Tapping virtual health’s full potential

While the communication piece is important, it isn’t the only aspect of care delivery that works better in person. In fact, the physicians we surveyed said that workflow and operations, clinical decision-making, and the “entire care process” are more effective during an in-person visit. Workflow and operations are more streamlined for in-person visits (26%) than for virtual patient encounters (13%), including resources and established processes that support operational efficiency and better care coordination (figure 1). As such, there’s an opportunity for health care organizations to optimize workflows for virtual visits that could remove friction for physicians, enable them to better engage with patients, and deliver higher quality of care.

In addition, physicians said that the clinical considerations are more straightforward for in-person visits: They can take vitals, perform physical exams, comprehensive assessments, and in-office procedures. In contrast, physicians said that the clinical considerations for virtual visits are nuanced, and some clinical decision-making is tougher—for instance, determining when to triage a patient to a higher level of care. At the same time, they acknowledge nonclinical benefits of virtual health visits, such as patient access and convenience.

To improve upon these aspects for virtual visits, health care organizations should:

• Help physicians strengthen their webside manner by reducing friction and elevating human experience.³ The workflow should consider things that on the surface have nothing to do with webside manner: Physicians and care teams should become accustomed to the technical and operational aspects of virtual health delivery. (Webside manner is the equivalent of a health care professional’s bedside manner in a virtual setting.) Health care organizations should help physicians in mastering the technical, clinical, and communication skills needed for virtual health visits and providing the requisite resources. Certain aspects are basic such as properly lining up the camera, looking at it during video conversations, and choosing appropriate lighting and audio equipment. Other elements may require additional investments, such as providing headsets for all team members and dual monitors for physicians (at home and at the clinic).
• Understand clinical aspects of virtual health that physicians struggle with. Provide education and training more broadly on virtual health care delivery aspects, such as how to conduct a physical exam virtually, or when to triage to a higher level of care. Facilitate peer-to-peer learning and experience-sharing.
• Cocreate with all users who have lived experience. As organizations design new workflows and processes, they should consider the experience of all users: patients and families, frontline clinicians, and support staff. For instance, many operational decisions benefit from collective input from physicians and other team members, such as booking criteria for visits, identifying elements of in-person visits that should be reproduced, removed, or changed in a virtual health workflow, and defining roles for different team members.⁴ That said, findings from our survey highlight that it is not a common practice for health care organizations to ask for such input: Only 38% of the physicians said that frontline clinicians were asked for input on incorporating virtual health into their workflow. However, physicians who were asked were more satisfied with the ease of use, had fewer criticisms, and identified more benefits to using virtual health.
• Balance standardization with customization. Involvement and buy-in of frontline staff can help determine what processes should be the same across the enterprise, specialty, and service line, and what processes should be different.⁵

Call to action: Invest in virtual health as part of a comprehensive care management program

The Deloitte Survey of US Physicians found that adoption of virtual health, especially video visits, grew during the COVID-19 pandemic, with 68% of physicians using video visits in 2022, up from 14% in 2018 (figure 2).⁶ Nearly one-third of physicians (30%) also reported that they implemented chat with patients.⁷ Our consumer survey, too, shows a large increase in use of virtual visits from 17% in 2018 to 42% in 2022. Wide adoption of video visits was made possible by regulatory changes that were implemented out of necessity during the pandemic, but it remains to be seen how changing regulations might shape future adoption.⁸

However, physician adoption of nonvideo virtual health modalities did not increase in 2022 and these findings are in line with results from the AMA 2021 Telehealth survey report.⁹ We found that in general, large practices were more likely than their small and medium counterparts to sustain adoption of nonvideo virtual health modalities.¹⁰ Between 2018 and winter 2020, on a total basis, we observed an increase in the adoption of remote patient monitoring, integration of data from patient wearables, and physician-to-physician virtual consultations (figure 2).

Between 2020 and 2022, however, physician-to-physician consultations increased in large but not in small or medium practices; the availability of remote patient monitoring at home decreased in medium and small practices, and there was an erosion in the implementation of other virtual health modalities (remote patient monitoring at other facilities, patient-reported outcome collection, and wearables) across the board.

It is possible that with the onset of the pandemic in spring 2020, the focus on emergency care and a lack of resources (especially in smaller practices) contributed to a slowdown in the implementation and optimization of nonvideo virtual health modalities.¹¹ Furthermore, the uncertain fate of telehealth regulations at the end of the public health emergency may have hindered adoption.¹² Another possibility is that physician practices failed to realize the benefits from nonvideo virtual health modalities, such as wearables, especially in the fee-for-service environment.

Video visits were the one exception to this trend, with adoption in outpatient settings growing to 81% in 2022, up from 14% in 2018 and 19% in 2020.

To achieve consistent adoption across all virtual health modalities, health care organizations should:

• Identify virtual health use cases with positive short-term ROI. While the regulatory environment creates financial uncertainty, virtual health use cases that don’t generate revenue through direct reimbursement can still produce a positive ROI. For provider organizations, this can happen when multiple metrics (provider productivity, practice capacity, access to care, and quality) are positively affected, particularly in profitable service lines such as orthopedics or capacity-constrained areas such as primary care. As organizations move away from fee-for-service to value-based care, they can expand their virtual health programs, adding use cases that may not make financial sense today but could in the future.
• Evaluate investments in care management capabilities built upon a virtual health foundation. Nonvideo virtual health modalities can support care management for patients with chronic conditions, an area of the health care delivery system that would benefit from more touch points and tools. In our Future of Health^TM vision, we expect care models to increasingly move from transactional to longitudinal. To achieve this, health care organizations should invest in a comprehensive care management program that supports continuity of care. Virtual health modalities beyond video visits are an essential component of such a program. Although designing a care management program may feel like a maiden voyage, organizations don’t have to start from scratch: They can borrow from health insurers’ and disease management companies’ playbooks when it comes to risk stratification, member engagement, gamification, and incentives, and outsource certain elements of the program.¹³

Call to action: Ensure that virtual health meets the needs of—and is accessible to—all patient populations

While virtual health visits are more convenient because they often eliminate the need to travel, find child care, and take time off work, the issue of access isn’t always as straightforward. Studies of virtual health utilization from claims and EHRs show that in the period of 2020–2021, patients with all types of insurance had similar access to virtual health, while the uninsured population had lower access.¹⁴ Some studies found that access for underserved populations has improved as a result of virtual health, while others indicate that the digital divide (known as the gap between those with and without access to technology) has exacerbated inequities. For instance, underserved populations were more likely to rely on audio-only and messaging services.¹⁵ On balance, virtual health’s effects on access appear to be mixed.¹⁶

In our consumer survey, the digital divide is expressed by differential use of virtual health based on income and reliability of internet service. Nearly half of consumers (46%) with very good/reliable internet service had a virtual visit in the last 12 months, compared with 31% of those with very poor/unreliable internet service. Although most consumers (81%) have broadband access, only half (52%) describe it as reliable and meeting their needs. Not surprisingly, households with the highest incomes are the most likely to have reliable internet service. Sixty-three percent of consumers with an annual household income greater than US$100,000 have reliable internet, compared with 46% of those making less than US$50,000.

When we asked physicians about the effects of virtual health on access to care for underserved groups, more said virtual health has increased access (39%) than decreased (7%) while 12% said it had no effect and 25% said the effects were mixed. This is a relatively optimistic view when compared to utilization studies and our consumer survey findings that show mixed effects on access. Interestingly, physicians who have implemented virtual health in their practice are much more positive about its effect on access.  

To narrow the digital divide, health care organizations can collaborate with local governments, utility providers, and businesses in their community (such as shopping centers, schools, shelters, libraries, and pharmacies) to provide free Wi-Fi and digital devices that can be used to receive virtual health services. For instance, Texas A&M Health Science Center collaborated with OnMed to place kiosks in a rural Texas community to measure patients’ vital signs, dispense common medications, and facilitate on-demand video visits with a nurse practitioner.¹⁷

Leaning on virtual health technologies to deliver state-of-the-art care

Our view is that virtual health is not a substitute for how care has traditionally been delivered. Instead, it offers new ways of care delivery that were not possible in the past. When done well, virtual health can improve care quality and continuity, reduce friction, and address health equity. And although there is still a lot to learn and improve on, organizations should assess their current maturity, reflect on how virtual care can help align with strategic goals, and begin to implement the following steps:

• Educate, support, and equip physicians to infuse the human element of care in virtual health encounters
• Rethink existing care models and assess how to prioritize virtual health investments for future care models
• Ensure virtual health is accessible to, and meets the needs of, all patient populations
• Develop a thorough understanding of the human experience of receiving and providing care, apply a thoughtful approach to workflow redesign, technology applications, and the use of care teams, and follow a careful change management plan
• Involve physicians, patients, and other care team members, and value their input while designing and implementing human-centered virtual health offerings and workflow processes
• Consider regulatory and policy issues that may impact your model, advocate for flexibility in virtual health design, and support associated adequate reimbursement

These steps can help satisfy consumers’ appetite for virtual health and digital technology and position health care organizations for a Future of Health^TM that centers on digitally enhanced, frictionless, affordable, high-quality, and equitable care.

Appendix. Study methodology

Appendix 1. Methodological notes: 2022 Deloitte Survey of US Physicians

Since 2011, the Deloitte Center for Health Solutions has surveyed a nationally representative sample of US physicians on their attitudes and perceptions about the current market trends impacting medicine and the future state of the practice of medicine.

The biennial survey was fielded between January 18 and March 20, 2022. This survey of 660 physicians is nationally representative of US primary care and specialty physicians with respect to years in practice, gender, geography, practice type, and specialty.

The general aim of the survey is to understand physician adoption and perception of key market trends of interest to the health care industry and policy. In 2022, 660 US primary care and specialty physicians were asked about a range of topics, including virtual health, digital technologies, care teams, health equity, and value-based care.

Sampling approach

We selected a random sample of physician records with complete mailing information from the American Medical Association (AMA) Physician Masterfile, and stratified it by physician specialty, to invite participation in an online 20-minute survey.

The resulting study sample is representative of the AMA Physician Masterfile with respect to years in practice, gender, geography, practice type, and specialty to reflect the national distribution of US physicians.

About the AMA Physician Masterfile

The AMA is the major association for US physicians and its Physician Masterfile contains records of more than 1.4 million US physicians (including AMA members and nonmembers) and is based upon graduating medical school and specialty certification records. It is used for both state and federal credentialing as well as for licensure purposes. This database is widely regarded as the gold standard for health policy work among primary care physicians and specialists, and is the source used by the federal government and academic researchers for survey studies among physicians.

Appendix 2. Methodological notes: 2022 Deloitte Survey of US Health Care Consumers

2022 Deloitte Survey of US Health Care Consumers: Since 2008, the Deloitte Center for Health Solutions (DCHS) has surveyed a nationally representative sample of US adults (18 and older) about their experiences and attitudes related to their health, health insurance, and health care in general. The national sample is representative of the US Census with respect to age, gender, race/ethnicity, income, geography, and insurance source. As part of this effort, from February 24 through March 14, 2022, DCHS conducted an online survey of 4,545 US adults.