Perspectives

Physicians and health systems could be left behind if they ignore consumer interest in virtual care

Health Care Current | June 26, 2018

This weekly series explores breaking news and developments in the US health care industry, examines key issues facing life sciences and health care companies, and provides updates and insights on policy, regulatory, and legislative changes.

My Take

Physicians and health systems could be left behind if they ignore consumer interest in virtual care

By Steve Burrill, Vice Chairman, US Health Care Providers Leader, Deloitte LLP

Smartphones and tablets have been with us for about a decade. Fortunately or unfortunately, these devices have become an extension of who we are. We rely on this technology for just about everything—from taking and sending high-resolution videos and photos to conducting meetings or visiting with family and friends using the video functions in our computers, smartphones, and tablets.

Given how much we now rely on these devices, it is surprising that so many hospital executives, physicians, and even consumers remain hesitant to use similar technology for health care visits. While each group has its own reasons for not fully embracing virtual care, they also understand that the technology could help improve the way care is delivered, according to results of new physician and consumer surveys from the Deloitte Center for Health Solutions.

Consumers have strong interest in virtual care—physicians, not so much

More than 4,500 consumers and 624 physicians in the US participated in our surveys. Nearly a quarter of surveyed consumers said they have experienced a virtual visit with a nurse or doctor. Of consumers who said they had never used virtual care, 57 percent said they are willing to try it. Physicians, however, appear less enthusiastic. Just 14 percent of surveyed physicians offer virtual visits. Among those who don’t have the technology, just 18 percent say they intend to add the capability within the next two years.

Half of surveyed consumers say they use wearables and other technology to track their health information, and 53 percent of them share this information with their doctors. But physicians are often either unable to use patient-generated data or they do not see the value in the data.

  • Just 9 percent of physicians say they have implemented technology for remote monitoring and/or integration of data from wearables.
  • Of the physicians who have not implemented this technology, 27 percent intend to incorporate it during the next one to two years.

Many physicians worry there is greater chance for medical error if they are not physically interacting with the patient, and about one-third of physician respondents cited data security as an area of concern. Despite these issues, the vast majority of physicians (9 out of 10) said they understand the potential benefits of virtual care, especially when it comes to helping improve patient experience (e.g., access to care, patient satisfaction, and improved communication with the care team). Our study results indicate that physicians consider chronic-condition management to be the most promising use of virtual care technologies.

Can hospitals and health systems help docs get over the fence?

Physicians who are employed by or affiliated with a hospital or health system are more likely than independent physicians to have implemented some type of virtual care technology in the past year—62 percent vs 49 percent, according to our physician survey (stay tuned for a deeper dive on this coming out in July).

There are likely several reasons for this. One is the cost: the technology isn’t cheap. Some sources cite a $60,000 price point for physicians to add the necessary equipment.1 Hospitals are more likely to have the financial resources for such purchases.

Our survey data suggests that experience with new technologies could help physicians warm up to virtual care. For example, physicians who have implemented at least one type of virtual care technology are somewhat less likely to voice concerns about medical errors when compared to physicians who have not, according to our survey results.

To help physicians and clinical staff accept virtual care, hospital executives need to anticipate and address likely resistance from the frontline staff. Limited experience with the technology, changes to the workflow, and shifting roles and responsibilities could keep virtual care from being incorporated into daily processes. However, many health care organizations are seeing success with virtual care when training is included in the strategic implementation.

Consider this: In Houston, a four-year-old ambulance-based teleconsultation strategy helped reduce unnecessary emergency room visits by nearly 7 percent, according to a recent report from the Deloitte Center for Health Solutions. Using the Emergency Telehealth and Navigation (ETHAN) system, emergency responders can refer patients to the most appropriate site of care on the spot. Training was key for getting EMS staff to buy into the program: the program’s organizers spent more than a year on educational outreach to ensure EMS staff understood the system.

Hospital leaders should communicate the need for adopting virtual care. Some organizations have found that real-life examples of virtual care and the impact on patients and caregivers can be more influential than data alone. Including examples in the implementation could help build a compelling business case for accepting and using the virtual care technology.

Value-based care could create demand for virtual care 

As the health care system marches closer toward a payment system based on value, hospital and health system leaders might need to be cautious about the virtual care capabilities they invest in now—and which ones they choose to implement down the road.

While virtual health is being implemented in some health systems, many executives appear to be taking a piecemeal approach, rather than adopting a comprehensive, system-wide virtual care strategy. As the sector moves closer to value-based care, the ability to offer virtual care options could give tech-savvy hospitals a competitive advantage, and physicians who are comfortable with virtual care could become more in-demand. Moreover, health plans and employers might seek out health systems that can offer virtual care options to optimize provider networks, expand access, and reduce costs.

Hospital leaders should help medical staff and patients move past their concerns. The changing reimbursement models, growing consumer demand, and advances in digital technologies will likely make virtual care a must-have for physicians and hospitals. From a business perspective, I see three important reasons why hospital leaders and physicians should consider opening the door wider for virtual care:

  1. It can give physicians and health systems another way to retain and grow their patient base.
  2. Responding to consumer demand for virtual care can be a step toward delivering patient-centric care. 
  3. Many nontraditional providers are already offering virtual care services. This could pose a potential competitive threat unless hospitals and health systems quickly move into this space.

Given how quickly our society has made smartphones and tablets indispensable, I expect that 10 years from now, we might find it difficult to remember a time when virtual care wasn’t an option.

This is the first in our consumer and physician series launching this summer and fall. Stay tuned for longer-form reports on this and other topics coming soon!

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1 Modern Healthcare, March 17, 2018 

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In the news

DOL to modify requirements for Association Health Plans

On June 19, the US Department of Labor (DOL) released a rule intended to make it easier for small businesses to band together to purchase health coverage for their employees. DOL Secretary Alexander Acosta says the rule will make association health plans (AHPs) more affordable. As a result, millions of employees—many of whom were not offered or could not afford health insurance—will gain coverage, Acosta said in a prepared statement. A recent RegPulse article further discusses the final rule.

The rule expands the conditions that satisfy the “commonality of interest” test, which AHPs must meet to be treated as part of the large-group market. By being part of the large-group market, AHPs can modify their benefit packages and offer cheaper plans. Therein lies the problem, according to critics of the rule: under the Affordable Care Act (ACA), AHPs were treated as small businesses, which are required to include essential health benefits in coverage offered to employees.

The rule has also received criticism for its potential effect on the individual market. Some groups, including America’s Health Insurance Plans and the American Academy of Actuaries, contend healthy people will be drawn toward these cheaper, “skinnier” plans, while less-healthy consumers will want the more comprehensive coverage available in the individual market. This could cause healthy people to leave the individual market and lead to higher premiums, they say.

DOL says the new rule contains important consumer protections, such as nondiscrimination provisions. The rule uses a group of several restaurants that form an AHP as an example: the AHP cannot exclude the employees who work at one restaurant due to their ages or health conditions that could make them more expensive to insure. The rule also mandates that AHPs take steps to protect consumers against fraud, and DOL is working with state insurance commissioners to prevent fraud, Acosta noted.

The rule will go into effect starting September 1 for fully-insured AHPs, January 1, 2019 for existing self-insured AHPs, and April 1, 2019 for new self-insured AHPs.

MedPAC’s report to Congress includes policy recommendations affecting hospitals, devices, and ACOs

The Medicare Payment Advisory Commission (MedPAC) issued its 2018 Report to the Congress: Medicare and the Health Care Delivery System on June 15. The report’s 10 chapters include policy recommendations for the Medicare program and across the health care system. Additionally, the report concluded that the Hospital Readmissions Reduction Program (HRRP) contributed to lowering readmission rates without raising emergency room visits or increasing mortality. This saved the program approximately $2 billion per year. The report includes the following recommendations:

  • Improve access to hospital emergency department services by (1) establishing voluntary outpatient-only hospitals for isolated rural communities, and (2) addressing the factors contributing to the growth of offsite emergency departments in urban locations.
  • Rebalance Medicare’s physician-fee schedule toward ambulatory evaluation and management services.
  • Change two of Medicare’s medical device payment policies: (1) the program’s payment structure for medical equipment, and (2) transparency regarding physician-owned distributors (PODS) of medical devices and equipment.
  • Formalize a set of principles to guide quality measurement and apply these principles to population-based outcome measures to evaluate quality of care for different populations. 
  • Review Medicare accountable care organization (ACO) models’ performance on cost and quality.
  • Consider the potential development of managed care plans for dual-eligible beneficiaries.

MACPAC releases 2018 Report to Congress on Medicaid and CHIP, featuring recommendations on opioids and prescription drug prices

On June 15, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2018 Report to Congress on Medicaid and CHIP. MACPAC’s research showed that only 12 states pay for the full continuum of substance use disorder (SUD) treatment services, and there are significant gaps in coverage. Additionally, the final report contains the following recommendations:

  • Improve the Medicaid Drug Rebate Program by (1) closing the loophole in the law that allows manufacturers to sell authorized generic drugs at a low price to a corporate subsidiary, and (2) allowing the Secretary of the US Department of Health and Human Services (HHS) to impose financial sanctions on manufacturers that misclassify brand-name drugs as generics.
  • Clarify laws and regulations to improve information exchange while maintaining record confidentiality protections for patients receiving treatment for SUDs.
  • Review the increase of state Medicaid programs delivering long-term care services through managed care to determine if patients’ complex health needs are being met.

Millennials are willing to share health data in exchange for lower premiums, study finds

Many young adults would allow health plans to use their personal health data to save money on coverage, according to the results of a recent poll. Among people between the ages of 18 and 34, 62 percent said they would let health plans collect their third-party data from social media websites, mobile apps, digital assistants, and other tech devices in exchange for lower premiums.

In a 2016 Harris Poll, two-thirds of Americans between the ages of 18 and 36 said they could not afford to spend $200 per month on premiums, and one in five said they could not afford health insurance at all.

Older respondents, however, are not as willing to share their personal data. While 45 percent of respondents between the ages of 35 and 54 said they would be willing to give health plans access to their digital health information, just 27 percent of respondents age 55 or older said they would be willing to share health data in exchange for lower premiums.

Atul Gawande picked to head Amazon-Berkshire-JPMorgan health care venture

Surgeon, researcher, and best-selling author Atul Gawande, M.D., has been tapped to lead the health care venture being developed by Amazon.com, Inc., Berkshire Hathaway, Inc., and JPMorgan Chase & Company. Early this year, the three companies announced plans to create an organization to reduce health care costs and improve satisfaction among their employees. The yet-to-be-named organization will be headquartered in Boston and will operate independently of its parent organizations, the companies said in a joint statement released on June 20.

Breaking Boundaries

VA launches “anywhere-to-anywhere” policy

June 11 was the go-live date for the Department of Veterans Affairs (VA) "anywhere-to-anywhere" policy, which allows qualified practitioners to log into VA's telehealth system and see patients—without having to worry about state restrictions. The recent VA Mission Act, which went into effect June 6, extends new regulatory protections to VA telehealth providers. The law prohibits states from imposing sanctions on practitioners that are recognized by VA as eligible to deliver telehealth services, even if they do not meet state licensing requirements.

The new VA policy marks another milestone in VA’s decade-long effort to lead the field in telehealth services. The goal of the connected care strategy is to move care closer to patients when it makes sense—such as a patient’s home or a preferred clinical location. In VA clinics, patients and local caregivers and technicians can use technology to connect to physicians and specialists. The VA Video Connect application was launched in June 2017. It allows physicians, mental health specialists, nurses, family members, and health care proxies provide medical visits, follow-up care, and psychotherapy while the patient is at home. Since being introduced, the application has logged 48,000 "ad hoc" patient visits involving 22,700 veterans and 4,500 unique VA providers.

The app for connecting patients at home to clinicians via video is simple and intuitive. Through the app, providers initiate visits and invite patients and other providers. The app generates a unique and temporary URL for each visit, which helps ensure that only invited participants can attend.

VA has implemented "point-to-point" telehealth at 900 sites of care for more than 50 specialties. Patient satisfaction is 92 percent. The VA’s goal is for telehealth visits become routine for all VA clinicians by 2020. Future plans include integrating patient data into the app, as well as providing digital stethoscopes to patients. Another strategy being implemented will enable Bluetooth-connected devices to transmit vital signs and data to VA providers in real time. The next step is to explore strategies for connecting technology to veterans who don’t have broadband access at home: these patients will use tablets (provided by VA) that operate over cellular connections.

(Source: Adam Mazmanian, VA “anywhere-to-anywhere” telehealth goes live, FWC, June 18, 2018)

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