Once the road less traveled, telehealth in pediatric practice became the de facto mode of health delivery during the early months of the COVID-19 pandemic.
Practice license and payment restrictions were lifted, allowing health workers to administer care across state lines. For populations such as children and youths with special health care needs, gaps narrowed and care became more accessible with the help of virtual care coordination. Appreciation for telehealth as an effective care modality grew along with an understanding of what its limitations really were.
Efforts now are underway to shape the future of pediatric telehealth. The AAP and the Section on Telehealth Care’s Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT) network co-hosted a symposium to characterize lessons learned and discuss how to evolve a health system that uses technology to deliver more effective, equitable and valuable care beyond the public health emergency.
Action items for pediatricians and the broader community of child health providers were proposed and prioritized by expert stakeholders, including family advocates, federal agencies, academic institutions and hospitals, nonprofit organizations, health insurers, quality measurement organizations, and AAP sections, committees and councils.
Aimed at improving telehealth in the areas of feasibility and usability, equitability and outcome measurement, the actions are grouped into three types: identification, building partnerships and advancing technology.
With collaboration, resources and funding, the following may be achieved within the next six months (* indicates actions that are particularly relevant to pediatricians).
Identify processes and tools
- Identify features of telemedicine that prioritize and facilitate outcomes and equity.*
- Determine which existing measures are relevant to telehealth. Many of these may be process measures rather than outcome measures.
- Identify International Classification of Diseases, Tenth Revision, Current Procedural Terminology and other code sets and modifiers for telemedicine use.*
- Identify policies and regulations that facilitate or deter access to care and communicate to policymakers.*
- Assess how families and caregivers are experiencing telehealth.
- Identify characteristics for programs that could participate in a “provider-based authorization” system that would reduce the number of prior authorizations needed.*
- Identify models of care that prioritize equity.
- Identify strategies to measure care coordination.
- Obtain consensus on telehealth measurement strategy/framework.
- Identify local capacity (i.e., practice, hospital, institutional center) to measure telehealth impact during and after implementation.*
- Identify ways to track equity.
- Identify and build partnerships with community workers, educational systems, federal agencies and other community sectors representing key stakeholders to help deliver equitable care.*
- Include diverse representation of families with fewer resources in the design of action items.*
Determine technical requirements to make EHR platforms more equitable.
After the previous items are completed, the following may be achieved in six to 36 months with collaboration, resources and funding.
Identify processes and tools
- Identify and improve state-based licensure/payment issues.
- Define risk stratification for social risk, including family and community factors.
- Define and have transparency regarding cost and outcomes of telemedicine care.
- Outline a process for coding, billing and payment for care coordination in health care, care integration across systems and care transitions.*
- Assess and understand differential wait times for care (with and without telehealth) for families from groups with fewer resources.
- Formulate an approach that integrates disability status, race, ethnicity and language when identifying and calculating measures.
- Develop a payer level database of data/standards (i.e., care coordination strategies).
Build collaborative partnerships
- Engage with partners on longer-term objectives.*
- Incentivize vendor partners to improve their products; initiate pilots for innovation.
- Engage with the Centers for Medicare & Medicaid Services and state Medicaid agencies on Medicaid waivers.
- Partner with payers on payment for equitable care.
- Engage with policy organizations within and outside the AAP.
Define technical standards for telehealth platforms, applications and portals that prioritizes outcome, quality and equity.*
Dr. Chuo is a member of the AAP Section on Telehealth’s SPROUT group and the Council on Quality Improvement and Patient Safety. Dr. Antonelli is a member of the AAP Councils on Children with Disabilities and Community Pediatrics.
The symposium was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) and the National Institutes of Health/National Center for Advancing Translational Sciences (NIH/NCATS) SPROUT- Clinical and Translational Science Awards Collaborative. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, NIH/NCATS or the U.S. government.