Virtual Care During the Pandemic: Five Lessons Learned
The pandemic has pushed us to innovate farther and faster, with unprecedented reliance on telehealth and virtual care. Recent data shows the majority of Americans have now experienced a telehealth visit and 88 percent of Americans hope to use virtual care beyond the pandemic. But despite the fact that the vast majority of patients who rely on virtual care are highly satisfied, challenges remain. Our overall goal should be to find ways to incorporate virtual care not as a one-off solution to overcome access barriers, but to incorporate it into integrated care delivery models for superior, more connected care. Fortunately, many CAPP medical groups are leading the innovation to find these pathways. Here are five lessons about integrating virtual care from the physician-led medical groups and health systems of CAPP.
A Patient’s Virtual Care Journey Begins Before They Ever See a Provider On Screen
Patients who struggle to get online are less satisfied with virtual care. Within the Henry Ford Health System for example, survey data showed that 16% of patients said they were uncomfortable with the technology of the video visit. Concerns varied by age group; not surprisingly, older patients have a harder time getting online. For these individuals, Henry Ford made several changes. Some patients now have staff who contact them before the visit to explain the process and make sure they can get online. In some cases, the care team can send a direct hyperlink to patients if they are having trouble starting their appointment. A more seamless experience improves patient satisfaction. (For a description of Henry Ford’s end-to-end virtual care system, see the presentation given by Courtney Stevens at the 2021 World Health Care Conference.)
Meanwhile, CAPP member groups and systems know that a large number of patients need additional education about both the availability and benefits of using virtual care. Northwell Health has just launched “ER on Demand,” a new telehealth program that operates from 8 pm to 8 am every night and provides access to an emergency medicine physician when it is too late to visit urgent care. As options like this are introduced, their success depends in large part of educating patients about their existence, availability and appropriate use.
Seeing Patients Remotely Requires Excellent “Webside Manner”
During the pandemic, many of the providers who work for CAPP groups and systems had to make rapid transitions to see patients remotely. As this pivot took place, we had to provide training and equipment to providers for this new delivery option. For example, CAPP member Sharp Rees Steely Medical Group purchased equipment to enable physicians to perform telemedicine encounters at home, trained those physicians remotely, and expanded from one to three telemedicine platforms in order to offer every doctor the options that would maximize their comfort working from home. Beyond the technology support, physicians were also encouraged to attend webside manner training sessions to teach best practices for video.
A recent study of virtual visits found patients feel more empowered when a physician seeing them virtually is responsive, empathetic, and reliable. These are skills all providers should have, and they can be bolstered with education.
Remote Care Can and Should Be Enhanced by At-home Technology
Prior to the pandemic, many CAPP groups had already begun at-home monitoring for certain patients. The pandemic accelerated this trend. One example is how the Permanente Medical Groups expanded their Hospital to Home program. Once a physician determines a patient can safely be treated at home, a paramedic team is dispatched to set up at-home monitoring equipment. The physician checks in daily via video, and the information gathered from the at-home monitoring devices gives the provider the important insights they need to manage that patient’s care.
After partnering with a new company who installs home monitoring devices, CAPP member Mayo Clinic/Mayo Health System has reported patients with at-home monitoring had similar medical outcomes to inpatients but with the benefits of reduced readmission rates, lower complication rates, and much higher satisfaction among patients.
Long before the pandemic began, Oschner Health System was a leader in virtual care. They have now expanded remote care by adding wellness coaching and medication management, which is especially helpful for patients with chronic disease. Oschner Health System relies on using iHealth devices that integrate data into the electronic medical record platform.
Payment Models Matter. A lot.
During the pandemic, state and federal authorities relaxed telehealth requirements and improved reimbursement rates to support the expansion of telehealth during COVID-19. But in many cases, it looks like these changes may not last much longer.
Adequate reimbursement rates are essential to the delivery of first-rate virtual care. But we also know virtual care often works best in a system that is not built on a fee-for-service payment system, where a provider is paid for every “unit” of care delivered. With value-based payment models like capitation or pre-payment, a group or system is paid a fixed amount in advance to manage patients’ total care. Healthcare systems built around these models think long term about their patients’ health, and make the technology investments like virtual care that foster better long-term outcomes as well as savings. That may be why we saw the use of telehealth rise more among physicians in value-based payment arrangements , compared to those in fee-for-service arrangements, both before and during the pandemic.
We Have More Work To Do To Advance Health Equity
A study completed in 2020 showed that virtual care use reflects the same type of health equity concerns we see with in-person medicine. In short, patients with lower incomes and less education, and patients of color are less likely to participate in virtual care. During “normal times” this is a concern. During a pandemic when virtual care may be the only safe option, it’s highly troubling. Coming out of the pandemic, our challenge is to ensure virtual care continues to work well for both our patients and providers and that is it effective for all patients, regardless of their background or income. If we do it right, we can ensure better coordinated, higher-quality, more affordable care for everyone.