22 February 2021
By Jon Freedman, Royce Cheng, and Melissa McCain
In the initial stages of the COVID-19 pandemic, adoption of telehealth substitutes for in-person care spiked as providers shuttered physical care sites. Telehealth utilization jumped from less than 1 percent of all visits at the end of February 2020 to more than 50 percent just five weeks later, according to Chartis’ Telehealth Adoption Tracker. While many health systems have increasingly incorporated elements of virtual care into their long-term strategic roadmaps, the details around the practical application of these elements have often been ambiguous, disconnected from broader system goals, and not highly prioritized.
“Health systems have a unique opportunity to build upon current momentum to develop an intentional and sustainable digitally forward care delivery model.”
The telehealth spike: Telehealth visits as a percentage of all visits
The urgency of COVID forced organizations to bring virtual care to the front of their care delivery efforts. Rapidly activating and scaling telehealth capabilities amid the pandemic certainly had its challenges, but health systems demonstrated remarkable technical, operational, and clinical adaptation in light of the urgency. Despite historic reluctance and inertia, providers learned that virtual care can be a viable part of the spectrum of care delivery. Clearly, much work remains to optimize the usability, quality, and security of the quickly implemented substitutes for in-person visits. But more substantially, health systems have a unique opportunity to build upon current momentum to develop an intentional and sustainable "digitally forward" care delivery model that deploys a variety of digital modalities materially and more precisely across the care continuum.
Transforming to a model that cohesively incorporates virtual care, delivers economically sustainable high-quality care, and effectively engages consumers requires a broad, intentional approach to care model redesign. The questions for infusing care delivery with virtual care are not about “if” but rather “when,” “how,” and “how much” care should be delivered virtually. In this article, we discuss how learnings from initial rapid forays into telehealth over the past year can serve as a catalyst for a lasting digitally forward care delivery model. We identify existing forces that health systems need to overcome and provide an overview of benefits that can be realized through a successful transformation.
For the purposes of this article, we define virtual care broadly as synchronous or asynchronous interactions between patients and providers delivered through various channels, or modalities.
Telehealth is a subset of virtual care, encompassing discrete, real-time (synchronous) modalities, such as video and telephonic visits.
Digital health, on the other hand, is the overarching spectrum of experience and capabilities required for the material transformation of healthcare delivery beyond specific care interactions.
In the context of these definitions, we are seeing increased adoption of virtual care among providers and patients, prompting a dramatic shift in the conversation about the future of care delivery. In national surveys, consumers have voiced their expectation that virtual care should be part of their portfolio of care options.[1] A 2021 report by Jarrard Inc., a Chartis Group company, found that 74 percent of consumers who have used telehealth want to continue to do so after the pandemic is under control. Providers have also signaled their intent to continue offering care virtually.[2]
“Ultimately, health systems are well-served by focusing on and aligning around the strategic benefits of a transformed care delivery approach with the broad deployment of fully integrated virtual care at the core.
Health systems historically have faced notable headwinds to implementing sustainable virtual care programs that are truly integrated with their enterprise care delivery strategy. Persistent challenges include siloed approaches to implementation; adoption of unintegrated point solutions; limited consumer and provider education, training, and support; a disparate or nonexistent focus on the consumer experience; and misapplication of existing in-person workflows to digital modalities. Many of these tangible barriers are certainly valid obstacles, yet they are addressable. In our experience, perhaps more challenging is a persistent “regression to the understood,” which often sits at the heart of organizational inertia.
Ultimately, health systems are well-served by focusing on and aligning around the strategic benefits of a transformed care delivery approach with the broad deployment of fully integrated virtual care at the core. Some of these strategic benefits include:
A strategic focus on benefit realization, combined with an intentional and programmatic approach to execution, will help dismantle historical barriers to truly leveraging virtual care throughout the enterprise care delivery platform. Realizing these potential benefits requires healthcare leadership to pivot from viewing virtual care as a siloed one-off approach for limited use cases to viewing the spectrum of digital modalities as the option of first resort. They should consider digital modalities for patient encounters across the care continuum and integrate these modalities as a situation-driven substitute, complement, or supplement to traditional in-person care.
Because it was a crisis response rather than a calculated implementation, the rapid adoption of limited telehealth capabilities had its shortcomings. But it also illustrated how a more refined virtual care model holds tremendous promise. Longer-term adoption, sustainability, and efficacy require a more deliberate approach. Immediate lessons learned are a tangible starting place for moving to a more expansive transformed model that proactively addresses historical barriers to implementation.
COVID-Related Implementation Experience | What We Learned |
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Telehealth’s video and telephonic visits were offered as a temporary, make-do “lift-and-shift” substitute for in-person care, with a one-size-fits-all approach for both patients and clinicians. |
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COVID-Related Implementation Experience | What We Learned |
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Telehealth was used to deliver care that could not be delivered in person because of COVID-related safety concerns. |
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COVID-Related Implementation Experience | What We Learned |
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Given the urgency of the public health crisis, organizations did not have time to rethink care team roles and align capacity specifically to enable virtual care. |
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COVID-Related Implementation Experience | What We Learned |
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The need to implement virtual care quickly resulted in disconnected technology and access platforms. |
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COVID-Related Implementation Experience | What We Learned |
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Temporary payment changes brought parity to telehealth reimbursement. |
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The COVID crisis has demonstrated the power and potential of virtual care. It has confirmed the anticipated consumer embrace of virtual care and highlighted the ability of health systems and providers to deliver. With learnings fresh in mind, health systems have the opportunity to take advantage of current momentum to accelerate the journey to a digitally forward mindset — one that fully and meaningfully intertwines virtual care throughout the broader care delivery system.
As the urgent response to the COVID crisis has proven, health systems are indeed capable of executing rapid change. Organizations should capitalize on their COVID response and subsequent learnings to holistically integrate virtual care throughout the care delivery system for the long run.
From Strategy to Tactics: The next article in this series will dive deeper into how to move from strategy to tactics. We will outline the requirements to operationalize the digitally forward care delivery model outlined here and discuss what it takes to realize virtual care benefits over the short and long terms. In the third and final article of the series, we will tackle the critical — and often overlooked — change management and communications strategies for ensuring physician and staff buy-in, engagement, and championship of the new model.
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