Article

Healthcare leaders: It’s time for ‘virtual care’ to simply be ‘care’

By Carley Thornell | June 8, 2022

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In the complicated matrix that is today’s U.S. healthcare system, there are few constants – except the consensus that it’s about time the Venn diagram of in-person and digital care coalesce in word and in deed.

Everyone from industry thought leaders participating in a recent ViVE conference convening the top doctors and technologists in healthcare innovation, to family clinicians in the Midwest have weighed in: It’s time for “virtual care” to simply be “care.”

Whether it’s enabling improved access or scheduling, an easier way to follow up on medications and lab results, or expanding mental health services that have become increasingly hard to come by due to the provider shortage, there should be no dialing back when it comes to advances in care delivery via telehealth, say experts.

Hybridization meets the needs of patients and clinicians

Delivering high-quality care both virtually and in-person was the plan all along at Gerald Champion Regional Medical Center, says telehealth project manager Jennifer Gruger. She was hired in 2019 to help implement, train, and encourage use of technology to grow the multispecialty group’s patient base cost-effectively across geographically diverse New Mexico. Having that foundation in place proved invaluable in the next year, of course, but patients have made their wishes clear: There should be no reversal of progress.

“athenaTelehealth really opened our eyes to what is possible when it comes to serving patients, expanding our reach and keeping providers satisfied and productive,” Gruger said.

Gerald Champion shares that patients of all ages have indicated that virtual and in-person options suit their scheduling and geographic needs, and that they want to see these options continue to be offered, said Gruger. Physicians have encouraged patients with limited mobility or chronic care management plans to leverage telehealth, while other patients prefer the modality for routine care, shorter follow-up appointments, and because of their rural locations.

Those preferences are reflected in data from the athenahealth network, which show that patients of all ages are more likely to embrace telehealth when practices encourage it. Virtual care appointments are also two times as likely to be scheduled for the same day as compared to in-person appointments; and are shorter in duration than in-person appointments. That presents opportunities for patients to suffer fewer disruptions in their day, or be impacted financially by taking time off from work, for instance.

Patients aren’t the only ones impacted by such efficiencies. At some practices, like the Henry J. Austin Health Center in New Jersey, clinicians are benefiting from flexibilities that have made CEO Kemi Alli reevaluate her scheduling strategy. She has many working parents who want their mornings free, for instance, or to take mid-day breaks and work in the evening. A hybrid approach to care that meets the needs of patients after hours – and meets them where they are – while also improving work-life balance for clinicians is one way to reduce burnout in healthcare head-on. The approach would also help increase satisfaction among female caregiver-clinicians in particular to schedule more patients in a day.

Diverse care delivery models address the growing demand for mental health services

Burnout is the major reason clinicians cite for wanting to leave their organization, finds KLAS Research. But at Esperanza Health Centers, Director of Behavioral Health Services Jessica Boland is using telehealth to combat that, and hiring challenges. The Chicago-based federally qualified healthcare group has hired several new providers since the pandemic began in order to meet patient demand for mental health services. The move improves equity in access, especially since FQHCs patients typically struggle to fit such services into their schedules or travel to. Commuting into the city was previously a deterrent for some candidates, Boland has embraced a flexible, hybrid model that’s increased the talent pool. It’s also enhanced her team’s productivity scores; those scores measure the volume and impact of services. Boland also says that the 30 to 35 percent no-show rate for behavioral health services has been “greatly reduced” thanks to incorporating more virtual care options – in essence, generating a more sustainable business model.

At Esperanza and other clinics of all sizes and care models across the country, demand for pediatric mental health services especially is at an all-time high — and is likely to stay that way “for a long, long time,” says Dr. Jeff Drasnin. The owner of ESD Pediatric Group in Milford, Ohio, is addressing that need – along with associated medication checks for higher volumes of ADHD, anxiety and depression prescriptions – by assigning one physician per day to telehealth appointments only. “Probably 90 to 95 percent of that are mental health-related appointments,” Drasnin said. The practice typically fills all of its virtual appointment volume of 22 visits daily, he said.

ESD’s experience aligns with recent athenahealth research that finds pediatric patients are among the most severely affected by the pandemic. Among survey respondents with children, 39 percent said COVID-19 implications impacted their offspring’s mental health, including new and worsening conditions. Data also show that the youngest patients average the highest number of mental health visits.

Drasnin did say, however, that there was a bit of a silver lining in that his new practice model increases access and alleviates commuting and time management stress for parents. “Many of my families are driving 45 minutes for a 30-minute appointment, and then driving back home 45 minutes,” he said. With an average of just one appointment a week, that’s six hours saved driving a month. “For them to be able to click on a computer or their phone, and have that visit, to them it's gigantic, just from a convenience perspective,” Drasnin added.

Enhancing access not just geographically, but to specialties

At DTC Family Health in Colorado, Dr. Lynne Joffe embraced virtual care not only for the convenience factor for both patients and clinicians, but for geographic priorities, too. Facing record snowfall over the past few years precipitated her decision to hybridize the schedule – oftentimes pivoting last minute – to accommodate keeping appointment volume high when icy roads don’t cooperate. In New Mexico, healthcare deserts made the choice to expand access to myriad geographies simple, said Gruger. But the transition also allowed Gerald Champion Regional Medical Center to expand access to specialties. That’s all the more important given the predicted shortage of clinicians in concentrations such as pulmonology and orthopedics, according to the Association of American Medical Colleges.

Yet, specialties like orthopedics are among the least likely to expand service options by using telehealth, research shows. Setting out to enhance patient access and differentiate her practice were just two of the myriad reasons Watauga Orthopaedics CEO Kim Wishon-Marden led the charge to adopt technology like online self-scheduling and a new after-hours urgent virtual care model, she said. The results have “revolutionized” the practice.

“As a clinician, you can make a good judgment call through telemed of whether the patient needs to go to the emergency room, or can come into the office the next day,” Wishon-Marden explained. “If you have the reassurance that a fracture won’t get any worse and they can be seen during normal hours, then you’ve saved them eight hours of their time and $3,000 to $5,000 by having that telehealth consult instead of going to the E/R.”

There are financial benefits for practices, too, thanks to enhanced schedule density. Clinicians are more satisfied and diverse care modalities that increase patient satisfaction go a long way to enhancing physician recruitment and retention, said Wishon-Marden.

What’s possible when supply meets demand

Consumer research from McKinsey & Company finds that 12 percent of specialist visits in the U.S. were delivered via telehealth in 2021 – but as Watauga believes, that’s likely more a function of modalities offered by the specialists and not demand. The same McKinsey research finds that 40 percent of consumers plan to use telehealth going forward, which is 264 percent higher than early 2020.

Perhaps even more intriguing is consumer propensity (40 and 60 percent surveyed) to use a broader set of solutions, including “digital front door,” or low-cost virtual-first health plans. The willingness to change patient behavior and beliefs, as well as implementing and encouraging use of new care modalities at the practice level, are among the most important first steps toward revolutionizing business models that enhance access, financial performance, and convenience.

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