In our Increasingly Digital World, Virtual Health is Sluggishly Gaining Traction | Deloitte US has been saved
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by Summer Knight, M.D., MBA, managing director and Srini Attili, principal, Life Sciences and Health Care, Deloitte Consulting LLP
There is no doubt our lives are in the midst of a digital transformation—from ordering movies and meals while sitting on the couch, to conducting online banking, to buying a used car via an app. The digital transformation in the health sector, however, tends to lag behind other industries.
Virtual health has been around for decades, so why hasn’t it caught on among health plans, hospitals, clinicians, or consumers? State regulatory requirements and outdated payment models may be two of the most obvious reasons. Unlike other industries like travel, retail, and entertainment, which are largely regulated on a federal level, health care is bound by both state and federal policies, some of which have contributed to the slow adoption of virtual care. Moreover, doctors and hospitals can be disincentivized to offer virtual care in a fee-for-service (FFS) model that only rewards in-person interactions. While virtual visits should be less expensive than face-to-face interactions, physicians and health systems should still maintain infrastructure in the existing bricks-and-mortar ecosystem. As a result, virtual-care payment models that are below parity can create another disincentive.
Implementing a virtual-health program can be an expensive and complex process. It also typically requires workflow changes and a transformation of the clinical team. During the transition, there can be more administrative work. In addition, virtual health systems also typically need to co-exist with legacy electronic medical record (EMR) systems. And while consumers and physicians might both see value in virtual care, just 14 percent of physicians have video-visit capability, and only 18 percent of the rest plan to add this capability in the next year or two, according to our 2018 survey of physicians.
Despite these barriers, we have noticed a growing swell of enthusiasm for virtual care among our health sector clients. What we typically don’t see, however, is a strategy for implementing a virtual-health program that can offer a return on investment (ROI).
Some regulatory barriers are crumbling
The rules that govern virtual care can vary from state to state, which has contributed to the slow adoption. For example, a physician in Pennsylvania might conduct monthly virtual visits with a patient who lives in a rural part of the state. If that patient crosses the state border, those virtual visits aren’t allowed if the physician isn’t licensed in that state (bending of this rule is sometimes allowed for established patients).1 Of the more than 985,000 licensed physicians in the US, only 15.5 percent are licensed in two states, and just 5.6 percent are licensed in three or more.2
About 30 states, Washington, D.C., and Guam now participate in the Interstate Medical Licensure Compact (IMLC), which was developed to expand the use of virtual care while abiding by state regulation of medical practices. IMLC had issued 6,671 state medical licenses to 4,446 physicians as of July 30, 2019 (the average number of state licenses obtained through the compact is three).3 While more than 40 states have enacted some form of virtual health law, only about 10 states require payment parity for virtual health, according to a report released in December by the law firm Foley & Lardner LLP.
Patients are becoming more comfortable with virtual visits
The idea of an ongoing patient-physician relationship appears to be fading, and the physician is becoming less critical for ensuring care continuity. Young consumers tend to choose convenience over such relationships. This increasingly generic relationship with the health care system could help encourage greater adoption of virtual care. However, leveraging digital and virtual care can help strengthen the bond between these younger consumers and their preferred providers by making it easier and more convenient to access advice, care, and personalized information.
As patients become more engaged, informed, and involved with their health decisions, they will likely demand better, faster, and real-time access to care. Giving clinicians the ability to reach patients virtually might also help offset anticipated physician shortages. Moreover, virtual health can generate cost savings of between $19 and $121 per visit, according to a 2019 study published in The American Journal of Emergency Medicine.4
Virtual care programs should start small
According to our recent report on virtual health, the health care industry is primed for expanded adoption of virtual health. Hospitals, health systems, and clinicians should become proficient in virtual health technologies to compete in an increasingly digital world. But launching a virtual health program is typically far more complex than implementing a new EMR system. Rather than investing broadly across the organization, we recommend first focusing on a particular problem to be solved and building a thoughtful program that solves that problem with an eye toward expansion. Growing the program and expanding virtual-health use cases can be based on successes. Of course, it is important to define an enterprise-wide strategy first. Here’s a look at four examples of health systems that have launched a virtual-health program:
1. Jefferson University Hospitals: More than 1 million people traveled to Philadelphia during Pope Francis’ 2015 visit. In preparation for the crush of people, the city closed a large part of Philadelphia to traffic. This security zone made it difficult for patients and employees to reach the six hospitals that stood within the barricade. An early pioneer for urgent virtual care, Jefferson University Hospitals saw the event as an opportunity to test its brand new JeffConnect telehealth service, which previously had been accessible only to employees. Licensed physicians in New Jersey, Pennsylvania, and Delaware were able to use the JeffConnect platform to connect with patients through an app. The app enables consultations in 18 physical and mental health specialties.5,6 This offering was a part of Philadelphia’s city-wide safety net.
2. Intermountain Healthcare: The health system’s Connect Care service has 35 telehealth programs that offer specialized care throughout Utah. The service connects clinicians with patients who need basic urgent care. The technology is also used within Intermountain hospitals to connect providers to other providers, creating a support network that can improve patient care. The technology ensures that a patient, no matter where they live, can have access to highly specialized care without having to be transferred to a tertiary hospital.7
3. Banner Health: The Phoenix-based health system operates hospitals and other health entities in seven states. The organization’s Banner iCare program includes an in-home virtual care delivery model to treat patients who have complex chronic illnesses. Through the use of a tablet-like device, patients interact directly with their health team—primary care physician, pharmacist, nurse, and health coach—to track and address any medical concerns. Banner iCare aims to decrease emergency department visits and hospitalization and increase medication compliance while providing care in the comfort of the patient’s home.8
4. Ochsner Health System: The New Orleans health system has fully integrated its EMR with Apple HealthKit™ developer software and has begun to use the Apple Watch® to help manage chronic diseases, starting with hypertension. Through wireless blood pressure cuffs integrated with HealthKit™ and the EMR, patients can regularly measure their blood pressure and heart rate at home. The data can also be sent directly to the clinic for monitoring. Specialized pharmacists can review the information in real time and adjust medications or make lifestyle recommendations as needed. Results are incorporated into the system’s online patient portal so patients can access to their personal health records and receive progress reports. Through the Apple Watch®, patients can also receive medication reminders, feedback from clinicians about potential side effects when a new medication is prescribed, renewal notifications for prescriptions, and activity tracking and exercise reminders.9
Virtual health goes beyond simply enabling video visits or teleconferencing appointments. It can also incorporate many of the benefits of digital health including artificial intelligence, machine learning, and analytics to create a more personalized health experience. Virtual care can complement, and in many instances replace, in-person visits. While adoption of virtual health has been slow, many of the barriers are starting to erode. We believe it’s not a question of if, but when virtual health will become a mainstay of a next-generation, healthcare consumer-focused, digitally enabled health care delivery model.
Apple HealthKit and Apple Watch are registered trademarks of Apple, Inc. Health Forward is an independent publication and has not been authorized, sponsored, or otherwise approved by Apple, Inc.
1. Pennsylvania Lawmakers Try Again to Pass Telehealth Legislation, mHealth Intelligence, October 9, 2019
2. Interstate medical licensure by the numbers, The American Medical Association, October 11, 2019
4. On-demand synchronous audio/video telemedicine visits are cost effective, The American Journal of Emergency Medicine, May 1, 2019
5. Preparing for the Pope with JeffConnect, Thomas Jefferson University Hospitals, September 17, 2015
7. Four ways a virtual hospital helps you, Intermountain Healthcare, March 12, 2018
9. Ochsner Health First in Nation to Manage Chronic Diseases with Apple Watch, Ochsner Health, April 23, 2015
Summer is a managing director in Deloitte Consulting’s Life Sciences & Health Care practice, where she leads the Virtual Health Product portfolio as well as the Virtual Health Platform Enablement practice for the firm. As a physician-executive, Summer specializes in the human experience within health care, helping organizations and clients create patient-centric, consumer-oriented health care delivery systems. With a special focus on strategic growth in the evolving health care economy, business model innovation, consumer-driven product and service strategies, and digital health, Summer’s passion and priority is humanizing health care. As a paramedic-turned-physician, Summer’s perspective and knowledge in the field are informed from more than 20 years of health care experience.
Srini is a Principal in Deloitte's Health Care practice leading technology enabled transformation initiatives for commercial health plans, Providers and federal health clients. Srini leads Deloitte's Operate services and Emerging business models covering industry focused solutions and emerging technologies for Healthcare and Life Sciences (HCLS) organizations. Prior to this, Srini was a Vice President and the U.S leader of IBM’s Public Sector Application Services business ($450m annual revenue) including Health Plans, Providers, Life Sciences, State and Local Governments and Higher Education institutions. He works across industries to shape and scale the shift to Digital transformations and creating solutions infused with industry context. Srini has extensive experience in leading transformational solutions, program management and systems engineering of large-scale, mission-critical enterprise applications for government and healthcare clients.