Myth Busters: What Might be Next for Virtual Health? | Deloitte US has been saved
By Anwesha Dutta, managing director, and Amrit Kumar, senior manager, Deloitte Consulting LLP
During the COVID-19 pandemic, virtual health became an important tool that helped patients stay connected to their clinicians without having to go to a medical facility. Now that the Public Health Emergency has been lifted (as of May 11), what role will virtual health play going forward?1
Prior to the pandemic, the use of virtual health was rather limited due to rigid rules that governed reimbursement rates, patient privacy, digital tools, and clinician licensing, among other issues.2 It seems unlikely that we will return to those rules, and we expect virtual health will continue to evolve in the post-pandemic era. However, there are a number of myths that could keep it from achieving its full potential.
Here is a look at three common myths…along with our take.
Myth #1: Virtual health will mean fewer hospital services, less revenue. Nearly 80% of surveyed physicians cite the lack of insurance coverage and low reimbursement rates as the primary barriers to virtual-health adoption, according to a 2021 study from the American Medical Association (AMA). Moreover, there is a perception that lower reimbursement rates for virtual services will have a negative impact on revenue, and that revenue could be eroded further because virtual patients do not use adjacent hospital services.3
Reality check: A majority of health care leaders (59%) said virtual health helped to improve revenue for their organization, according to the results of a survey conducted by the Healthcare Information and Management Systems Society (HIMSS).4 Another study, from the American Telemedicine Association (ATA), found hospitals that adopted virtual health experienced higher patient volume, which helped to boost revenue.5 In addition, increased attention to prevention and wellness led to better patient health, which reduced unnecessary in-person visits and readmissions, and increased ambulatory referrals. Deloitte’s Virtual Health team developed a model to estimate profitability for various virtual health scenarios. Consider this example: A large teaching hospital serves about 500,000 patients who have one or more chronic conditions (e.g., hypertension, congestive heart failure, cancer, diabetes, asthma). The hospital establishes a virtual health program to manage those patients. Our modeling estimates this hospital could generate as much as $10.5 million in profit after the first year with a virtual health program. This profit would be driven largely by better patient engagement, which could lead to increased revenue from multiple channels. The model estimates a 3X profit growth in three years with this program.
Myth #2: Virtual health is not profitable because the required technology is expensive. Almost 70% of health care leaders said high technology costs are a significant barrier to adopting a virtual health program, according to a study conducted by HIMSS & Vidyo.6 An ATA study found that 35% of survey respondents thought virtual health would lead to increased costs for their organization in the short term.7
Reality check: The initial setup costs for a virtual health program are often balanced by higher economies of scale that are typically realized as participation grows. Case in point: The University of Mississippi Medical Center (UMMC) has a remote patient monitoring platform for managing diabetes within the state, particularly in rural areas. In its first year of operation, the program achieved an initial monthly cost savings of $340,000 by eliminating the need for hospital visits among its 100 enrolled patients. The annual statewide savings was estimated at $190 million.8 Moreover, virtual health can help reduce the total cost of care for patients by removing their transportation expenses and limiting time spent away from work. A 2023 study found that cancer patients saved between $147.40 and $186.10 (per visit) by using virtual health instead of inpatient visits.9 In the era of staff shortages and clinician burnout (see Addressing health care's talent emergency), virtual health can help optimize staff costs by utilizing care delivery models that leverage remote solutions, such as hospital at home. One study estimated a 38% reduction in costs for hospitals when patients receive care at home.10
Myth #3: Virtual Health might reduce quality of care for certain service lines. A physical examination has generally been the primary way for clinicians to diagnosis a patient. A doctor usually needs to see, touch, and feel the patient to understand the condition. This might be why only 55% of surveyed patients thought virtual health offered the same or better quality of care as an in-person visit.11 Among people who have had a virtual health visit, just 30% said the quality of care was on par with an in-person visit, according to Deloitte’ 2022 Survey of US Health Care Consumers. Physical interactions are still considered to be an essential component of care. In service lines like behavioral health, in-person care is often seen as being superior for achieving improvements due to the ability to detect nonverbal cues such as fidgeting, poor hygiene, or signs of intoxication.12
Reality check: While virtual health became a key channel of care during the pandemic, it remains a key mode of care delivery even as the pandemic has subsided.13 When designed intentionally, virtual health can also help promote health equity by improving access to care. This can ensure continuous monitoring of a patient's vitals and symptoms, which might not be possible with physical visits.14 Virtual health can also be superior to in-person care in its ability to allow for non-English speaking patients to connect with off-site bilingual providers, as well as its acceptability in primary care settings for the collaboration of care.15 To ensure consistency with physical examinations, care providers are coming up with new assessment methodologies suited for virtual health, like in the case of Weill Cornell’s Center for Virtual Health, which developed a virtual exam now used by thousands of physicians to assess respiratory distress without an in-person visit.16
Additionally, when virtual health is aligned with an enterprise digital-health strategy—with human-centered design approaches—adoption can increase.17 Based on our recent research study with the Scottsdale Institute, 77% of surveyed executives said they are actively reimagining their consumers’ health journeys. They are beginning to shift focus away from the treatment of illness and toward prevention of disease and well-being.18 Moreover, virtual health often yields comparable results to in-person care for the treatment of depression, anxiety and post-traumatic stress disorder (PTSD), particularly when cognitive behavioral therapy is used. Comparable therapeutic alliance has also been reported when comparing in-person vs. tele-mental health care.19
Conclusion
The COVID-19 pandemic was a catalyst for the widespread adoption and acceptance of virtual health by clinicians as well as patients. Although the Public Health Emergency has ended, the momentum that has built up over the past three years will likely continue. Some health systems have made significant investments in infrastructure, software, and training to support virtual health programs. Although virtual health may still be in its infancy, growing patient demand, improved infrastructure, regulatory changes, and cost-effectiveness may help to drive continued growth for virtual health. We expect hospitals, health systems, clinicians, and patients will likely continue to find new ways to use it.
Acknowledgements: Urvi Shah, Manju Murali, Unnati Gupta, Anmol Seth, Lindsey Norberg, and Nishant Srivastava
Endnotes:
1 Fact Sheet: End of the COVID-19 public health emergency, U.S. Department of Health and Human Services, May 9, 2023
2 The state of telehealth before and after COVID-19, National Institutes of Health, April 25, 2022
3 2021 Telehealth Survey Report, American Medical Association, 2022
4 Most provider organizations boosting telehealth investments, Healthcare IT News, September 30, 2021
5 COVID-19 Healthcare Coalition surveys physicians on telehealth impact during COVID-19, The American Telemedicine Association, November 17, 2020
6 5 biggest barriers to telehealth implementation, Azalea Health
7 COVID-19 Healthcare Coalition surveys physicians on telehealth impact during COVID-19, The American Telemedicine Association, November 17, 2020
8 Transforming health care from the ground up, Harvard Business Review, July 2018
9 Estimated indirect cost savings of using telehealth, JAMA, November 18, 2020
10 Home hospital model reduces costs by 38%, The Harvard Gazette, December 16, 2019
11 State of Telemedicine Report, Doximity, February 2022
12 A systematic review of providers' attitudes toward telemental health, National Institutes of Health, January 6, 2020
13 Telehealth adoption during the COVID-19 pandemic, National Institutes of Health, March 31, 2022
14 Why are women more likely to use telehealth?, Healthcare Dive, November 2, 2021
15 The effectiveness of telemental health, June 19, 2013
16 Covid-19 accelerated the adoption of telehealth, Cornell SC Johnson College of Business, April 11, 2022
17 Tapping Virtual Health’s Full Potential, Wall Street Journal, Dec 2022
19 Virtual care for behavioral health conditions, National Institutes of Health, October 20, 2022
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