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Closing the Quality Gap of TeleHealth

Posted by Ita Cremen
Ita Cremen
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4 minute read

Working in the field of clinical navigation, I’m excited to see that Telehealth has grown exponentially in the last nine months and its purported effects on the healthcare system are positive. With the easing of regulations and expansion of coverage for telehealth services, physicians are now increasingly able to safely “visit” with their patients. Talk about a major win for a consumer-friendly, modern approach to delivering care!

As exciting as this news is to someone like me (having two small children), I’m in a quandary about how healthcare quality can be maintained in this new landscape when it’s been a significant endemic challenge to our healthcare system even prior to the pandemic.

As healthcare is being doled out, seemingly as a commodity through Telehealth, is there risk for even more misdiagnosis and sub-optimal treatment?

I often read about the many challenges and hurdles to optimizing care navigation, coordination, outcomes and continuity of care, as well as many innovative solutions. Telehealth emerged to mitigate a portion of these challenges and make care more accessible and subsequently surged in adoption during the pandemic.

Let me be clear, the majority of applications of provider-to-patient Telehealth visits can be very effective…

However, from my vantage point, Telehealth can obscure care navigation even more than in “normal” times and complicates the assurance of being matched with the right physician.

The Mayo Clinic’s landmark study published in 20171 produced alarming occurrence and cost data about patient misdiagnosis and/or incorrect treatment for the patient. Additionally, several statistics from longitudinal research are now universally accepted, even though under-reported. These include the facts that 12 million adults are misdiagnosed in the US each year2 and more than ½ of all adults will receive an incorrect treatment plan during their lifetime3.

With my experience working in healthcare and being a patient/caregiver, I came to realize that physician referrals (PCPs or Specialists) are based on personal relationships or completely random. Examples of the status quo include: a referring physician’s relationship with a specialist, recommendations from friends and family, or referrals that are selected at random out of a directory of in-network providers. There is minimal quality-qualification-personalization matching involved. Furthermore, there is increasingly more “steerage pressure” for referring providers to refer in-system and now, many referrals are being directed by a telehealth service.

Think about it - most telehealth services tee up completely random doctors for first visits based on which doctor is available! Then add random referrals to a specialist and you’ve just amplified the chance of mismatching patients and physicians!


More than ever before, diagnoses are being made virtually. A McKinsey & Co. report4 cites that physicians are seeing 50 to 175 times more patients via telehealth than they did pre-pandemic.

With a telehealth visit, one must consider the added risk that you might be misdiagnosed by a perfectly good doctor and/or receive a referral to a random specialist that doesn’t sub-specialize in your condition, due to the functional limitations and immaturity of telehealth clinical navigation.

With telehealth, you might be heading towards a sub-optimal patient journey, with sub-optimal outcomes, albeit more conveniently!

As previously noted, prior to the pandemic, the same question should be at the forefront of decision-making regarding which physician(s) to see for health and wellness needs, that is, “Who is the best physician to treat my medical condition?” Can you simply trust in a clinician-based referral made by a provider who diagnosed you? What criteria is that clinician basing their selection decision on or what makes that clinician qualified to choose the best physician for you within a specific sub-specialty or having a specific area of clinical focus?

With the increasing number of diagnoses and subsequent specialist referrals being made virtually, how does one resolve the ever-elusive answer to the question: Am I being diagnosed, referred to, and/or treated by the best doctor for my specific needs?

The bottom line is this: we should be guided by objective quality first and not by a subjective or random referral path. The question of who is best suited, trained, and experienced to treat me and my family, should always be our first consideration, regardless of how we receive care. At ArmadaHealth, we find the best quality doctors first and consider their Telehealth policy as part of our personalized matching services, eliminating the random roulette wheel of healthcare.

With knowledge and trust that you are connected with a choice of the best physicians who are matched to your personalized needs, you can have confidence that quality healthcare can be delivered in any modality.

Discover how we complement Telehealth providers and can ensure quality for your employees or members with our service QualityCare Connect or our tool for care coordination, QualityCare Navigator.


1 https://www.institutefornaturalhealing.com/2017/04/mayo-clinic-88-patients-misdiagnosed/

2 https://qualitysafety.bmj.com/content/23/9/727

3 https://www.ncbi.nlm.nih.gov/books/NBK338600/ 

4 https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality


Topics: Quality Transparency, healthcare quality, physician referrals, access to healthcare, doctor referrals, telehealth, telemedicine, virtual medicine

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