Posted: 28 Apr. 2020 12 min. read

COVID-19 might have accelerated virtual health by a decade

by Bill Fera, principal, and Urvi Shah, senior manager, Deloitte Consulting LLP

Over the past several weeks, as the COVID-19 pandemic began to take root around the country, many hospitals and health systems were able to quickly stand up the technology they needed to conduct virtual visits. Some organizations expanded existing virtual health/telehealth programs while others launched new capabilities to connect patients to clinicians. In some cases, the technology might have been clunky and the processes not ideal because it had to be implemented and/or expanded too hastily. At the same time, most clinicians and patients have been forgiving because they recognize the uniqueness of the situation.

Between November 2019 and January of this year, the Deloitte Center for Health Solutions collaborated with the ATA (American Telemedicine Association) to find out how health care executives expected virtual health might evolve in the future. Most of them predicted it could alter the landscape over the next 20 years. In just one month, the COVID-19 pandemic has potentially shortened that timeline significantly.

Virtual health is emerging as a significant part of the health care delivery system. Patients and clinicians who have experienced the convenience of virtual health might not want to go back to a predominantly in-person model of care. However, as the crisis stabilizes, organizations might discover that patients and clinicians aren’t as forgiving of a system where the processes, platforms, and workflow are still being worked out. As hospitals and health systems move from responding to the crisis to recovering from it, they may see an influx in demand from patients who had deferred non-essential services or had been reluctant to reach out to their physician. They are also likely to see continued demand for services that they have received virtually. In response, health organizations should begin thinking about how to scale the virtual health capabilities that worked well and build on them. The organizations that can create a seamless experience for patients will likely be best positioned to thrive in the post-pandemic world.

COVID-19 has accelerated regulatory flexibility  

The US Centers for Medicare and Medicaid Services (CMS) started to open the door to virtual health services in late 2018 when it issued its final 2019 Physician Fee Schedule and Quality Payment Program. Some services, such as tele-stroke and end-stage renal disease home dialysis services, were granted nationwide Medicare coverage—along with expanded coverage for remote patient monitoring.

That door has since been opened much wider in response to the COVID-19 pandemic. Late last month, CMS expanded Medicare coverage of 85 new services that can be provided virtually. In an April 10 memo, the agency clarified that Medicare Advantage (MA) plans and other organizations that submit diagnoses for risk-adjusted payment can submit diagnoses for risk adjustment that are from telehealth visits.

Prior to COVID-19, some of our clients were already moving more of their behavioral/mental health services into the virtual space (this was one area where they were generally reimbursed). As we move past this crisis, many providers and health care stakeholders will likely push to continue the increased flexibility and payment for in-demand services such as routine follow-up visits related to chronic care or simple urgent care needs, especially if this crisis period yields promising practices and successful outcomes.

What are the next steps in expanding virtual health?

Based on our research, health care organizations should consider the following steps as they enhance their virtual health capabilities:

  • Define an enterprise-wide virtual health strategy: Organizations should determine their overarching objectives and define where they fit in the evolving ecosystem. They should consider the patient populations that would benefit the most, where to invest in technology, analytics, and interoperability solutions, and which metrics will be most useful in evaluating success.
  • Strive to be both consumer- and clinician-centric with virtual health interventions: Health care stakeholders are increasingly aware that the current system is not patient- or consumer-centric. Physicians and clinical teams are on the front lines of patient care, and they should be engaged in decisions. Moving to a more consumer-centric model will likely require work-flow redesign and an aligning of clinicians and staff across the organization’s network to support and advance virtual health offerings. Focus on improving quality and health outcomes, as well as improving patient and clinician experience. A whole new approach to team-based care can also be enabled by virtual health and could yield tremendous benefits and satisfaction for both patients and clinicians.
  • Prepare the workforce for changes: Widespread adoption of virtual health will likely require new training opportunities, starting in medical schools. As more physician-patient interactions happen virtually, health systems should ensure clinicians are trained on how to interact with the patient during a virtual visit. Clinicians should also define best practices for virtual visits. New pockets of previously dormant resources could be activated as a result, and scheduling of clinical staff and patient visits will likely need to be revamped. 
  • Partner and collaborate: Alliances will likely be key to the future of virtual health. Organizations are increasingly recognizing that they cannot go it alone because they lack all of the necessary offerings to thrive in an increasingly virtual health care system. To effectively address the drivers of health—and ensure everyone can benefit from evolving technology, scientific discovery, and improved care models—health plans and health systems will likely need to partner and collaborate with community service providers, technology companies, retail pharmacies, employers, and others. 

Even as the COVID-19 curve begins to flatten, patients might be reluctant to go to a hospital or doctor’s office for care and risk being exposed to sick people. In addition, positive experiences with virtual health today might mean tomorrow’s patients are less willing to take a day off of work to travel to an in-person doctor visit. When we look back on this outbreak 20 years from now, we might recall it as being a tipping point for how the United States and other countries respond to potential health emergencies, and a tipping point for virtual health.  

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Bill Fera, MD

Bill Fera, MD

Principal | Deloitte Consulting LLP

Bill Fera, MD, is a principal, Deloitte Consulting LLP. Fera specializes in technology-enabled transformation to support the advancement of population health strategies. As a practicing physician, health system executive, and consultant, Fera has worked across health plans and health systems to drive toward a value-based, patient-centered model of care. He is based in Pittsburgh, PA.