Virtual health has already demonstrated that it can act as a catalyst for care model transformation. Every day, new applications emerge that are tapping into virtual health’s transformative potential. We suggest that care model transformation occurs on (at least) three levels.
Virtual health in focus
Virtual Health as a Catalyst for Care Model Transformation—Part 1
Temporality of virtual care:
- Synchronous virtual health: real-time two-way digital communication between provider and patient
- Asynchronous virtual health: data shared with provider for offline review
- Use cases categorized as “both” can be either synchronous or asynchronous
We are proposing a virtual health landscape framework to illustrate the three transformation types by showcasing examples of demonstrated, emerging, and next-gen virtual health solutions. The framework features a settings of care axis (left side) and a temporality of virtual health (across the top).
In the following, we explore a few of the use cases highlighted in the framework.
Demonstrated virtual health solutions transform the care model by reducing barriers to access by overcoming geographic hurdles, alleviating impacts of provider shortages.
Description: Demonstrated virtual health use cases have been widely implemented across the industry, and their impact on the care model manifest as results from real-world examples.
Use Case Example: Tele-health applications, such as virtual care visits, tele-ICU, or tele-stroke programs, are prime examples of demonstrated virtual health solutions.
Progress to Date: Health systems across the US have been turning to tele-health to drive better outcomes and improve the overall patient experience. Examples of tele-ICU, tele-stroke, and tele-behavioral health abound.
Care Model Transformation Impact: Tele-healthcare has also demonstrated a positive impact on the quality, efficiency, and cost of care delivered. For example, results from a tele-health program in the mid-west found a 35% decrease in length of stay and 30% fewer deaths.1 Tele-healthcare success is not limited to only the ICU; a tele-stroke program introduced in a Southern California hospital network found numerous improvements in quality measures, including a 75% increase in timely use of a clot-dissolving drug following a tele-health consult with a specialist, a 12-minute reduction in time until diagnostic imaging text, an 11-minute reduction in drug administration, and a reduced door-to- needle time to under an hour.2
Emerging virtual health use cases transform the care model by triaging patients according to acuity tiers, notably to lower-acuity and lower-cost settings such as the home. The patient experience is elevated, and clinical quality is improved, for example by avoiding nosocomial (hospital-acquired) infections. Virtual health solutions are the catalyst to scaling hospital-at-home.
Description: Emerging virtual health use cases have demonstrated accretive benefits when deployed appropriately, but their full transformative potential has likely not yet been realized.
Use Case Example: The “hospital-at-home” model shifts care to a patient’s home, a movement that is catalyzed by virtual health applications such as remote monitoring.
Progress to Date: Hospital-at-home programs primarily aim to free up inpatient capacity and reduce total episodic cost. They have also demonstrated the ability to improve patient outcomes by reducing hospital-acquired conditions and avoiding readmission.3 Traditional hospital-at-home models foresee daily nurse visits and less frequent physician house-calls. Certain diagnostics can be performed at home (e.g., electrocardiograms or phlebotomy) and some therapeutic interventions are possible (intravenous medication, wound care) in the comfort of the home.4
Care Model Transformation Potential: Virtual health has the potential to scale the hospital-at-home model. Innovators are now digitizing the hospital-at-home, adding smart devices for continuous remote-monitoring and artificial intelligence (AI) enabled interpretation of live data feeds. Smart technologies also enable clinicians to interact with patients between in-person visits and control treatment automation (i.e. smart IV pumps). The hospital-at-home and hospital-on-the-go are also transforming how care is provided in the military health system, on deployment, and in other remote settings.
Next-gen virtual health will transform the care model by empowering self- service care and thereby reshaping the traditional patient/provider interactions. Virtual health solutions augmented by artificial intelligence promise precision care through continuous monitoring, consistent use of care pathways, and real- time interventions—irrespective of time, location, or relationship.
Description: Next-gen virtual health use cases can further transform the care model, eventually replacing the traditional patient- provider relationship with AI-enabled self-care solutions.
Use Case Example: Self-care solutions to manage chronic conditions and rehabilitation connect biometric sensors to AI engines and feedback loops. The AI engines are equipped with neural networks and machine learning algorithms and loaded with leading care practices (and/or clinical pathways). The algorithms can recommend treatment adjustments and interact directly with the patient; they can also digitally modify settings on therapeutic smart devices to implement the proposed treatment plan. And when needed an alert can be routed to the care team.
Progress to Date: A well-known example of self-care is the continuous glucose monitor and digital insulin pump (see our blog “An integrated health ecosystem can be greater than the sum of its digital devices”).5 The insulin solution empowers patients and affords insulin-dependent children a new level of autonomy. Another example of self-care is a digital therapy assistant that guides patients through prescribed physical exercises after arthroplasty. The solution automatically analyzes range of motion and recommends exercise progression. While licensed physical therapists can monitor patient progress, they are no longer necessary actors in the rehab process. When tested, this intervention has shown an ability to improve adherence and enhance in-person therapy as well as increase patient engagement through personalized programs.6 These are two rudimentary examples, but a multitude of more sophisticated self-care applications can be envisioned.
Care Model Transformation Potential: The potential for self-service solutions is practically unconstrained. The synchronous patient-to-machine interactions allow for real-time care management. The interactions with the clinician are asynchronous, thus reducing the burden on the care team. It is easy to see how such technology has the potential to vastly transform the way diagnosis, treatment plan, and follow-up care is provided. Most importantly, it completely reshapes the way health care conceptualizes the patient–provider relationship.
We used a virtual health landscape framework to identify and discuss examples of demonstrated, emerging, and next-gen virtual health applications. We discussed the care model transformation impact of each type of virtual health solution, and we have started painting a picture of the future of self-service health care. In Part 2, we will explore key enablers of care model transformation and key aspects of change management to navigate the care model transformation.
Felix Matthews, MD, MBA
Managing Director, Deloitte Consulting LLP
Lt. General (Ret.) C. Bruce Green, MD, MPH
Managing Director, Deloitte Consulting LLP
Acknowledgements: Ken Abrams, MD, MBA; Summer Knight, MD, MBA; Mark Ediger, MD, MPH; Amy McDonough, MHA; Zach Miller; Mamta Elias, MBA
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