Contributors: Wren Keber, Lisa Soroka, and Z. Colette Edwards, WG'84, MD' 85
To learn more about Wren, Lisa, and Colette, click here.
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Introduction
Virtual care disruptors have been making waves in the healthcare industry, even before the COVID-19 pandemic. As we navigate the complexities and fragmentation of the healthcare system, many envision alternative pathways to engage with providers, challenging the "status quo." New disruptors in this space must understand existing healthcare systems and workflows already in place — both care delivery and payment — and work within these frameworks or work outside current thinking to make meaningful impact by taking a different path to the desired outcome - all without detracting from their intended “disruptive value.” The individual provider-patient connection/relationship will need to remain a critically important cornerstone of the healthcare system. We believe disruptors will find the most success when this connection/relationship is central to their approach.
What Disruptors See [What’s The Opportunity?]
Equal access to high-quality, affordable healthcare is a significant challenge for a multitude of patients, and the numbers continue to grow. We believe virtual care presents a unique opportunity to improve access, especially for those who face barriers to traditional in-person care. Virtual care can help address health inequities by potentially providing more convenient and timely access to a wide range of healthcare services. Different age groups appreciate virtual care for varied reasons. Younger individuals, for example, often engage with virtual care similarly to how they interact daily with other industries. (e.g., banking, retail, government). Those in rural areas have limited ability to take time from work for care without a financial impact, or do not have easy access to transportation. A virtual approach can mean the difference between getting care or not.
Virtual care also offers opportunities to optimize management of chronic conditions. More regular check-ins to detect struggles with following a treatment plan or affording prescribed medications, to monitor adherence to activities at home like blood pressure checks, blood glucose levels, weight checks to detect fluid retention, to reinforce understanding, and to celebrate progress are all steps that can be key to successful outcomes. Tools like the Patient Health Questionnaire 9 (PHQ-9) for depression and screening for social determinants of health can supplement quantitative data collection to help aid and enhance the diagnostic journey without requiring patients to return to the office. They can also identify the need to loop in other care team members like a dietitian, social worker, or behavioral health therapist to better treat the whole person. Data can also be collected in advance of an in-person visit. This convenience can be particularly beneficial for patients who are hesitant to visit in-person and/or need to ask non-urgent questions.
Types of Virtual Care Solutions
Telehealth: This type of billable encounter with a credentialed and licensed provider is usually conducted with two-way audio and video. Telehealth allows patients to have face-to-face interactions with their healthcare practitioners from the comfort of their homes. Further, this type of visit is particularly beneficial for routine check-ups, follow-up appointments, and consultations that do not require physical examinations. Telehealth can also be used for mental health services, such as virtual therapy sessions, providing patients with access to mental healthcare without the need to travel.
Secure Chat: Non-billable and typically triaged and handled by a care team, secure chat allows for real-time interaction without the need for an in-person appointment. This type of encounter is ideal for addressing immediate (but not urgent) concerns, such as providing guidance on minor health issues, or answering questions. Secure chat can improve patient satisfaction by offering quick and convenient access to healthcare advice, resulting in a reduced need for in-person visits for non-urgent matters.
Secure Messaging: Also non-billable, this method is not real-time and usually involves a response within 24 to 48 hours. Secure messaging is useful for patients who have non-urgent questions and/or need additional follow-up information after a consultation. It allows patients to communicate with their healthcare providers and/or administrative support staff at their convenience, without needing to schedule an appointment or make a phone call. Secure messaging can also be used for sending test results, prescription refills, and other routine communications. Often these are transactional tasks within an app or portal.
Audio-Only or SMS-Based Monitoring: These approaches can be particularly useful in rural or underserved areas where internet access may be limited or intermittent. Audio-only consultations provide an alternative to video calls, allowing patients to speak with their healthcare providers over the phone. SMS-based monitoring involves sending text messages to patients to remind them of medication schedules, follow-up appointments, and/or to check on their health status. Using this capability can help ensure patients adhere to their treatment plans and receive timely care. Depending on the specific type of encounter and payment landscape, these may be billable or non-billable encounters.
Remote Monitoring: This supplementary technology involves the use of active or passive devices to monitor facets of patients' health status remotely, providing a stream of data to healthcare providers. Remote monitoring devices, such as wearable fitness trackers, glucose monitors, and blood pressure cuffs, can track vital signs and other health metrics in real-time. This data can be transmitted to healthcare providers, allowing them to monitor patients' conditions remotely and intervene if necessary. Remote monitoring is particularly beneficial for managing chronic conditions (e.g., diabetes and hypertension), as it can identify trends and enable oversight to help prevent acute events and/or complications. Information Technology (IT) can also provide data to train rising risk algorithms (software intended to flag a change in chronic disease severity or status.)
Successful Deployment [Making Disruption “Stick”]
For any virtual care disruptor to succeed, they must ensure their proposed solutions are viable within today’s complex healthcare ecosystem. That means HIPAA compliance, cybersecure systems, overcoming patient resistance/concerns/fears, not losing sight that the technology is a means to an end and not the end in and of itself, and preserving human connection in the process. The process should not add to the stress and administrative burden of clinicians and staff, nor should it disrupt existing workflows unless it makes lives easier and has been vetted by those who will be using the technology. Lots of virtual care tools look good on paper - but fail to live up to their potential when applied to real people because they don’t consider the aforementioned success factors. The patient experience should also be optimized to increase, accelerate, and maintain adoption.
Very real and valid concerns exist around the completeness and quality of virtual visits compared to those which are in-person. Does the interaction feel more rote than personal, and does the technology serve as a distraction, especially if things don’t go smoothly with the logistics? Are subtle signs and body language missed when there is a screen between patient and practitioner? How much does the use of this technology impact the patient-clinician relationship, particularly in scenarios in which there are more virtual than in-person visits over the course of the year? These concerns must be addressed. And training in techniques like active listening and best practices to optimize a virtual visit are part of the answer.
Timely and accurate payment across all lines of business is crucial to cover costs and contribute to provider revenue and/or compensation. With reimbursement levels falling each year, disruptions must pay for themselves in a short period of time in terms of not just revenue but also time and burnout avoidance. Considerations for success include:
- demonstrating real financial value (either new revenue and/or savings) Highlight potential cost savings associated with virtual care, such as medically appropriate reductions in utilization, emergency room visits, hospital admissions/readmission, and/or expenses for patients (and other barriers to accessing care). Disruptors must provide data and case studies that showcase the financial benefits of virtual care solutions, or they are very unlikely to garner significant interest. Healthcare margins are already incredibly tight; any new investment must include a positive return on investment (ROI) to be seriously considered.
- emphasizing high quality and outcomes. Guarantees of improvements in patient outcomes and satisfaction. Emphasize the alignment with value-based care initiatives and the potential for achieving better health outcomes. Virtual care fits nicely into a team-based approach and can increase the ability for clinicians to practice at the top of their license as well as more easily include caregivers in the process of achieving the best outcomes possible.
- integrating seamlessly into workflows. Design virtual care solutions that integrate seamlessly into existing provider workflows. Minimize administrative burdens and provide training and support to ensure smooth adoption. The technology should be intuitive, not require constant training and updating, have integration capabilities, e.g., SSO, EHR, labs/imaging, and scribes, medication prescribing, and generate clear action items for practitioner, staff, and patient. Concretely demonstrate how disruption brings convenience and efficiency without sacrificing quality and patient satisfaction, both without adding more complexity and administrative tasks/work.
- and addressing security and compliance. Ensure virtual care solutions meet stringent security and compliance standards. Address concerns related to data privacy, consent management, and regulatory requirements. Building trust with healthcare administrators and providers is essential for widespread adoption of any disruption. Any change needs to include service-level agreements (SLAs) that have been rigorously negotiated in partnership with the provider organization’s legal, risk management, and information security teams.
Conclusion
Disruptors in the virtual care space have the potential to positively impact the healthcare landscape by improving access, enhancing patient engagement and satisfaction, and supporting providers and staff, all while increasing the ability to deliver high-quality care. By understanding and working with end-users, addressing financial and quality concerns, and prioritizing security and compliance, disruptors can create significant and sustainable positive change and a long-lasting relationship with their customers.
Contact Wren at: [email protected]
Contact Lisa at: [email protected]
Contact Colette at: [email protected]