The following is part three in a four-part series examining how the growing telehealth industry is influencing healthcare delivery. Story one is available here, and story two can be read here. The third part focuses on the telehealth industry's move to in-home care, fueled by connected devices and expanded access to high-speed broadband. The fourth part will explore the growth of telepsychiatry and tele-behavioral health.

While telehealth has primarily built on a traditional model that requires patients to visit healthcare facilities, tech companies, healthcare industry members and regulators are eyeing a future where patients receive services in their homes.

The successful transition to in-home care will rely on the proliferation of connected devices, the expansion of broadband to unserved and underserved areas and regulatory changes in multiple industries, all three of which are underway.

The U.S. Federal Communications Commission's Brendan Carr, who has been spearheading the agency's work on telemedicine, said in an interview that the commission's goal is to launch a program to support projects for providers to deliver care to the home.

"Instead of going to a brick and mortar facility, the internet connection means that the delivery of care can be brought directly to you and we've spent a lot of time on the road ... seeing pilots where this is working," said Carr, a commissioner at the agency.

In July 2019, the agency approved a notice of proposed rulemaking for a three year, $100 million pilot to allow healthcare providers to cover the costs of broadband for low-income patients, veterans and others accessing telehealth services. The pilot is funded by the commission's Universal Service Fund, which subsidizes telecommunications services in remote and underserved areas.

A likely next step in the commission's process would be an order formally launching the pilot.

Carr is also looking to 5G, the next generation of cellular network technology, to expand telehealth.

"One of the reasons why we need 5G for a lot of this is that 4G can only support, actually, a relatively limited number of IoT or other devices right now," he said. "Going to 5G is going to mean all of these IoT devices, telehealth devices really can be connected at scale to a network, and it will work."

5G promises to usher in a new era of connectivity with increased bandwidth that enables a new era of IoT devices in homes and the workplace. When fully implemented, 5G will enable download speeds many times faster than the current 4G LTE networks.

Bob Sutton, President and CEO of Avera Health, a national hospital system, said in an interview that moving telehealth to patients' homes would further eliminate access barriers.

The Centers for Medicare and Medicaid Services has been slow to cover in-home services for Medicare, and state coverage plans for Medicaid vary widely. Most in-home services are not covered through traditional Medicare, but the CMS recently opened up coverage for Medicare Advantage plans, which are operated by private companies.

Regardless of current reimbursement challenges, Sutton is confident that government and private insurers will ultimately pay for the services.

"I feel very strongly that the reimbursement model is going to drive that we deliver care as close to the patient as possible, and that will include home care," Sutton said.

Eventually, hospitals will be reserved for only the sickest patients, and most patients will not have to come into a facility, he said.

Avera eCARE CEO Deanna Larson said the company is collaborating with federal health officials to expand reimbursement for telehealth services. Source: S&P Global Market Intelligence

Deanna Larson, CEO for Avera eCARE LLC, a national telehealth provider and subsidiary of Avera Health, said in an interview that while the company is working to remove adoption hurdles like adequate reimbursement from health insurers and the federal government, opening up payment models for telehealth will ease market entry for tech competitors like Amazon.com Inc., Facebook Inc. and Apple Inc. to succeed in the healthcare space.

Tech companies test healthcare waters

Big tech companies have invested in digital healthcare in different ways over the past few years. None, however, have presented a public-facing telehealth offering to rival companies like Avera eCARE.

In October 2019, Facebook launched a new preventative health tool targeting cancer screenings, flu vaccines and heart health.

Roni Zeiger, head of health strategy for Facebook, said in an interview that the project is meant to connect patients to information but not directly put them in contact with doctors using telehealth services via texting or video conferencing.

Instead of pursuing a commercial telehealth offering, Zeiger said, Facebook can impact the industry through other ventures such as its health support groups project, which connects users with others who have the same medical condition.

"One of the ways that Facebook can provide value to people in the context of their health is to make it easier to connect with others who've gone through similar experiences," Zeiger said. "That's something that in general the healthcare system is not very well set up to do."

The healthcare sector has also caught the attention of other big tech companies.

Microsoft Corp. is entering into a partnership with Providence St. Joseph Health, a large hospital system, to improve hospital care; Alphabet Inc.'s Google LLC is acquiring Fitbit Inc. for $2.1 billion and starting a data partnership with Ascension Health Inc., another large healthcare system; and Apple's Apple Watch has gained U.S. Food and Drug Administration approval to be marketed as a medical device to measure heart rhythm and alert patients when an irregular heartbeat is detected.

Johnson & Johnson said Feb. 25 that plans are underway to work with Apple on a study to see if the heart health features on the iPhone and Apple Watch can help improve health outcomes for stroke patients with the early detection of atrial fibrillation, an irregular heartbeat that can increase the risk of stroke and heart failure.

In September 2019, Amazon launched a platform, known as Amazon Care, which allows its employees to access either virtual or in-person healthcare services.

Morningstar analyst R.J. Hottovy even expects Amazon to offer a commercial healthcare platform in the next five years that would utilize remote patient monitoring systems and connected devices.

While some big tech players, such as Facebook, have said outright they are not pursuing a commercial telehealth offering, a representative for Amazon was more tight-lipped about the company's future telehealth strategies, declining to comment on the future of Amazon Care.

The future of tech companies' involvement in healthcare remains unclear. But Lisa Gill, a senior analyst for healthcare technology and distribution for J.P. Morgan, said in an interview that rumors of big tech taking over healthcare have been ongoing for 20 years, and she does not believe this is likely to happen anytime soon.