
Telehealth was already gaining significant momentum prior to the COVID pandemic, but its continued upward trajectory has been solidified by the vital role it is playing in this unprecedented war. A recent survey by Sage Growth Partner (SGP) and Black Book Market Research found that 25% of consumers reported having used telehealth prior to the current COVID-19 pandemic. Fifty-nine percent reported they are more likely to use telehealth services now than previously, and 33% state they would even leave their current physician for a provider who offered telehealth access.
Further evidence of the demand for telehealth can be found in the fact that the industry is on pace to have its largest private funding year ever and is set to be valued at $175.5B by 2026. But the private sector isn’t the only place where we are seeing massive telehealth funding. Only months before the COVID outbreak, the Department of Veterans Affairs requested a telehealth budget increase of $105 million bringing their total budget request for FY2020 to $1.1 billion. Under the $2 trillion stimulus law that went into effect in April of this year, the Veterans Health Administration was allocated $17.2 billion to care for veterans with COVID-19 and expand telehealth services. The VA Office of Connected Care, which oversees telehealth services, has spent $39 million of CARES Act funding for equipment for telehealth patients and clinicians, such as iPads, webcams, and speakers, as well as expanding the telehealth help desk and improving the IT infrastructure. This massive amount of funding and demand illustrates how the stage is perfectly set for telehealth services not only to rapidly expand but also to evolve into a steady foundation that will last for years to come.
The Penicillin Comparison
You may be wondering why the VA is so critical to the expansion of telehealth. The answer can be found in the history of penicillin.
Before World War II, penicillin had just begun to be recognized as an effective antibiotic. In the spring of 1943, pilot studies persuaded the U.S. Army to purchase 150 million units per week for hospital use. One year later, in 1944, the army was using 85 percent of all American penicillin output because it had proven to make such a remarkable difference for recovering soldiers. In fact, it was estimated that 10 to 15 percent of all wounded U.S. servicemen eluded death due to the availability of this “wonder drug.” World War II created the perfect combination of demand and testing ground for penicillin to gain sudden international credibility that would secure its use long after the fighting stopped.
Although our current war is being fought by different soldiers, the military - or in this case the VA - still has a crucial part to play in the war’s outcome. The VA is receiving a significant amount (in the billions) of funding to fight the virus and as the largest healthcare system in the nation, they have a tremendous amount of reach. Last year alone, the VA reported that over 900,000 veterans received care through the VA telehealth program. Telehealth video appointments using the department's VA Video Connect have spiked 1,000% since February and Veterans Affairs' providers have conducted 1.1 million tele-mental health visits to more than 350,000 veterans this year. The VA’s servicing this number of patients through telehealth services is parallel to when the U.S. Army was receiving 85 percent of all American penicillin during World War II.
The VA’s Powerful Motivation
There will undoubtedly be skepticism as to whether a government agency, specifically one of the VA’s size and reputation, can effectively produce tangible change in the COVID war. That skepticism may be well-founded, but the VA has a lot at stake in this war and will be motivated like never before to get this right.
In 2017, the average age of a male veteran who was using VA benefits was 64, while the average age of a female veteran using VA benefits was 48. This means that the average VA patient (especially males) is at a significantly higher risk of developing a severe case of COVID and potentially dying from the virus. In traditional wars, the military has been at the greatest risk for suffering the heaviest losses since they were the group most commonly targeted. This COVID war has produced an eerily similar situation for the VA as veterans could suffer enormous losses from an enemy that is highly effective in attacking their average member. The high stakes associated with this war will motivate the VA to reach for new heights in providing quality healthcare to its membership.
Beyond The War
The VA is perfectly positioned to lead the “telehealth front” in this war, and the reasons to hope they succeed go well beyond the current COVID conflict since telehealth services have the potential to address a plethora of healthcare problems facing our nation besides helping doctors treat patients from a safe social distance. The good news is that the VA is making significant strides in two of these crucial areas.
One of the biggest healthcare areas where telehealth is poised to leave a lasting positive impact is rural health. Rural health initiatives were a large priority for the VA’s telehealth efforts prior to COVID. The VA reports that a quarter of all veterans in the U.S 4.7 million veterans live in rural areas. which presents specific health challenges that place residents at a higher risk for health problems, especially COVID. The higher probability of health issues in rural areas stems from the fact that, compared to urban areas, rural areas typically have higher poverty rates, more elderly residents, and fewer physician practices, hospitals, and other health delivery resources. Consequently, the VA has significant motivation to develop an effective solution for rural health issues since 57 percent of rural veterans are enrolled in the VA health care system, a significantly higher percentage than the 37 percent of veterans enrolled in cities. A victory in telehealth for rural veterans will pave the way for additional health care systems to follow the VA’s blueprint and to expand the availability of telehealth services to meet the needs of our nation’s often-underserved rural civilian population.
Mental health is the second key area where telehealth services have the potential to significantly improve the healthcare landscape for the future. Mental health has been on top of the VA’s healthcare priority list for years now. In fact, the agency had a $9.4 billion budget request for mental health in FY2020, much of which was devoted to virtual programs and services. One of the most serious side effects of the COVID pandemic is the toll it is taking on our nation’s mental health. Recent Census Bureau data shows that a third of Americans are feeling extreme anxiety and nearly a quarter show signs of depression. Many experts are warning that the mental health effects of COVID-19 will long outlast the actual pandemic. That warning is another reason why it is so important to find solutions, like telehealth, that not only help fight this epidemic but will also help address the aftermath of this war. A victory in telehealth aimed at mental health will provide our nation with a resource desperately needed both for mental survival while the COVID battle wages on and also for speeding up our recovery afterward by reducing the pandemic’s lingering mental effects.
Like the effects of a leaky roof that is ignored until it rains, this pandemic has exposed many of our nation’s overlooked weaknesses, especially in healthcare. It is creating necessities that are forcing us to think and act in more innovative ways. The hope is that, while this war is unlike any in history, our nation will emerge as it has in the past, not only victorious in surviving the enemy attack, but also in capitalizing on the hardships of war to develop and implement innovative and lasting solutions for the measurable (or notable) advancement of society. The expanded use of effective telehealth services should emerge at the top of this list with the VA in the best position to lead the charge.