Virtual Health as a Catalyst for Care Model Transformation – Part 2

In Part 1, we used a virtual health landscape framework to identify and discuss examples of demonstrated, emerging, and next-gen virtual health solutions. We explored the care model transformation impact of each and their contribution to a proposed vision of the future of self-service health care (Refer to Part 1: ‘Virtual Health as a Catalyst for Care Model Transformation – Part 1’).

Experience with COVID 19 “safer at home” and physical distancing has highlighted other advantages of virtual health adoption. Safety - and not just patient convenience - will likely be a future driver for the adoption of virtual health systems. Many health care providers have scrambled to implement virtual health solutions quickly over the past few weeks. Yet, to ensure sustainability, a number of enabling capabilities now need to be worked through methodically.

In Part 2, i.e. this article, we therefore examine enablers of each of these solutions and discuss how they are pre-requisites for care model transformation. We propose that enablers form somewhat of a pyramid, in which capabilities for next-gen virtual health solutions are additive to capabilities for demonstrated and emerging solutions (i.e. like a pyramid).

Demonstrated virtual health solutions help transform the care model by reducing barriers to access by overcoming geographic hurdles and alleviating impacts of provider shortages. 

Successfully deploying a demonstrated solution in a manner that truly transforms the care model is dependent on commitment from leadership, adoption of the new technologies, and mechanisms that can prevent provider burnout.

• Organizational Commitment
  
  In the Deloitte 2018 Survey of US Physicians, 9 out of 10 physicians surveyed indicated they understand the potential benefits of virtual health capabilities; however, only 14% have implemented technologies related to virtual visits.¹ To help physicians and other clinical staff overcome these existing reservations on even broadly tested solutions, health system leaders should clearly demonstrate the need for and advantages of virtual health adoption to the organization. 
  
  Organizations should be willing to invest in resources to train providers and alleviate data security and accuracy-related concerns. At the same time, it will be necessary to implement a governance model where clinical teams serve as champions of key initiatives and where new virtual health opportunities are vetted prior to future deployment. A clearly defined governance model can establish clear ownership and accountability to help drive delivery and quality outcomes.
   
• Technology Adoption
  
  Even demonstrated solutions require the appropriate technology solutions to be in place to facilitate a virtual interaction. To enable solutions such as tele-ICU and tele-stroke, health systems should invest in the foundational technology capabilities and infrastructure to transmit patient data both asynchronously as well as in real-time.
  
  Prior to deploying capital towards new technology capabilities, an organization should consider its current technology infrastructure and EHR capabilities, third party vendors, and experience with technology integrations.² These new capabilities will need to be supported by additional investment that drives provider adoption by training providers on how to properly use virtual health technologies and how to appropriately incorporate them into their day-to-day workflows. In addition to technology training, it will also be important to train providers on virtual communication and the specific techniques that can employed to communicate empathetically in a virtual health setting.
   
• Care Team Empowerment
  
  Demonstrated solutions have shown that virtual health capabilities can increase access for patients, thereby rapidly increasing volumes for providers.³ As such, implementing mechanisms that empower the care team and mitigate burnout need to be a high priority. Beyond the virtual health-enabling technologies themselves, health systems should be prepared to invest in supplemental technologies, such as documentation automation or AI backed-diagnostic support, that can save time providers spend on certain administrative or clinical tasks. Similarly, adequate support staff must be available and user-friendly workflows designed and implemented.
   

As discussed in Part 1, emerging virtual health solutions transform the care model by triaging patients according to acuity tiers and distributing care to acuity-appropriate sites (e.g., hospital-at-home). 

To increase adoption and scale these emerging solutions, providers need access to the proper financial incentives, support from interoperable platforms, and the capacity to work at their top-of-licensure more frequently.

• Value-Based Payment Models
  
  The adoption of emerging virtual health solutions will be heavily dependent on the adoption of value-based payment models across the healthcare ecosystem as value-based payment models offer providers an added financial incentive to deliver care at a lower cost in-the home or in alternative care settings.
  
  This transition out of the hospital is already underway as health system reliance on revenue from inpatient care, traditionally a significant source of revenue, has been declining as revenues from outpatient care increase.⁴ However, both payer and provider appetite for value-based arrangements must continue to grow to provide sufficient incentives for providers to treat patients virtually in alternative settings of care.
   
• Secure & Interoperable Technology Platform Solutions
  
  As emerging virtual health solutions redirect care delivery to lower-acuity and lower-cost settings – home settings in particular – interoperability is essential to maintaining insight into the patient along the care continuum. A truly secure, interoperable, and scalable platform will be critical as health systems need to maintain a secure connection to the patient through various platforms and devices. The optimal platform will also allow for more seamless integration of data gathered from electronic health records, smart phones, analytics engines, and telehealth platforms, enabling health systems to maintain an up-to-date, holistic patient profile.
   
• New Staffing & Resourcing Models
  
  To scale the delivery of higher acuity care across multiple settings, health systems will need to develop new resourcing models that enable providers to operate at the top of their license more frequently. New resourcing and staffing models should focus on deploying non-physician clinical providers to manage a greater share of virtual health tasks and conduct home-visits to tend to hospital-at-home patients. 
  
  As emerging solutions enable higher acuity cases to be conducted virtually, strategically reallocating provider resources will be key to ensuring that provider time is spent treating cases at the top of their license.
   

Next-gen virtual health can transform the care model by empowering self-service care (augmented by artificial intelligence), thereby reshaping traditional patient/provider interactions. 

As next-gen virtual health technologies transform the patient/provider relationship, patients will need to be more engaged in their healthcare experience. These completely new approaches to care delivery will also necessitate an evaluation of current workflows.

• Patient Education
  
  As more care is enabled by self-service, it will be even more critical for patients to be engaged in the care delivery process and educated on how to properly participate. For example, if a health system were to move to a fully self-service model for preventive care or chronic disease management, it will be imperative that patients are engaged, empowered, and educated on how to manage care on their own. Similarly, next-gen solutions in rehabilitative care may be ineffective unless patients are engaged to the point that they consistently wear remote monitoring devices (e.g., a smart knee brace), and are educated on how to adjust these devices based on provider feedback.
   
• Workflow Integration
  
  For virtual health to become the norm for providers, care delivery and workflows leveraging virtual health capabilities should become routine.⁵ Historically, it has been easier for providers to integrate asynchronous care into their day-to-day practice given that its ‘store-and-forward’ nature makes it less disruptive to existing workflows. 
  
  Nevertheless, to support all three types of solutions (next-gen in particular) and leverage the truly transformative potential of virtual health, full workflow integration will be a necessity. Health systems will need to strategically incorporate next-gen forms of asynchronous care delivery on top of the more traditional synchronous and asynchronous virtual care without disrupting providers’ responsibility for in-person workflows. Providers must have input into the clinical process design, workflow, and overall program integration. Workflow integration will need to be supported by change management protocols to encourage acceptance among providers.
   

To effectively leverage virtual health to catalyze care model transformation, certain enablers are required in the short-term to facilitate the success of demonstrated solutions. Moreover, to capture the transformative potential of both emerging and next-gen solutions, the reimbursement and value-based payment landscape will need to continue to evolve, new capabilities will need to be developed, and the patient must be adequately prepared to play a larger role in their healthcare experience.

Acknowledgements: Emily Zerishnek, Zach Miller, Mamta Elias 

Felix Matthews, MD, MBA
Managing Director, Deloitte Consulting LLP
[email protected]

Lt. General (Ret.) C. Bruce Green, MD, MPH
Managing Director, Deloitte Consulting LLP
[email protected]
 

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