Five Areas of Virtual Health Disruption | Deloitte US has been saved
By Felix Matthews, MD, MBA, managing director, and Bill Laughlin, senior manager, Deloitte Consulting LLP
Prior to the COVID-19 pandemic, virtual health followed an increasing but relatively limited adoption curve. Our bi-annual survey of US physicians found that as of 2020 and prior to COVID-19, only 19% of physicians had implemented some form of video visits at their primary work setting.
The pandemic started a seismic shift toward virtual health, which has emerged as a necessary, vital, and significant part of the health care ecosystem. Many health systems have embraced virtual visits at an unexpected velocity, as exemplified by a New York academic center that observed a 40-fold increase in non-urgent virtual visits between March and April.1 Patients have become more educated and aware of the convenience of virtual health, and they show no signs of wanting to travel to the doctor’s office and wait to be seen.
Meanwhile, some once-skeptical clinicians now acknowledge the value of virtual health in engaging with their patients. Further, a broadened reimbursement landscape, driven by multiple telehealth waivers, lifted one of the last barriers to virtual-health adoption.2 While the regulatory permanence of these waivers is in question, it is likely safe to say that consumer demand for virtual health is here to stay and, along with it, a new care model.
Our Five Areas of Virtual Health framework identifies areas where virtual health can transform the care continuum:
- Wellness, prevention, and health management
- Outpatient care
- Inpatient care
- Interventions and research
- Health care administration
Within each of these areas, our framework identifies orthodoxies that existed before COVID-19, along with examples of how virtual health is reshaping care models and the patient experience. Orthodoxies are generally accepted approaches which are typically developed out of best practices that have been standardized. But over time, orthodoxies can become outdated.
The COVID-19 pandemic might have disrupted many orthodoxies, and the post-COVID-19 recovery period offers an opportunity to determine which disruptions to the care models should be adopted permanently. We are urging our health care clients to use our framework to determine areas that have already started to shift to a new care model. The next step is to identify which virtual-health capabilities—which might have been cobbled together hastily over the past months—should be formalized.
Disruption is upon us
We have already seen concrete examples of virtual health disruption in the market. Below we highlight some interesting instances of how health plans, hospitals and health systems, and other ecosystem players are contributing to the disruption that is occurring across the care continuum.
Health Management
Wellness: BlueShield of Northeastern New York is offering virtual wellness support to engage at-risk New Yorkers. The COVID-19 Member Well-being Outreach Program provides members with personalized outreach calls offering telehealth support, assistance with online prescriptions, education, and additional resources focused on improving the health of members as they follow stay-at-home guidance. 3
Coordination: UC San Diego Health has launched a trial of an eCOVID program, which provides remote patients with a wearable device to continuously monitor vital signs such as heart rate and oxygen-saturation levels. It also tracks their activity level and quality of sleep. This data, along with outputs from a daily questionnaire app, is sent to a secure dashboard that provides alerts and guidance for providers to help prioritize caseloads.4
Outpatient Care
Diagnostics: In partnership with Healthy.io, Geisinger conducted a study to measure the effectiveness of a smartphone-based home test for chronic kidney disease. To perform the test, patients urinate on a test strip and then scan the strip using a smartphone camera. The 60-second scan allows Healthy.io’s computer-vision techniques to detect early signs of kidney disease, UTI infections, bladder cancer, and/or pregnancy-related complications such as preeclampsia risk.5
Access: Anthem, Inc. launched a digital application called Sydney Care that includes an artificial-intelligence (AI)-powered symptom checker, personalized engagement features, and access to personalized health information as well as virtual health services. The app connects consumers with virtual primary-care providers and lets users to take a COVID-19 assessment.6
Rehab: The Duke Clinical Research Institute has partnered with Reflexion’s Virtual Exercise Rehabilitation (VERA) to better understand the effects of virtual physical therapy on patients before and after a total knee-replacement surgery. VERA supports a robust rehabilitation experience in the home through an avatar coach, a 3D imaging system, a dashboard to support clinical review, and telemedicine capabilities.7
Inpatient Care
Inpatient Stay: Lifesprk, a home-based care provider, has partnered with North Memorial Health Hospital to create a hospital-at-home model during COVID-19. The model gives patients access to non-stop virtual support from Lifesprk’s team and an in-home monitoring kit that includes pulse oximeters, scales, and video-calling capabilities.8
Coordination: Houston Methodist is using cameras, connected devices, and machine-learning algorithms to operate a command center that enables remote care for patients in ICUs, including COVID-19 cases. Information from the connected machines is fed into the patient-monitoring and analytics platform and alerts providers about which patients should be watched more carefully.9
Intervention and Research
MedTech: Explorer Surgical built cloud-based surgical procedure workflows that allow care teams to connect to the operating room (OR) remotely. The platform provides live content in a simulation environment for provider training. During procedures, it can display images and videos on mobile tablets for providers in the room, while reps monitor progress and provide live feedback remotely.10
Trials: Deloitte’s MyPath for Clinical is a modular, patient-centric platform that can help accelerate the execution of digital clinical trials by taking a holistic approach to connect clinical-trial participants, investigators, and clinical-research associates. It leverages modern cloud, mobile, and connected medical-device technologies and enables personalized digital patient engagement with guidance and support along the clinical-trial lifecycle with enhanced direct connectivity to investigators and patient communities.
Administration
Payment: Aetna, Inc. reimburses all providers for telehealth at the same rate as in-person visits for applicable telehealth codes, including for mental health care services.11
Billing: Change Healthcare is launching a consumer health platform that collects health information (e.g., clinical, financial, administrative) from multiple electronic sources and helps consumers evaluate health care choices by conducting online research, reading reviews, comparing prices, and engaging those who best fit their needs and budgets.12
Five questions to consider
Virtual-health disruption is already upon us. Here are five key questions that health care organizations should consider as they take steps toward a more virtual health care ecosystem:
- How can your organization build upon and scale virtual-health capabilities that worked well during the pandemic?
- How can you implement virtual-health technologies without sacrificing the quality of the care?
- What do you need to offer your clinical-care teams to support this new environment?
- Which governance structures will help your organization integrate new virtual-health capabilities and manage operations as you scale?
- Which of your strategic partners can help you to be disruptive rather disrupted?
Contributors: Ken Abrams, MD, MBA; Josh Lee, MBA; Zach Miller; Mamta Elias, MBA; Courtney Burton; Emily Zerishnek
Endnotes
1. Telemedicine transforms response to COVID-19 pandemic in disease epicenter, NYU Langone Health / NYU School of Medicine, ScienceDaily, April 30, 2020
2. Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge, CMS, March 30, 2020
3. Health insurance providers respond to COVID-19, AHIP, July 28, 2020
4. How remote patient monitoring is aiding the COVID-19 fight, HealthTech, June 11, 2020
5. New Home Test for Kidney Damage Shows Promising Results, Geisinger press release, February 11, 2020
6. Anthem, Inc. Leads Collaboration to Develop Tools to Help Public Officials and Businesses Make Informed Decisions Related to COVID-19, Anthem, Inc. press release, June 11, 2020
7. Duke Clinical Research Institute Presents on Effects of Virtual Exercise Rehabilitation Assistant, Reflexion Health, March 30, 2019
8. Lifesprk, North Memorial Health partner on hospital-at-home model to decompress COVID-19 surges, Home Health Care News, July 2, 2020
9. Hospitals deploy technology to reduce ICU staff exposure to Covid-19, Wall Street Journal, May 7, 2020
10. COVID-19 will cause a paradigm shift in how medtech companies interact with providers, medgadget, May 27, 2020
11. Health insurance providers respond to COVID-19, AHIP, July 28, 2020
12. Change Healthcare rolls out software to let patients book healthcare like shopping for a hotel room, Fierce Healthcare, June 3, 2020
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Felix Matthews, MD, MBA
Managing Director | Deloitte Consulting LLP
Dr. Matthews is a Managing Director and physician leader at Deloitte Consulting LLP. Felix is the National Lead for our Academic Health / Research Leaders practice. He advises his clients on strategies to succeed in an increasingly competitive market. His clients include academic health systems, national health plans, and life sciences companies. He is experienced in corporate strategy, care model innovation, physician engagement strategies, clinical affiliation strategy, value-based payments, operating model design, and digital strategy, among others. He also advises his clients on strategy implementation and enabling capabilities. With over 20 years combined experience in medical practice and health care consulting, Felix brings to his clients a unique blend of clinical understanding and business insight. Felix trained in trauma surgery and accident medicine and has led research focused on clinical technology innovation at major academic centers in the US and abroad. Felix is also a published author in peer-reviewed medical journals and a columnist on virtual health.
