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.

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.

Focus on Strategic Benefits to Drive Intentional Change and Remove Historical Barriers

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:

• Attracting new patients and keeping existing patients
  A growing patient base is core to a health system’s survival. Consumers have loudly and persistently proclaimed their preference for convenient, simple, and safe experiences and for having a voice in how they receive their care. Virtual care is now expected. Health systems can either provide these offerings or risk giving consumers a reason to go elsewhere.
  
  
• Keeping patients constantly connected to their trusted care team
  Extending care beyond episodic visits and leveraging digital modalities across the care continuum can keep patients connected. In addition to the positive impacts on care quality, this builds consumer loyalty and “stickiness,” making it beneficially difficult for consumers to move to a new relationship with a different provider.
  
  
• Increasing quality and affordability of care
  Healthcare organizations have ample opportunity across a wide variety of patient needs and care scenarios to optimize the benefits of care delivery components, including cost, experience, quality, and efficiency. One example is utilizing remote patient monitoring to decrease re-admissions and the associated costs to the health system and patient. Another example is deploying virtual triage applications to drive patients to the right types of care based on their needs and preferences, thereby optimizing for limited capacity of the care team and right-sizing utilization.
  
  
• Improving the provider experience
  The robust application of integrated virtual care would enable a more satisfying provider experience in two ways. First, it can facilitate greater schedule flexibility and appropriate hours, time blocks, and structures — ultimately delivering the improved work-life balance so many providers are looking for. Second, it allows for more refined care coordination across the care team. Each provider can engage with the “right” types of patient cases at the right points in the care journey and through the right types of interactions and modalities, and this will increase professional satisfaction and allow each care team member to practice what they trained for.

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.

Key Lessons from Forays into Telehealth and Implications for a Digitally Forward Care Model

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.

Where We Go from Here: Key Lessons from Pandemic-Prompted Telehealth Adoption

1. Care Delivery

2. Consumer Experience

3. Operations

4. Technology

5. Economics