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Lessons learned from 2020: Expanding virtual care beyond traditional telemedicine

The advancements made around telemedicine over the last 18 months are significant, but should be viewed as the first steps of an important journey for healthcare going forward.

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The impact of the Covid-19 pandemic is shaping the future of healthcare in nearly every realm, from provider reimbursement, to in-person visit volume, to triage services. However, the pandemic has arguably had the largest effect on the adoption of telemedicine, both by patients and providers. Because patients have been less inclined to meet with providers in-person due to the risk of Covid-19 exposure, its use has skyrocketed over the past year-and-a-half. In mid-April 2020, telemedicine comprised an estimated 69% of all visits, while visits to in-person providers dropped by 60%.

As time passed, however, many telemedicine providers experienced significant decreases in usage as pandemic-related restrictions and fears subsided. For example, research shows that as of August 2020, overall in-person visits had reverted to pre-pandemic levels. Although the percentage of visits taking place via telemedicine is slowly declining from its April peak and the number of in-person visits is increasing, research shows that patients want continued access to virtual services moving forward. It’s clear that at least in some form, virtual care is here to stay.

The current challenges with transactional telemedicine

The widespread adoption of telemedicine is a major step forward in care delivery, but there is still quite a bit of ground to cover if we hope to realize the full potential of virtual care. Traditional, transactional telemedicine is only one piece of the puzzle. In some instances, it can even introduce new challenges — especially when it comes to over-utilization, which can lead to inefficient use of physicians’ time and drive provider burnout. At first, many experts predicted that telemedicine would be the key to addressing skyrocketing burnout rates. However, after a year of actual use, it’s becoming clear that relying solely on telemedicine, as opposed to a holistic and overarching virtual care model, can increase the burden on physicians when they have to meet with many patients for minor issues that do not require medical expertise to treat. In fact, researchers at the University of Michigan recently reported that 12.6% of ophthalmologists believe that telemedicine has been overutilized since the start of the coronavirus pandemic.

These additional “appointments” for concerns that may not truly require a physician consultation ultimately create a busier schedule for providers and can contribute to their feelings of being stressed and overworked. This is a major concern in the industry, as recent reports show that more than half (54%) of physicians said Covid-19 changed their employment plans and of that 54%, 21% are seriously considering early retirement, while 15% are seriously considering leaving the practice of medicine entirely. This is poised to worsen the projected physician shortage, which could be as high as 124,000 physicians, nationwide, by 2034.

Furthermore, while at first glance telemedicine may seem more streamlined, there is still significant room for improvement when it comes to patient experience. For in-person care, patients must refer to their health plan to find an in-network doctor, who then may refer them to a specialist, with whom they have to schedule a separate visit. Then, assuming that specialist is able to diagnose or treat them, they may have to work with a pharmacy in yet another location to fill a prescription. Finally, they must coordinate with their provider’s billing departments to figure out how much they owe. This is a lot for anyone – but it can be particularly daunting for a sick person. With telemedicine, patients may still have to find an in-network doctor, and this time, it has to be one who offers telemedicine visits. If they need to see a specialist or fill a prescription, they must go through all the same steps – although in this instance, each step might include downloading and using a different app on a phone that is already overloaded with apps.

As a result of these lingering challenges, we must reassess the path forward to effective digital healthcare offerings. Patients could benefit significantly from the ability to access all of the necessary services in one place. Instead of navigating through five or six different apps and websites just to complete one healthcare transaction, they could address all of the critical steps along the journey in one streamlined location. This includes everything from initial triage and preventive care to diagnosis, treatment, and even benefits inquiries and billing. In order to create a truly efficient and effective model, we must also ensure that patients can access the type of care that is most appropriate for their needs. Patients with a rash or a stomachache, for example, could use virtual care to connect with a nurse who can recommend at-home care or over-the-counter treatments for low-acuity cases, saving both the patient and the health system money.

Moving forward: Virtually blended care
The unique turning point presented by the pandemic offers us an opportunity to figure out how virtual care can most effectively contribute to the healthcare system moving forward. We are increasingly seeing a world where entire episodes of care move from channel-specific interactions – like facility-only-based care for musculoskeletal disorder issues or phone-call-based consultations to discuss insurance coverage – to multichannel interactions. With multichannel care, patients can interact with providers in-person or via chat, phone, or another medium based on what aligns best with their needs at each specific point in the care episode. For example, a patient’s initial triage could be chat-based or bot-assisted with a nurse. Then, it could develop into a telemedicine encounter, a phone conversation, or an in-person appointment – or all of the above at different points in the journey.

As such, health systems, payers, and patients have begun to consider how this virtually blended model can provide meaningful access to the most appropriate healthcare and care coordination services across value-based and fee-for-service reimbursement models. A streamlined approach supports patients as they navigate their care journey and benefits health plan members (and payers alike) through quality site-of-care optimizations and corresponding cost savings. Providing this bundle of services, which traditional models lack, ensures patients receive the right care, in the right place, at the right time, every time.

While healthcare leaders continue to identify the ways in which virtual care can improve efficiencies for clinicians and enhance the patient experience, it is critical to consider its impact on the entire medical system. The advancements made around telemedicine over the last 18 months are significant, but should be viewed as the first steps of an important journey for healthcare going forward. We must move beyond reactive, fragmented models of care to more unified, omnichannel approaches. This will benefit all stakeholders, as patients will receive appropriate care, clinicians will be able to focus on the most at-risk patients, and payers will be able to better control costs by shepherding people to the right people and places based on their needs.

Photo: marchmeena29, Getty Images

Nick D'Addezio serves as the Vice President, Strategy and Business Development at Pager, a leading virtual care collaboration platform. In this role, he leads the organization in identifying innovative applications for virtual care to drive value across the healthcare industry. Prior to his time at Pager, D'Addezio served as the Executive Director, Strategic Services: Development and International for the Blue Cross Blue Shield Association. He has also served as a Managing Director at BCBSA and as an Engagement Manager at Oliver Wyman's Health and Life Sciences Practice. D'Addezio graduated from Penn State University with a BS in Finance.

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