The Covid-19 pandemic has accelerated what would have been years (or even decades) of change into arguably some of the most transformational six months the industry has ever seen. The many challenges facing the healthcare industry pre-pandemic – gaps in access, provider shortages, interoperability obstacles – are undeniable. The pandemic has served to exacerbate these challenges and even bring to the fore new ones. Consumers are grappling with increased difficulties in managing their personal health — extreme loneliness prompting a decline in mental health while also facing added barriers to maintaining a healthy lifestyle. With 70% of consumers having deferred or canceled treatment, both the healthy and chronically ill are overdue for care. In addition to access challenges, unemployment has left many consumers alone in navigating the confusing search for replacement health insurance.
Consumer sentiment has also shifted dramatically. Individuals are concerned about visiting physical healthcare facilities with 42% of consumers feeling uncomfortable going to a hospital and 45% not wanting to visit urgent care or walk-in clinics. As a result, people are looking for alternative channels to access care. These healthcare consumers are increasingly willing to engage with digital health solutions that serve as a lifeline for continuing care and provide a new level of convenience.
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Other key healthcare stakeholders have depended on and supported this shift. Providers are rapidly activating virtual health programs, payers are instituting major regulatory changes, and employers are developing new partnerships with digital health solutions to support their workforce. Together, these shifts represent a non-trivial wave of opportunity for the world of digital health.
Is there a place for face-to-face care in a post-Covid-19 world?
Virtual care is not just a temporary stopgap – much of the digital shift is expected to stick. Half of consumers are already accessing care from their home via digital means and 37% are very likely to use it in the future, a drastic increase from the 8% that used telehealth in 2019. Consumers are reporting overwhelmingly positive experiences attributable to quicker, more personalized responses and greater convenience. While in-person outpatient visits have started to rebound in May, they remain roughly one third lower than pre-pandemic.
Consumers who have tried telehealth during the pandemic are likely to re-engage for a wider range of needs. New use cases such as virtual primary care, peri-surgical consultations, behavioral health, pediatrics, and dermatology will be explored. Funding in digital health for specialty areas such as musculoskeletal, women’s health, and digital therapeutics has skyrocketed, with companies benefitting from huge adoption surges during the pandemic and some even providing clinically-validated care from home.
While promising, digital adoption does not equate to the full retirement of face-to-face care. Physical interaction between a patient and their provider is at times critical; this is particularly true for highly complex patients with multiple comorbidities, or for specialties where physical examination can be a critical input. As such, virtual care cannot be simply viewed as a replacement for existing models of care – the nature of face-to-face care must evolve to adequately integrate technology into a cohesive system that embraces both “tech” and “touch.”
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Health care facilities will become hubs for the highest acuity patients, those unable to receive in-home care, and those in need of specialized clinical equipment. For other consumer segments, facility-based providers will develop new models that increasingly leverage enabling technology and shift care outside of the walls of the clinic.
There are three areas in particular in which face-to-face care will play a role yet will benefit from digital health. First, elder care will continue to depend on the physical presence of caregivers. However, with over 50% of caregivers more likely to choose home care for their loved ones than they were pre-Covid-19, aging consumers will move away from costly, infection-prone long term care facilities into safer, more cost effective, and more comfortable home-based settings. Care teams will increasingly rely on remote monitoring and telehealth technology that enables always-on patient monitoring and efficient use of resources.
Second, the need for inpatient hospital care for high acuity patients will persist. High-risk patient cases and trauma cases, for example, will remain in the hospital. Importantly, though, the traditional definition of inpatient-level acuity will evolve; consumers who were previously considered inpatient candidates, such as those recovering from pneumonia, will be presented with new options to receive ‘hospital at home’ care. Partnerships such as that of Mayo Clinic and Medically Home or Intermountain and Castell will serve to make such care options more widely available.
Lastly, physical healthcare facilities will continue to enable care access for vulnerable populations. Urgent care facilities, community health centers, and retail clinics serve as a key point of entry for many without access to other care facilities or telehealth. Barriers such as digital literacy and unreliable internet access disproportionately affect individuals of color and those with low socioeconomic status. In rural areas, nearly 20% of community health centers do not have adequate broadband services to provide virtual care. Until disparities in access to virtual care are remedied, these physical sites of care will serve as a main access point.
Is our system equipped to support this shift to virtual?
Our system was inherently designed to support the provision of face-to-face care. Providers have made massive investments in state-of-the-art facilities and have trained staff on the techniques and procedures of in-person care. Payers have built reimbursement policies around facility-based care delivery. Employers have developed health plans centered around in-person benefits and 80% of large employers offer on-site healthcare clinics.
Partnerships between the healthcare incumbents, digital health companies, and other stakeholders will be critical to enabling the shift to virtual care. Technology platforms such as the newly merged Livongo-Teladoc (Livongo is a 7wireVentures portfolio company) will arm payers, providers, and employers with the extensions of care needed to reach consumers where they are. Both payers and employers will need to rethink benefit design to make virtual care front and center.
Clinician training will be another critical dependency in the success of virtual care. With the increasing availability and adoption of remote monitoring and virtual communication tools, providers will have access to an overwhelming volume of patient data. Care teams will need to establish workflow procedures for data monitoring and escalation of patient cases for intervention. Further, providers will need to adapt new communication skills that allow for effective assessment and treatment of their patients virtually.
Finally, the continued shift to value-based payments along with lasting reimbursement changes will be essential. With the major success of virtual care delivery during the pandemic, CMS and Congress will be encouraged to enact long-term changes that enable continued access. Further, the continued advancement of value-based agreements between payers and providers will provide necessary incentive for investment in new models that improve cost efficiency while enabling a better patient experience.
The pandemic has shined a spotlight on the promise of digital health in reinventing the world of care delivery. While we believe there will always be a place for face-to-face care, the shift to virtual will drive a more intentional and cost-effective use of it.
Photo: Hero Images, Getty Images
Alyssa Jaffee is a Partner at 7wireVentures, where she focuses on investments in digital healthcare and technology-enabled services that empower consumers to be better stewards of their health in today’s changing healthcare ecosystem. Alyssa sits on the board of Caraway and Ayogo Health and is a board observer with Zerigo Health, NOCD, Jasper Health, and Brightline, and MedArrive.
Alyssa's prior experience in venture capital includes her time as an investor at Pritzker Group Venture Capital where she led investments in Bright.md and Tovala as well as worked closely with Apervita, Mingle Health, and AiCure. Additionally, she worked at Hyde Park Angels (HPA), one of the Midwest's largest angel organizations and Healthbox, an early-stage healthcare innovation firm, supporting their accelerator program called the Studio. Alyssa is also a Co-Founder of TransparentCareer, a 2016 NVC winning company focused on helping people make more data-driven career decisions.
Prior to business school, Alyssa worked as the Senior Director of Performance Technologies for the Advisory Board Company. There, Alyssa was charged with expanding new business through the sales of technology platforms. With an extensive travel regimen, Alyssa met with hundreds of hospital executive teams to understand their strategic needs and recommend various solutions. She has copious amounts of experience in launching new products and thinking about go-to-market strategies.
Alyssa holds a bachelor’s degree in Marketing and Spanish from the University of Wisconsin-Madison and an M.B.A. from the University of Chicago – Booth School of Business. Her work and accomplishments have been featured in Fortune, Stat News, MedCity News, Crain’s, and more.
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