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Virtual Health - Are We There Yet?
Rakesh Mehta, Director of Virtual Health, Carle Foundation Hospital
Standards, evidence base, and protocols time tested with scientific rigor are the norm in healthcare. In other words, virtual health care industry generally introduces new methods of treatment only after much deliberation by scientific organizations and medical committees. But a lot of more-modern technologies defy this pattern. These technologies are so new that clear evidence regarding the clinical efficacy of their use is still emerging. Virtual health (or telemedicine, a narrower term) is one such technology.
To be sure, we hear a lot about great strides by virtual health in the media and how it can be the panacea of all the problems related to access to healthcare. But the reality in the trenches is far from that. Executive and physician buy-in and a change in a culture of practice of medicine are strategic considerations critical to the adoption of virtual health. Tactical factors related to workflows, electronic health record (EHR) integration, compliance/patient privacy, availability of patient presenters and training, also determine the success of virtual health programs.
Consensus on the value of virtual health in providing access to the patient and convenience both to the patient and the provider is emerging, and interest is increasing for the adoption of this technology. Still, the detractors far outnumber the cheerleaders. At a minimum, this is still an evolving industry. The good news – we are getting there.
While virtual health is not new, consulting with patients on their mobile devices using a host of applications and third-party services was unheard of in mainstream healthcare a few years ago.
The industry has undoubtedly matured in terms of developing innovative technology, use-case applications, and creating increased awareness and mindshare of both providers and payers.
Several surveys show a vast majority of provider organizations have tried virtual health and plan to expand their programs. Although we all take survey results with our usual grain of salt and skepticism, the impact of this “modality of care” is increasingly difficult to ignore.
A pivot from calling virtual health “technology” to a “care-delivery modality” was purposeful. This platform delivers care – whether at a distance, asynchronously or by collecting patient data remotely and intervening to impact outcomes. It is safe to say this is a hard-to-ignore technology is lasting beyond the “fad” threshold.
With that settled, we can move to crucial questions:
• Has this care-delivery modality come of age?
• Will it have a significant impact on patient care?
• Will it reduce healthcare costs (the Holy Grail in the U.S. healthcare system)?
• Or will it plateau before ever reaching such a significant peak?
Virtual health technology seems to have come a long way in terms of sophistication, features/ functionalities, ease of use that, in many cases, try to mimic the in-person clinical workflow. So yes, it has come of age.
Several of these technologies integrate with EHR systems, allowing clinicians to benefit from seamless virtual-consult workflows very similar to workflows in the physical world. Patients can use these downloadable applications on their mobile devices to leverage the convenience of virtual clinical encounters from their homes and in their communities. The span of technology solutions increasingly maps the patient-care continuum across the home, ambulatory, urgent/ emergent/acute and post-acute settings. So this modality has a strong potential to impact the care, especially in the new world of value-based care and in a shifting model of healthcare where care is shifting to the patient home setting.
Models of virtual care are evolving, as well. Several companies now offer direct-to-consumer virtual services for low-acuity conditions resourced by their private panel of providers. Several companies started offering similar services in hard-to-find specialty services. Remote monitoring of patients facing chronic diseases at home collects data asynchronously. It allows data tracking with inbuilt analytics and, in some cases, predictive algorithms to warn of an impending poor clinical outcome.
The list goes on, and applying virtual health opportunities to specific clinical-use cases is a function of how innovative a provider organization prefers to be. But with the gradual shift to value-based care, the case for deploying such innovative care delivery modality is stronger than ever. From an efficiency, access and convenience perspective, there is a reasonable opportunity to leverage virtual health to reduce some of the costs of healthcare, especially in the areas of readmissions reduction and reduction of unnecessary utilization in high-cost settings of care. But we are not quite there yet.
From prohibitive costs of cart systems to the lack of real integration for all care settings, these solutions need to evolve further before they provide a ubiquitous virtual experience for the providers and patients.
Reimbursement is a persistent barrier. Virtual health operates in an environment that lacks uniform reimbursement-related regulation and offers only restricted coverage for virtual health in specific care settings.
Some recent improvements make incumbents in this space hopeful things might change, although the pace of such change is pure speculation. Private pay models have been able to gain limited traction while the vast majority of providers waits for reimbursement to catch up to advances in the industry. The move from volume to value-based care provides some justification for investing in virtual health, but for any significant adoption to occur, value-based care needs to become healthcare’s predominant financial model.
Adoption of virtual health is still in its infancy for reasons not entirely explainable by the newness of the modality or reimbursement issues. Some of the additional barriers to broader adoption stem from the lack of information about this modality and the lack of education related to the specific conditions this modality can treat.
Not the final words
We in this space are excited about the prospect of virtual health, and many indicators point to more widespread and ever-increasing adoption, although at a pace that is tough to predict. The technology solutions and innovative models, though far from perfect, are helping overcome barriers and making virtual workflows more seamless.
Although adoption is lagging, macroeconomics of the national healthcare cost trajectory will nudge increasing numbers of providers and patients to evaluate virtual health for the appropriate clinical scenarios. We feel that it has significant potential in providing access, encouraging healthy behaviors improved quality of care, and overcoming social disparities for patient populations. We may have just now begun to realize its value and cannot afford to lose the momentum in its adoption.