By now it’s obvious to everyone that virtual care is here to stay. It offers demonstrable benefits in terms of convenient access to care leading to increased continuity of care which can result in improved outcomes and lower cost of care.

Given the plethora of competition to traditional healthcare delivery through digital health companies (such as Ro, BetterHelp or Amazon Clinic), it behooves today’s healthcare leaders and virtual care disciples to get serious about ensuring the sustainability of virtual care, lest your organization loses patients to the new kids on block.

In order to make virtual care here to stay, it needs to be sustainable in three key areas:

  • strategically sustainable
  • financially sustainable
  • clinically sustainable
Strategically Sustainable Virtual Care

Prior to the Covid-19 pandemic, telehealth (a.k.a. virtual care) was thought of (at best) as an esoteric way to occasionally get specialty care to those who live far, far away. Telehealth first blossomed with forward-thinking academic health centers (such as the University of Virginia) offering access to their subspecialty care in rural areas.

In 2020, the Covid-19 health crisis opened people’s eyes to how much of today’s care delivery was actually possible without ever laying hands and in many cases (due to the lack of proper telehealth support) without ever laying eyes on the patients. Still, telehealth was thought of as a stop-gap measure when in-person is impossible or not feasible. Yet, many clinicians, especially in primary care, did not have a great experience, since the launch was haphazard at best, and lacked even the most basic clinician training and no signs of Telehealth TechChecks to get the patients well prepared for the visit.

To achieve virtual care sustainability, what is needed first is a mindset shift in healthcare’s executive leaders. The insight that “What got you here, won’t get you there.” While virtual care is a clinical tool (more on that below), it can also serve as a very powerful strategic tool that can create strategic success.

Here are just a few examples from an article I wrote a few weeks ago:

  • Virtual Care attracts and retains patients who want convenience and comfort, yet don’t want to give up the relationships with their trusted care providers.
  • Virtual Care attracts and retains innovative, forward thinking clinicians and staff that understand the importance of mastering digital health and virtual care as an investment into their career.
  • Virtual Care expands your organization’s reach into the outlying areas and makes you a better steward of the communities’ resources, by reducing travel time.
  • Virtual Care offers opportunities for frequent touch points, which in turn increase patient engagement and participation in the execution of their care plan, leading to better outcomes.
  • Virtual Care can more easily fill schedule holes, reduce now shows and cancellations, and increase the overall patient panel, adding significantly to the bottom line.
  • In an inpatient environment, Virtual Care can expand the care team’s clinical capabilities and thereby enable care for more complex, sicker patients.
  • etc.

To make virtual care here to stay, to ensure its sustainability, the first step is to get leadership on board. The optimization, growth, and expansion of virtual care is, after all, an exercise in change management, and change always starts at the top.

Clinically Sustainable Virtual Care

Leadership commitment is, however, not limited to the executive leadership. After all, healthcare organizations and in the business of care delivery. Therefore, the engagement and buy-in by clinicians is a critical, key ingredient to sustainable success.

The first hurdle, though, is the aforementioned bad experience during Covid. For those organizations who had not launched their telehealth services, the rollout was something like: “Here’s a webcam and a Zoom license. Now do telehealth.”

That obviously did not go over well with the experience-driven and evidence-based mindset of clinicians. Especially not when the majority of initial video visits resulted in poor video quality or poor audio quality, leaving many clinicians to resort back to the phone.

If I’ve picked up anything about physicians in my 20+ years working alongside clinicians, it’s that they’ve been indoctrinated during training with a strong mindset of being (or at least appearing) in control of every situation, especially in front of patients.

But the telehealth experience doing Covid took away the familiar exam room, the nurse-led rooming process, the ability to see, feel, smell the patient to make holistic assessment leading to diagnosis, to be confirmed by further tests.

Therefore, virtual care sustainability requires the buy in and commitment of the clinical leadership and the key influencers in the clinical team. It requires an open dialog among colleagues about the efficacy and the limitations of virtual care.

One of our clients, a rural community health center, just recently implemented their in-house developed clinical guidelines defining when it would be appropriate for patients calling for a same-day primary care appointment to be offered telehealth. This immediately resulted in a video to a recently discharged patient that had no transportation.

Telehealth has been practiced successfully by thousands of clinicians across the world, in virtually every specialty. All of the renowned clinics and health systems have flourishing, growing, expanding telehealth programs. It’s time to get with the program and apply in your own clinic what has long been proven.

The key ingredients for clinical sustainability? How about these five.

  1. Clinical Leadership that clearly promotes virtual care as an alternative care delivery modality.
  2. Virtual care workflows that are optimized for the clinicians time, handling technical problems, rooming, and post visit activities just like in the in-person world.
  3. A structured training program on webside manners (a.k.a., how to act professionally in a video visit), the use of technology, and how to conduct (and document) virtual exams.
  4. Collaboratively developed clinical guidelines for your clinic, as to under what circumstances virtual care is and when it is not appropriate for “good care”.
  5. An operational and technical support team to assist the clinicians in having a good experience with virtual care.
Financially Sustainable Virtual Care

The last element of virtual care sustainability, and not surprisingly the one that usually comes to mind first, is to ensure the long-term financial viability of virtual care.

The holy grail that most of us are waiting for is obviously an environment of only outcome based, capitated payment. Because then the whole conversation about the fee-for-service reimbursement of a specific virtual care service becomes a moot point: if it serves the patient, if it engages or even activates the patient, then any of the various virtual care modalities will do. A quick video chat? A secure message to check in? A quick peek of your glucose levels or your activity level for today? A phone call to make sure you’re okay? No problem, we’re here for you to help you get better and stay well.

But back to the real world of fee-for-service reimbursement. Here’s the surprising reality: In an oversimplified way, contrary to popular belief, for much of the healthcare delivered in the US, video visits are paid at the same rate as in person visits. Similarly, remote physiological monitoring services under normal circumstances provide sufficient reimbursement to cover the cost and staff/clinician time.

This is true for Medicare, for Medicaid in most if not all states, and for most of the 40+ states whose legislators have passed payment parity laws (26 states) or service parity laws (17 states and DC), this is true for commercial insurance as well.

On the flip side, audio-only visits are reimbursed at a much lower rate and FQHCs and Rural Health Clinics are also experiencing “video visit payment discrimination” that hopefully will be fixed by the end of 2024. But still from a financial point of view, a virtual care visit is better than no visit.

The long-term strategy for financial sustainability of virtual care is to continue to invest and engage in value-based contracts, focusing on improving patient outcomes at the lowest cost, and here virtual care is an invaluable tool.

A Blueprint towards Virtual Care Sustainability

So where should an organization start? Here are a few resources to get you started:

  1. Assess your organization’s telehealth maturity. This framework that we developed pre-2020 will help to identify your organization’s blind spots and opportunities for improvement.
  2. Armed with insights about your blind spots, run your organization’s virtual care services program through a systematic optimization that includes well-defined workflows, staff & clinician training, and a support structure. You cannot expect to expand and grow your virtual care services from a shaky foundation.
  3. Review your organization’s virtual care strategy. Do you have one in place? Is it any good? A strategy is key to build buy in and commitment from your clinicians and your staff.

Virtual Care is not simply a technology, nor is it a fad to ignore. Care delivered at a distance is the undeniable reality of the future.

While virtual care optimization to achieve sustainability is not rocket science, it does require multidisciplinary expertise in change management, strategic planning, workflow design, clinician training, policy development, technology, reimbursement, etc.

If you don’t have that expertise on your team or cannot hire that expertise, then I strongly recommend that you secure that expertise through virtual care experts like the Ingenium Team or other consulting firms. The competition will not stop innovating any time soon.

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Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.

Contact Christian by phone or text at 657-464-3648, via email, or video chat.