Virtual Health Replaced Some In-Person Visits During the Pandemic, but can it Transform Health Care? | Deloitte US has been saved
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By Urvi Shah, senior manager, and Elizabeth Baca, M.D., M.P.A., specialist leader, Deloitte Consulting, LLP
While virtual health has the potential to transform the way care is delivered, it’s too soon to know if that potential will be realized. The shift from paper medical records to electronic medical records promised a similar transformation, yet EMRs never fully captured the benefits of a digital platform. Instead, they typically replicate the paper documentation processes. As a result, documentation and workflow became more cumbersome and contributed to increased clinician burnout.
Between March and April 2020—as concern about the COVID-19 pandemic grew—demand for virtual care skyrocketed with some organizations seeing up to 40-fold increases in volume.1 By July, however, utilization declined and plateaued, comprising just 21% of total encounters—down from 69% in April.2
In the year since the pandemic emerged, virtual health has reached a point where it could become more than just a substitute for in-person visits. Recent Deloitte research shows one in two clinical leaders thought the pandemic led to significant shifts in their health system’s virtual-health strategy. Continued investments into virtual health and enterprise-wide virtual-health strategies were among the top initiatives being pursued, according to respondents. Virtual health could help transform care delivery. This transformation is necessary and could be used to meet the needs of patients more effectively, keep them healthier, and respond to various drivers of health to help ensure more equitable care.
About 80% of consumers who have used telehealth services say they are willing to use it again, according to Deloitte’s 2020 Health Care Consumer Survey. The Centers for Medicare and Medicaid Services (CMS) recently increased reimbursement parity between in-person services and virtual services.3 Similarly, some commercial health plans have updated their 2021 reimbursement policies to ensure physicians are paid the same whether a visit is virtual or in-person.4
Four dimensions of virtual health transformation
We have identified four dimensions that health care organizations can use to evaluate the types of care that can be offered virtually, the conditions that can be treated virtually, and the considerations that should be given to the social, economic, and environmental factors (also known as drivers of health) when integrating virtual health into new care pathways. Organizations should evaluate various scenarios with input from clinicians, patients, and care teams to understand their respective needs across these four dimensions:
Properly understanding the risk profile of patients is critical to determining whether newly designed virtual care pathways are appropriate. Although it is the final dimension, the patient’s needs—and ability to realize the benefits of virtual health—should be considered to varying degrees across the rest of the dimensions as well.
A decision set for virtual health transformation
We recommend that health care organizations assess each dimension from the top down. The dimensions at the top will help determine the types of specialties and services best suited for virtual health. The dimensions at the bottom account for more patient-specific considerations and are equally critical to enabling care model transformation.
Consider the following use-cases:
Use case #1: For an economically stable, congestive heart failure (CHF) patient recovering from a moderately severe acute CHF exacerbation, virtual health can lead to a new care pathway where, upon stabilization, remote patient monitoring becomes an integral part of follow-up care. Virtual health can also augment care with proactive alerts and virtual follow-ups when needed.
Use-case #2: A patient living in an urban setting with limited access to care, making limited income, and recently diagnosed with eclampsia (i.e., high-risk pregnancy), the application of virtual health might be limited to virtual visits when a diagnostic test or ultrasound is not required. But it can still be integrated into workflows accordingly and require intentionality in design and deployment. Additional follow-ups could be conducted virtually if the patient has access to a remote blood-pressure cuff, other remote vitals monitors, and internet connectivity.
Here are five questions health care organizations should consider as they implement or expand virtual health:
Early in the pandemic, virtual visits were seen as a substitute for in-person visits. The urgent need to adjust to the situation allowed organizations to see how virtual care could be used. There were also unique regulatory pressures lifted during this time allowing for less friction for conducting virtual visits. We now have a great opportunity to leverage those learnings and take them a step further.
Acknowledgments: Felix Matthews, M.D., MBA, Zach Miller, Sonal Purohit
1. Telemedicine transforms response to COVID-19 pandemic in disease epicenter, ScienceDaily, April 30, 2020
2. Telehealth: Fad or the future?, Epic Health Research Network, August 18, 2020
3. Trump administration finalizes permanent expansion of Medicare telehealth services, press release, US Centers for Medicare and Medicaid Services, December 1, 2020
4. Cigna institutes new reimbursement policy for virtual care, FPM Journal, January 21, 2021