Every year athenahealth looks back on the year that was and assesses what happened in healthcare. It is not news that 2020 tested and strained the medical ecosystem in ways none of us could have anticipated. COVID-19 highlighted a number of inequities in access and outcomes, leaving some people far more vulnerable to the impact of the pandemic than others.

There will and should be a reckoning for these realizations. But, just as the crucible of battlefield medicine yields advances in care, this year’s healthcare crisis generated innovation in virtual care, patient engagement, care management, and healthcare regulation. All of these signal a transition toward a more holistic model of care that puts the patient squarely at the center. 

Recently, athenahealth sat down with three experts to talk about what we, as an industry, have learned this year, and how that may point the way forward. 

Virtual care keeps patients at the center of care 

As pandemic-related lockdowns began in the early spring, virtual visits spiked as a percentage of visits. Practices all across the country turned on a dime to offer telehealth. “What we saw this year was an emergency use,” says Jessica Sweeney-Platt, vice-president of research and editorial strategy at athenahealth, “virtual care being used to support a bare minimum of access.” 

And there was a rapid shift in patient behavior. According to Matt Longley, director of product strategy at athenahealth, virtual care “used to be relatively onerous and it was hard to convince patients that it was as good as an in-person visit.” But now, patients and providers alike have accepted that there are many kinds of interactions that just don’t require the patient to come into the office. 

In a matter of days, Garza Medical Group in San Antonio went from everyone working in the office to no one working in the office. Using virtual care tools, one person checked in the patient, someone else collected payment, and Dr. Nora Garza clicked in to see patients virtually as soon as the light turned green — all from their separate homes. “The fact that my staff wasn’t next to each other meant nothing,” she said. 

She was able to order mammograms, colon cancer screenings, blood work, and more, without missing a beat. And then she would receive the results directly through the athenahealth EHR and could share them with the patient through a virtual visit.  

“They haven’t set foot in your office in six or even nine months,” says Garza, “and still you do good medicine, still they feel connected, still they feel take care of.” 

Innovation and outreach maintains patient engagement 

Garza Medical Group stayed connected to their patients in a very real way throughout the pandemic. Technology was only part of the story – the practice had to decide how and when to reach out to patients, and who to target for COVID-19 outreach, care reminders, and general communications. 

Relying on the ubiquity of cell phones, Garza’s staff was able to keep in constant contact with patients. They text patients with reminders for routine care or to stay in touch about pandemic testing and results. The practice’s approach is summed up in their holiday athenahealth text campaign “It’s Best to Test,” through which they offer free COVID-19 tests on weekends to anyone in the community. Patients also get weekly reminders about pandemic safety and testing.  

Pandemic leads to care management changes that support high-risk patients 

Practices need to connect even more frequently with patients suffering from chronic conditions, especially during the outbreak of a disease like COVID-19 that puts them at particularly high risk. Innovative practices were able to keep these patients safe from COVID without sacrificing the routine care connections designed to keep these patients healthy. 

By the summer of 2020, providers and practices had moved beyond the initial emergency deployment of virtual care. It became clear that this technology could be a boon for the frequent check-ins recommended for patients with chronic conditions. And, according to Longley, patients have changed their expectations for care, now “expecting the same consumer convenience they have everywhere else in their lives.”

Sweeney-Platt believes this technology can “build relationships between patients with chronic disease burden and their care team in a way that minimizes the burden on the patient.” High-risk patients who, in a normal year, have five or six in-person appointments can both reduce that number and increase their connection with the care team through more frequent, shorter touchpoints. “One of the unfulfilled promises of healthcare technology is that it will serve as a relationship enhancer rather than as a barrier,” says Sweeney-Platt. “Everyone in the sector is eager to see that promise fulfilled.” 

Virtual visits take place in the patient’s home, offering insight that isn’t possible in a clinical setting. Longley points out that as the focus of healthcare shifts to a more holistic view of the patient, it is increasingly clear that care can no longer happen in isolation in the provider’s office. “It’s about home environment, social determinants of health, looking at the contents of their fridge. We haven’t always thought of these things as medicine, but they are incredibly impactful, especially for chronically ill patients.” 

In many ways, 2020 has really begun to change the way people think about bringing care to high-risk patients where they are. 

COVID-19 highlights the importance of alternative financial models 

The drastic drop in visit volume in early 2020 threatened the financial viability of many practices. But, according to Sweeney-Platt, practices that had taken on a fair amount of risk were shielded from the impact. “One of the things that I have been hearing from our customers is that they are interested in exploring alternatives to fee-for-service reimbursement.  During COVID, practices that were paid on a per-member, per-month basis got paid whether or not the patient came in, and had a bit of a financial cushion.”  

Virtual care really makes the most sense in a world where there is a balance between fee-for-service and value-based care. According to Sweeney-Platt, if you are responsible for the total cost of care “it is a lot more rational to find those moments where a quick 10-minute check-in can play a role because it’s better for the patients, and the provider can be paid for their time.” 

One of the best things to come out of this crisis may be a real tipping point for value-based care. 

Regulatory changes enable progress 

Radical regulatory changes made all of this possible. First, and perhaps most importantly, the Centers for Medicare and Medicaid Services and many commercial payers agreed to reimburse for virtual visits at the same rate as in-person visits — even audio-only visits. “And we are talking to anyone who can listen to make those payment changes permanent,” says Sweeney-Platt. 

Temporarily easing some restrictions around data privacy allowed providers to quickly deploy virtual care to prevent deferred care. And Longley believes now that patients have gotten a taste of the convenience of virtual visits it has become a consumer expectation. 

And this year’s 21^st Century Cures Act set the tone for a new approach to ownership of and access to health data. This act takes a clear stance that records belong to the patient. They need to be able to make use of it, and to control who accesses it. It is yet another way in which 2020 moved toward making the patient the center of the story. 

As Sweeney-Platt says, “this is an extraordinary moment for technology-enabled solutions in healthcare and we never want to go back to the way it was before.”