What the COVID-19 Telehealth Spike Revealed About Achieving Lasting Adoption of Virtual Care

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.

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


COVID-Related Implementation ExperienceWhat We Learned
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.
  • Many visit types are well-supported and clinically sound when conducted by telehealth.
  • Telehealth is not a suitable substitute for all types of in-person visits.
  • Digital solutions should be explored for the gaps experienced in diagnostic and therapeutic visits.

Where to Go from Here

Health systems should:
  • Differentiate between care journeys (based on condition types, acuity, etc.) to selectively apply digital modalities.
  • Include asynchronous digital modalities (e.g., remote patient monitoring, symptom checkers, and virtual triage) to engage with patients more continuously over time.
  • Design a holistic care model in which virtual and in-person care complement one another. It is not all or nothing.

2. Consumer Experience


COVID-Related Implementation ExperienceWhat We Learned
Telehealth was used to deliver care that could not be delivered in person because of COVID-related safety concerns.
  • Consumers appreciate the convenience and safety of telehealth visits.
  • Consumers widely accepted telehealth, thus validating assumptions about expectations.
  • Dissatisfaction was not about the fact that care was virtual but rather about glitches in delivery, such as technical challenges, inconsistent tools across care settings, and lack of clear instruction and support for using telehealth applications.
  • Telehealth visits require different engagement behaviors and operational support systems (e.g., tech support) than in-person interactions.
  • Functions surrounding virtual care (e.g., making appointments, registration, follow-up) were often disjointed and designed for in-person visits.

Where to Go from Here

Health systems should:
  • Fine-tune digital experiences to meet consumer expectations and drive satisfaction.
  • For synchronous virtual visits, focus on “webside” manner.
  • Leverage digital to accelerate the trend of empowering consumers and their caregivers/family members to be a part of their own care team.
  • Understand where consumers cannot easily engage in virtual care (e.g., lack of broadband, multilanguage support), and ensure equitable access.
  • Apply digital solutions and communications to enhance and simplify interactions throughout the care journey, not just at the point of service.
  • Implement consumer education and engagement strategies to drive understanding about distinct types of care delivery.
  • Support care team members as the foremost advocates to their patients for the benefits of virtual care, in all its forms.

3. Operations


COVID-Related Implementation ExperienceWhat We Learned
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.
  • The experience of care team members, including interactions and workflows, need to be reconsidered as digital modalities are integrated.
  • Simply shifting schedules from in-person to telehealth visits missed the opportunity to better match supply with demand and support efficient capacity management.
  • Continued physician-predominant care in a geographically unconstrained virtual care model fails to take full advantage of advanced practice provider (APP) skills and limits capacity for physicians to see patients who most need to be seen by a physician.
  • Failing to apply the appropriate scheduling templates for different visit types (including virtual) limits capacity for all care team members and does not expand access to care.

Where to Go from Here

Health systems should:
  • Through enhanced informatics, optimize operational workflows for each digital modality, including asynchronous.
  • Reevaluate and reconfigure capacity and schedules with consideration of a full care team not constrained by geography.
  • Drive provider satisfaction by leveraging flexibility enabled by virtual care models.
  • Consider more nuanced scheduling templates and staffing strategies for distinct types of patient interactions.
  • Engage and educate providers and staff around leading practices for virtual care operations.

4. Technology


COVID-Related Implementation ExperienceWhat We Learned
The need to implement virtual care quickly resulted in disconnected technology and access platforms.
  • Organizations quickly stood up capabilities that were not connected to other systems.
  • Simply shifting schedules from in-person to telehealth visits missed the opportunity to better match supply with demand and support efficient capacity management.
  • Redundant and parallel processes and platforms (one for telehealth and one for in-person care) were inefficient and confusing for consumers as well as clinical and operational teams.
  • Traditional processes designed to support in-person care were misapplied for telehealth (e.g., having to call the service center for a video visit appointment).

Where to Go from Here

Health systems should:
  • Re-evaluate digital architecture with an eye to an integrated platform that provides a seamless and cohesive consumer and provider experience.
  • Synchronize in-person and virtual care workflows for both consumers and providers.
  • Leverage investments in virtual care system and process to update outdated and inefficient in-person ways of doing things.
  • Prioritize consumer privacy and security imperatives without impeding progress.
  • Effectively and efficiently integrate virtual care applications with the EHR and other systems.
  • Deploy reliable and redundant technology solutions to satisfy a “never-go-down” situation.
  • Realize the full potential of implemented technologies through a cross-functional programmatic approach to workflow design, change management, education, training, etc.

5. Economics


COVID-Related Implementation ExperienceWhat We Learned
Temporary payment changes brought parity to telehealth reimbursement.
  • Temporary measures lowered historic reimbursement barriers that prevented broad adoption.
  • A lack of certainty on payment parity is a barrier to sustaining gains.
  • Few organizations expect payors to sustain equivalent reimbursement levels for telehealth.
  • Thinking about reimbursement has generally been limited to the more binary implications of swapping in-person physician visits for telehealth visits.

Where to Go from Here

Health systems should:
  • Consider possibilities for fundamentally different business models that integrate various digital modalities and their reimbursement rules throughout the care model.
  • Leverage a broader definition of virtual care to expand access, optimize limited capacity, and realize new revenue opportunities.
  • Implement digital care modalities that bend the cost curve and attract consumers based on convenience and simplicity.

The Urgency of Digitally Forward Delivery

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.

Sources

[1] “Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist, J.D. Power Finds,” J.D. Power (October 1, 2020): www.jdpower.com/business/press-releases/2020-us-telehealth-satisfaction-study
[1] Bendix, Jeff, “Survey: Most patients satisfied with virtual care,” Medical Economics (September 14, 2020): www.medicaleconomics.com/view/survey-most-patients-satisfied-with-virtual-care
[1] Heath, Sara, “Patient Satisfaction with Telehealth High Following COVID-19,” Patient Engagement HIT (October 7, 2020): patientengagementhit.com/news/patient-satisfaction-with-telehealth-high-following-covid-19
[1] Landi, Heather, “Patients want to keep using virtual care after COVID-19 pandemic ends, survey finds,” Fierce Healthcare (July 14, 2020): www.fiercehealthcare.com/practices/patients-want-to-keep-using-virtual-care-after-covid-19-pandemic-ends-survey-finds

[2] The COVID-19 Healthcare Coalition Telehealth Impact Study Work Group, “Telehealth Impact: Physician Survey Analysis.” COVID-19 Healthcare Coalition (November 16, 2020): c19hcc.org/telehealth/physician-survey-analysis/
[2] Wicklund, Eric, “ COVID-19 Survey: Doctors Like Telehealth and Want to Continue Using It,” mHealth Intelligence (November 17, 2020): mhealthintelligence.com/news/covid-19-survey-doctors-like-telehealth-and-want-to-continue-using-it
[2] Sermo Team, “Telemedicine Explodes In These Uncertain Times,” Sermo Blog (April 16, 2020): www.sermo.com/blog-telemedicine-explodes-in-these-uncertain-times/


Learn More from the Authors

Jon Freedman
Associate Principal, Chartis Digital
[email protected]

Royce Cheng
Principal, Chartis Digital
[email protected]

Melissa McCain
Director, Performance
[email protected]


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© 2021 The Chartis Group, LLC. All rights reserved. This content draws on the research and experience of Chartis consultants and other sources. It is for general information purposes only and should not be used as a substitute for consultation with professional advisors.

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