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Challenges and Opportunities in Virtual Care — Are You In?

In our recent Benchmark Survey Report, we examined some of the trends that are shaping how healthcare organizations are deploying virtual care solutions. We examined the opportunities that exist for new players to get into the game, as well as how those that are already playing can expand their offerings. We also dove into some of the challenges that are being felt throughout the industry – whether in the day-to-day management of currently deployed virtual care platforms or the challenges that are expected by those that have yet to launch any telemedicine services. One thing was clear from our survey however, as virtual care continues to advance, the opportunities that exist in the industry greatly outweigh the challenges.

We’ve Come a Long Way

The truth is virtual care is nowhere near where it was 10 years ago, or even just last year for that matter. For example, our Benchmark Survey indicates that while the industry still leans heavily on video – one of the more traditional modes of careModality Type Deployment, video alone isn’t sufficient to meet the changing needs of today’s patients and providers. Because of this, many are turning to multi-modal care, with 61% of health systems reporting they offer more than one mode of care today. Which of these is gaining the most momentum? Believe it or not, it’s chat, with 44% of health systems saying they expect to include chat in their virtual care launch.

As technology changes, the clinical impact that these platforms provide also improves. Our study shows that virtual care solutions have the power to impact both clinical quality and efficiency. Quality reporting has always been difficult for healthcare providers, but 33% of survey respondents say their technology provider offers a reporting and analytics solution and 30% say their technology provider offers scheduled or ad hoc reporting. At the same time, virtual care is enabling providers to shorten patient visits by as much as 15 minutes – from the current patient visit average which is approximately 16 minutes to between one and five minutes, as reported in our survey. I don’t know about you but the ability to make five or ten times the health impact is an amazing opportunity I would not want to miss out on!

Miles to Go Before We Sleep

As much as virtual care has evolved, there are still hurdles that we need to get over before we can realize the adoption rates that we seek. What’s fascinating however is that the actual challenges providers face in their day-to-day operations are different from those that respondents anticipate they’ll encounter, which include integration, patient utilization, and claim management. Diving into each of these a bit deeper:

  • Program ChallengesIntegration – EMR integration specifically, has long been a pain point for providers and our research shows that this is only growing as an important focus area as virtual care adoption moves into the mainstream. About 21% of survey respondents who have virtual care identify lack of EMR integration as a challenge, even though 42% say their service doesn’t integrate with the EMR at all. That’s in comparison to the fact that nearly 54% of our survey respondents expect EMR integration to be a major challenge.
  • Patient Utilization – There’s still a bit of a “Field of Dreams” assumption to virtual care, despite research from multiple sources, including a 2018 Deloitte study, showing slow adoption. If you don’t believe me, just look at the disparity in the number of respondents in our survey who identified patient utilization as a challenge. Only 31% of those without a virtual care solution, compared to 64% of those with a virtual care service already deployed.
  • Managing Claims – We also saw an under-realization of the challenges associated with managing claims and reimbursement. In fact, only 15% of respondents without a virtual care solution thought that this would be a top challenge, versus the 39% of those with virtual care services who acknowledged this obstacle. The truth is, the healthcare revenue cycle has many parts, making it difficult to manage. Increased integration of virtual care solutions with EMRs and other legacy systems are important and can help make your life a lot easier.

What Lies Ahead

As patients, providers and as those with a stake in the virtual care industry, we should feel encouraged by the opportunities we have at our fingertips. Our survey shows that nearly 100% of health systems expect utilization to increase in the next 12 months – and that’s great news for everyone! So where should we focus our efforts and what can we expect? Undoubtedly, there are many applications for virtual care, but there’s a growing desire for it to be used for more complex conditions, with a big focus on behavioral health. However, to realize this in an effective way, we need increased collaboration between the technology companies that are creating the virtual care solutions and the health systems that are deploying them.

Regardless, the fact that we’re seeing such confidence from health systems when it comes to expanding their virtual care offerings in the coming year, signals to us that the industry is ripe for incredible growth. And it’s about time! Virtual care has long suffered from slow adoption rates, brought on by patients who were hesitant about leaving their trusted physicians and providers who were weary of expected financial and technological barriers. But virtual care doesn’t have to be scary and as our survey shows, many organizations have skewed ideas about the challenges that actually exist in the industry. To overcome this perception, we must educate patients and providers about the opportunities associated with virtual care, while continuing to focus on improving the patient experience. Though technology vendors may provide the platform, I believe, it’s with health systems, who are in a unique position to confidently vouch for the integrity of virtual care, and effectively market the service to truly increase adoption expand access to quality health care.

Interested in learning more about the On-Demand Virtual Care Benchmark Report?

We called out our key business, technology, and clinical findings, discussed what they mean for virtual care in 2019, and hosted an open discussion about the research in our latest webinar: Top Virtual Care Trends for 2019.

Get my Webinar

HIMSS19: A Sunny Outlook for Virtual Care

Sunny Outlook for Virtual Care

Last week, myself and some of our Zipnosis team had the privilege of attending HIMSS19 in Orlando, Florida – a global conference bringing together over 45,000 health information and technology professionals, clinicians, executives and market suppliers. Due to the rapid changes in today’s current healthcare climate, this year’s event had a strong focus on innovative ways to improve the patient experience, monitor the patient journey and drive synergy across the industry. In the face of change, the brightest minds convened on ways to generate new efficiencies while improving levels of convenience, safety and accessibility across the healthcare continuum.

As innovation builds, policy changes and trends surface. Sometimes this can make the healthcare industry look cloudy at best. Below are three major takeaways from HIMMS19, giving way to a much sunnier forecast, especially when it comes to the evolution of virtual care:

Utilizing Data in a Turbulent Atmosphere

Often times, salient trends are a direct result of major legislation. Day 1 at HIMSS19, the Trump administration released its proposed interoperability and data blocking rules. It’s no coincidence that a major theme at the conference this year revolved around the idea of data-sharing and new technologies to support the free flow of data between patients and physicians. As data is integrated and utilized, it’s vital that it also be safe guarded.

Cybersecurity and the idea of securing actionable data was a prominent theme at HIMSS19. When it comes to virtual care, both the exchange and safety of patient data is key. We need to assure patients that their health data will be used responsibly, while also finding new ways to free data previously locked in silos to do our part to advance population health and provide more personalized care.

Making it a Breeze to Personalize the Patient Experience

Another major theme prevalent at HIMSS19 was the overarching idea of empowering patients to make more informed decisions about their health. What patients want today, is interactions that are as specific and personalized as possible, but also innately human. Ironically, humans alone often struggle to create the type of personalized experiences that patients today crave. As such, wearables and other devices were once again prevalent at this year at HIMSS, with many innovators demonstrating how these technologies are empowering patients to take control of health experiences.

Leaning on AI and innovation to continue to address complexities across the healthcare continuum is something we will continue to see more of as personalization becomes increasingly important. For virtual care, adaptive interviews are a game-changer: asking patients only the most relevant questions determined by demographic information and previous responses. Aside from the convenience of virtual care, patients also receive personalized and clinically impactful interactions that are synonymous with the typical doctor’s visit to keep that human touch alive and well.

Spotting the Reimbursement Rainbow

As strategies to engage patient populations change, it’s important to consider the impact of these programs on reimbursement models, which are shifting to accommodate the rise of virtual care. At HIMSS19, while various sessions focused on the power of technology to improve patient care outcomes, many also focused on helping providers execute on a future-forward vision. Improving payment accuracy and developing a reimbursement strategy that is supportive of new technologies is essential to changing the public perception of newer methodologies. Capturing reimbursements that prop up provider budgets as justified by the utilization of virtual care will be essential moving forward.

HIMSS19 made it quite apparent that the healthcare industry is changing rapidly to make patient/provider interactions more personable, streamlined, cost-effective and more efficient than ever before. In today’s digital age, it’s important to consider how our strategies and processes can be enhanced with innovation. While a storm of change is inevitable amidst intense innovation and policy modifications, like with every storm, once it’s over the sky and our future will become clear once again.

Want to Hug Your Health Data?

The other day, the Zip team attended the MSP Business Journal Healthcare Update Forum at the Hyatt Regency in downtown Minneapolis. It was a well assembled panel of MN healthcare leaders:

  • Dr. Kenneth Holmen, CEO of CentraCare Health
  • Barbara Joers, CEO of Gillette Children’s Specialty Healthcare
  • Philip Kaufman, CEO of UnitedHealthcare of Minnesota, North Dakota and South Dakota
  • Dr. Craig Samitt, CEO of Blue Cross and Blue Shield of Minnesota
  • Troy Simonson, CEO of Twin Cities Orthopedics

Early in the discussion, Philip Kaufman made a comment about how consumers need better health data to improve engagement/costs/etc.  

Data is important, but I was struck by how disconnected this sounded. Philip isn’t alone – many leaders in the healthcare space carry this perspective about the role of data in our lives. But after years of working with provider organizations, and knowing or being a patient, it just doesn’t feel applicable to most healthcare decisions.

Health Data for Comfort

I asked myself “when was the last time I used a white-paper or clinical trial data to make a healthcare decision?” Not once. Now, maybe when I need a heart transplant I would do research on the best options for me (like my uncle is doing now…), but much of it isn’t about the data. It’s about “where’s the best place?” or “who’s the best doctor for…”  

If you unpack this a bit, it’s really about emotions. Trust. Stopping the pain. Grappling with the sobering fragility and finiteness of our lives. Fear of the unknown. Human responses to uniquely human afflictions.

Candidly, I’ve never once run to my database or spreadsheet when I’m scared or hurting. I run to someone I love & trust. I hug my mom. I reach out for my wife. I turn to my friends.

Which gets at, what I believe, a perspective flaw in digital health experience design: data and logic over empathy and humanity. And I’m not leaving us out of the accountability pool. I, too, suffer(ed) from the same bias in designing Zipnosis as Philip suffers as he seeks a more engaged patient population.  

Empathy First

At Zipnosis, we’ve come a long way in terms of incorporating empathy into our platform, but today, I’m challenging us to go further. It’s time to take the reins and build experiences rather than technologies.

As we make product choices, we must ask ourselves what fundamental, human emotional need does it meet at that moment in the patient’s journey. It may not be elegant – but it will be effective.

When a customer (patient or provider) requests a feature, their reasons aren’t typically logical but emotional. A provider who needs to ask one more question has an underlying sense of duty to treat a patient as best as possible. A patient who wants to give context around their symptoms or health history wants to get the care they need.  

As our team works toward our vision of making Zipnosis the undisputed standard in virtual care, we must acknowledge that we won’t succeed unless and until we put human and emotional needs first.

As with many challenges in healthcare technology, there are no quick fixes here. But I believe that we – not just Zipnosis, but companies all across the healthcare space – have a duty to put patients’ needs first. That means  addressing their clinical concerns with quality and precision (hello, data!) and meeting their emotional needs with empathy and understanding.

‘Cause even the hottest data model in the world can’t hug it out with you.

Healthcare’s STD Infection Crisis – How Virtual Care Can Help

Last week, the Centers for Disease Control and Prevention announced that rates of chlamydia, gonorrhea and syphilis in the U.S. climbed for the fifth year in a row. The newly released data prompted a call for federal intervention at the 2018 STD Prevention Conference. This begs the question, how did we get here? And more importantly, what can we do about it?

STD Infection by the Numbers

In 2015, the American Sexual Health Association noted that rates of chlamydia, gonorrhea and syphilis reached a record high. And they’ve kept growing from there.

Preliminary CDC data from 2017 shows a 31% growth rate in diagnoses of these three common STDs since 2013. Individually, diagnosed cases of gonorrhea increased 67% and syphilis 76%. Chlamydia didn’t see quite the same rate of increase, but it remains the most common of these conditions with more than 1.7 million diagnosed cases in 2017.

Candy Hadsall, RN, MA, a prevention nurse specialist with the Minnesota Department of Health was at the conference and noted that the data wasn’t particularly surprising. “The CDC’s announcement that STD infection rates climbed again in 2017 just confirmed what we’re seeing in the field,” she said.

These numbers present a concerning – and initially, more than a little baffling – trend. After all, each of these infections is curable with appropriate antibiotic intervention, and the long-term effects of going untreated can be serious. So, why are infection rates continuing to grow?

The Root of the Problem

The factors influencing the increase in infections are complex and varied. A 2007 study in Sexually Transmitted Infections found an abundance of socio-demographic influences on infection rates, including race, income, gender, state of residence, age and history of incarceration. It also notes that attitudes toward sexual behavior and STD testing are prime factors in the diseases’ spread.

In the CDC’s recent announcement, Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention noted, “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

At its core, the STD infection crisis is driven by this combination of attitudinal, demographic, economic and healthcare infrastructure influences.

Virtual Care’s Role in Fighting STD Infection

One of the best ways to stem the tide of STD infection is by reducing access barriers to testing and treatment, and here is where virtual care shows its value. The ways that virtual care can help patients overcome common barriers to care like geography, time and cost is well-documented. When it comes to sensitive issues like sexually transmitted diseases, virtual care can help mitigate emotional barriers, as well.

In an interview with MedCity News, Geri Lynn Baumblatt (then of Emmi Solutions from Wolters Kluwer Health) noted that patients tend to “engage in impression management” when seeing their doctor. What that means is, they try to paint themselves in the best possible light – consciously or unconsciously – in an attempt to avoid judgement and shame. While Baumblatt was speaking specifically about addiction concerns, this concept translates to sexual behavior. A solution that doesn’t require a face-to-face discussion can often produce more honest answers about sexual behavior and STD risk.

Hadsall concurs that the feeling of anonymity could help patients overcome the shame and stigma associated with STD infection. She also notes that adequate resources are a challenge in STD screening. “It’s just not possible to effectively screen everyone who should be screened,” she said. “Even at very high infectivity rates of 10-15%, that’s still 85-90 out of 100 people who are screened and test negative. With an online screening option, we could do a lot more and potentially make a real dent in STD infections.”

A Virtual Solution

Image: Stop STD Infection

Understanding the value of lowering barriers to STD testing and treatment, we developed evidence based protocols to support health systems as they work to manage steeply climbing STD rates for their patient populations. Our expedited partner therapy protocol enables patients whose partner has been diagnosed with chlamydia to get treatment. As the most commonly diagnosed STD across the country, and the one that is most frequently asymptomatic, this facilitates quick, discreet care for patients – without even requiring a test. By lowering barriers to receiving care for known chlamydia exposure, health systems can help reduce the continued spread of chlamydia.

We also recently created an evidence-based virtual care STD testing protocol that gathers risk assessment data and enables patients to access lab tests for chlamydia, gonorrhea and syphilis. This protocol leverages lab integration workflows to capture patient information and seamlessly route them to a lab location for testing. Our aim is to help health systems use the asynchronous patient interview to overcome the embarrassment patients feel talking about STDs, potentially increasing the likelihood of individuals to seek testing.

The continued rise of STD infections is a complex issue, impacted by everything from socio-cultural norms to poverty rates and education to healthcare access. It may feel overwhelming, but looking at individual pieces can still make a sizable impact. There are many factors virtual care can’t impact. What we can do is help take the strain off of the systems currently unable to manage this growing health crisis and lowering barriers to STD testing and treatment.

Virtual Care and the Quadruple Aim

It’s no secret the healthcare industry is facing some challenges. Factors like patient access, achieving consistent health outcomes across populations, rising healthcare costs, and growing physician burnout are causing healthcare organizations to strategize around how to make healthcare in the U.S. more effective. These challenges form the foundation of the quadruple aim – a set of goals designed to usher in positive change in the healthcare landscape.

Achieving the Quadruple Aim

Significant improvements in these areas will necessarily be facilitated through the use of technology. Virtual care, sometimes called telemedicine, can help health systems support improvements in each of these key areas.

There are two distinct modes of virtual care: Synchronous, including phone and video, and asynchronous or “store-and-forward” like Zipnosis’ online adaptive interview. An asynchronous solution collects and organizes patient-provided health history and symptom information, enabling providers to access it at a later time. Providers then make a diagnosis and develop a recommended treatment plan, which is sent back to the patient. Asynchronous technology, specifically, is instrumental to achieving the quadruple aim due to its inherent efficiency.

So, how exactly does virtual care impact the quadruple aim? Let’s take a look:

Aim: Improve Patient Access

Access to care is a growing concern in the healthcare industry. With the passage of the Affordable Care Act in 2008, millions of people have insurance coverage. But this isn’t enough. Access is more than insurance; it’s the ability to receive care when and how a patient needs it. And that remains a challenge today.

Merritt Hawkins’ 2017 Survey of Physician Appointment Wait Times found that in the U.S., the average wait time for a new patient appointment is 24.1 days – a 30 percent increase since 2014. This can be explained in part by the growing gap between the number of practicing physicians and the population for which they care. According to the Association of American Medical Colleges, there is a current shortfall of between 14,000 and 25,000 physicians across all disciplines. They further project a shortage of up to 100,000 physicians by the year 2030. Access is a particular challenge in rural areas, where hospitals have been closing at a rate of one per month since 2010.

Virtual care helps address the challenge of patient access by breaking down the geographic barriers between physicians and patients. Using a virtual care service, a patient that lives hours from the nearest clinic or hospital can receive care without having to worry about the drive. A study by the UC Davis School of Medicine found that by receiving care online, patients avoided driving millions of miles. What’s more, a virtual care solution that offers asynchronous care is available on-demand, meaning that patients can access care in a time that works for them, rather than having to schedule an appointment. This care delivery model also helps physicians to unlock marginal capacity, enabling them to safely and effectively diagnose and treat more patients than with in-person or video visits.

Aim: Improve Health Outcomes

Often viewed through the lens of population health, achieving consistent health outcomes has become increasingly challenging in the face of growing care fragmentation. Instead of offering a solution, direct-to-consumer telemedicine companies who deliver care outside the continuum only exacerbate the fragmented care environment. Conversely, virtual care delivered by a health system offers the same patient benefits while facilitating effective coordination of care and supporting consistent patient record documentation.

Achieving consistent health outcomes requires consistency in care delivery. This is another area where virtual care can offer a solution. By developing protocols for care on a foundation of national best practices and incorporating organic clinical decision support in the form of diagnosis and treatment pathways, virtual care can support consistent, guideline-adherent care. And because an asynchronous model captures a large volume of structured data, virtual care can help health systems measure things like guideline adherence and antibiotic stewardship.

Aim: Lower Overall Healthcare Spend

It’s impossible to have a complete conversation about healthcare in the U.S. without discussing the continued growth of healthcare spend. According to the Centers for Medicare and Medicaid Services (CMS), U.S. healthcare spending reached $3.2 trillion in 2015, accounting for approximately 18 percent of the country’s Gross Domestic Product. CMS data shows that between 2010 and 2015, the average annual growth in national health expenditures was 4.3 percent, more than double inflation.

The costs of healthcare are born in varying degrees by insurance companies, employers, health systems and healthcare providers, individuals, and the taxpaying public. One trend in healthcare is the assumption of greater risk by both individuals and health systems, through high deductible health plans and value-based care, respectively.

Virtual care holds the potential to curtail healthcare spending on a broad scale. While research needs to be done to verify the impacts on various parties, early indicators are that virtual care offers both patients and health systems a means of delivering and receiving care at a lower cost than in-person care. Moreover, virtual care has the potential to reduce emergency department usage by siphoning off those seeking convenience for non-emergency care and by treating conditions early that may could become emergencies if not treated.

Virtual care is also expanding outside of the realm of urgent/ambulatory care to support longitudinal needs such as post-operative care or chronic condition management. This means that a future state could see the cost savings from virtual care – to patients, health systems, and payors – grow exponentially.

Aim: Reduce Physician Burnout/Improve Physician Engagement

Simply put, the healthcare industry – in any country, under any circumstances – does not function without healthcare providers. And providers are becoming burned out in record numbers. In fact, this is a top factor contributing to the growing physician shortage mentioned above. One of the key reasons cited for physician burnout is the increased clerical burden physicians are undertaking.

Virtual care, particularly the asynchronous model, significantly reduces clerical burden by aggregating patient-generated symptom information and inputting it directly into the EMR through advanced integration capabilities. As a result, virtual care enables physicians to focus on practicing medicine rather than documentation. Further, routing routine health concerns to the virtual care platform enables physicians to focus on more complex health concerns, putting their energy to the patients who really need their expertise.

Healthcare Going Forward

As we work to improve healthcare for health systems, physicians, and most importantly, patients, it is vital that we look to new technologies like virtual care to help achieve those ends. Virtual care offers clear solutions to help the healthcare industry achieve each element of the quadruple aim. And that bodes well for all of us.

 

About the Author

Dr. William Riley is a Professor in the School for the Science of Health Care Delivery at Arizona State University, where he teaches process engineering, health finance, and health care quality and safety design. He previously served as the Associate Dean for the School of Public Health at the University of Minnesota.

To his present role in academics, Dr. Riley brings 25 years of senior executive experience in health care organizations, including serving as President and CEO of Pacific Medical Center in Seattle, Washington; CEO of Aspen Medical Group in St. Paul, Minnesota; Senior Vice President at Blue Cross Blue Shield of Minnesota in St. Paul; and Senior Vice President of St. Paul-Ramsey Medical Center/Ramsey Clinic.

Dr. Riley’s research areas include quality improvement and patient safety, with several nationwide and international projects currently underway. He is the author of more than 60 articles related to quality management, patient safety and health care management, and has co-authored two books on performance improvement in health care.

A past chair of the Public Health Accreditation Board, Dr. Riley serves on several boards, including the Fairview Physicians Associates (FPA), an affiliate of Fairview Health Systems. He received his PhD from the University of Minnesota School of Public Health.

What’s in a Name? Online Healthcare Terminology and Why it Matters

We are at a critical inflection point in healthcare delivery. This inflection point is front and center for online healthcare as traditional telemedicine evolves into virtual care. It is important that the industry adopts the right vernacular to define and capture the shift, just a biology has allowed us to classify species and their evolution. To that end, I propose we clarify and define the terms we use to describe the new online care delivery models. Specifically, “telemedicine” and “virtual care.”

Over the past couple months, I’ve shared some thoughts on how telemedicine and virtual care differ. To recap:

Telemedicine = Testing; Virtual Care = Viable

For nearly 70 years, we have been testing with telemedicine. They have been vital tests of technology, payment models, clinical quality, patient satisfaction and all the bits and pieces between each of those components.

Telemedicine = Analog; Virtual Care = Digital

Telemedicine was developed when cathode ray tubes were en vogue. Telemedicine providers are not technology companies, but service companies that use technology to assist with care delivery. It’s a model that fits the pants healthcare has worn for the past 70 years, but is woefully ill-fitting for the new models.

Virtual Care has digital DNA. These companies are technology providers who facilitate care delivery on their platforms. They assume healthcare is going to be dominated by data and devices.

Telemedicine = Transactions; Virtual Care = Value

Telemedicine is all about handling healthcare transactions for a fee. Each time the phone rings or the video conference queues up, a charge is initiated. Telemedicine is anchored in fee-for-service payment models.

Virtual Care is required for value-based care payment models. These companies push the transactional cost of care as close to $0.00 as possible while unlocking new value streams off their platforms and data.

What about other terms like mHealth, connected care, digital medicine or digital health? I won’t spend much time here digesting, but I throw out my gut reaction:

mHealth: The “m” already feels like shag carpet. It was cool for a moment but no body wants to live with it.

Connected Care: It sounds like horse without a hitching post. What are we connecting to – proprietary data sets companies may not want to share? Facebook? Instagram? The Apple Watch only the affluent can afford?

Digital Medicine: It sounds antiseptic; cold, clinical and focused on data not care.

Digital Health: I actually kind of like this one, but it feels a little too broad for our purposes. In my mind digital health encompasses all the electronic tools that patients and providers use to facilitate care and wellness.

So, there you have it. My 12 cents on how and why we need to segment the market between virtual care and telemedicine. It’s time turn our eyes to the next 20 years, thank the telemedicine times and venture towards virtual care.

The Digital Healthcare Revenue Question: Are You Blockbuster or Netflix?

When people ask me my Big Hairy Audacious Goal (BHAG) for Zipnosis, I reply: “To make the transactional cost of healthcare $0.00.” The looks I get range from quizzical to quizzical and concerned. After all, people are used to the current payment model and don’t see how Zipnosis will be able to stay in business without transactional revenue. Of course, this isn’t going to happen overnight – but the healthcare of the future is going to be paid for differently than it is today.

Remember, for a minute, Blockbuster – the prime example of a company on the wrong side of the payment and technology equation. In the Blockbuster era, renting a movie was transactional. You went to the video store, chose your movies, and paid at the counter. Until there was Netflix. Even before the advent of streaming, Netflix erased the transaction from renting movies. By selling movie rentals on a monthly subscription model, they broke the transactional payment mold and helped seal Blockbuster’s fate. The same is occurring, albeit more slowly, in healthcare.

For me, this is the most important change in the industry today – not the technology we’re developing, but the ability to help shift the pricing and reimbursement discussion away from fee-for-service and closer to value-based care delivery. And that’s really the difference between the current state (telemedicine) and the future state (virtual care) – the shift from transactions to value. This shows up in two key ways: technology and payment structure.

Transactions vs. Value: Technology

The healthcare industry has been testing out uses for Telemedicine Patient and Clinician on Tablettelemedicine for ages because it is familiar. Telemedicine feels close to our current health system/experience: I sit in front of a computer or on a phone and talk to a healthcare provider instead of in a clinic. The only difference is my location. Telemedicine technology, like video queues, call centers, and nurse line systems, have been architected to support this 1-to-1, transactional experience.

But the analog technology telemedicine brings can only scale so far. Just like video stores could only serve so many people, telemedicine has an upper utilization limit. If as an industry and society, we are truly committed to increasing access to care, telemedicine technology becomes a wall at which the number of visits will exceed the infrastructure’s ability to manage them.

The future is more on the Netflix model, where technology and workflow enable significantly higher volume than previously imagined. Another company that successfully harnesses technology to facilitate an unbelievable number of transactions is Amazon. Instead of building a massive call center to meet the needs of their shoppers, Amazon invested in a technology platform that can and does handle far more transactions than humanly possible. There literally are not enough people on the planet to process the transactions Amazon processes.

Similar to both Amazon and Netflix, for healthcare to move beyond transactions, it must adopt new technology platforms – like virtual care. Virtual care is designed to handle a stream of data from many devices and sources. If we want to even contemplate continuous monitoring or predictive care models, we must not just transform the back-end “big data” warehouses, but the last mile of care delivery so its actually available to patients and clinicians. To put a fine point on it, analog telemedicine technology cannot meet this need but digital virtual care platforms do.

Transactions vs. Value: Payment

The transition from fee-for-service to value-based-care is happening in very quantified ways using bundled payments. This is akin to a shift from the Blockbuster model of renting a video – if you want 10 videos you pay $5/video or $50 – to Netflix, where you’re paying a set fee and can consume as much content as you’d like. Netflix can do this because their transactional cost is effectively $0 for you to view the content – even back in the DVD subscription days.

This is where the technology and the payment intersect. You cannot have a scalable value-based care payment system using transactional telemedicine technology. Conversely, transactional fee models are not fit for most virtual care platforms; it’s like asking Netflix to charge you each time you watch The Unbreakable Kimmy Schmidt. They can’t, and why would you?

The Future of Healthcare Revenue

Which brings me back to my BHAG for Zipnosis: driving a $0.00 transactional cost for healthcare. It’s terrifying for a Blockbuster-type payment model, but manna from heaven in a value-based world. It also creates a juicy chicken and egg problem. Do the technology platforms need to be in place before the economics? Or vice versa?

Both value-based care and virtual care technology are here and growing, but I think consumer choice will be what creates the tipping point in the industry. Our research shows that most patients don’t want video visits, and we know that transactional, video-based solutions aren’t the standard of convenience in any other industry. It’s simply not the way the rest of the digital economy works.

The good news is that health systems who have a line of sight into value-based care and are bold enough to install virtual care platforms will be the Netflixes and Amazons of healthcare’s digital age.

Telemedicine Transactions Virtual Care Value
Cost: Pay per visit – high transactional costs Cost: $0.00 transactional cost – pay for value
Back End: Human processing Back End: Platform (technology) processing
Reimbursement Model: Fee-for-service payment Reimbursement Model: Value-based care models
Volume Impact: Value is in single-purpose use Volume Impact: Scalable to meet demand

Transforming Care in the Digital Age

Zipnosis Chief Clinical Officer Kevin Smith’s most recent article for Health IT Outcomes discusses how virtual care can make an impact on care quality. Responding to a study published in JAMA Ophthalmology, he notes that virtual care can help more effectively capture patient-reported symptom information and ensure EHR records are accurate. Read more.

So, How Does Virtual Care Fit into Your Digital Health Strategy?

No one will be shocked to hear that technology is driving the future of care delivery or that staying  current with healthcare technology is increasingly vital to organizational success. But you may be surprised at the role virtual care can play in your digital health strategy.

The Digital Health Ecosystem

Being successful in this brave, new, technology-fueled world means building a digital health ecosystem. Like an ecosystem in the natural world, all components should come together to create a seamless whole. Your digital ecosystem needs to support the overall goals of your healthcare organization, including enhanced patient access, continuity of care through EMR integration, simplifying billing and claims processes, easy patient visit scheduling, and superior patient experience through portal integration.

Having a clear digital health strategy that outlines the technologies you will employ and how they will work in concert to support the continuum of care is critical. It’s easy for health systems to become so focused the individual technology solutions, they can’t see the (digital) forest for the (virtual) trees. Without that strategy, they may not realize there’s a virtual care-shaped hole in their digital health ecosystem.

Virtual Care: The Missing Puzzle Piece

It seems myopic from today’s perspective, but virtual care was traditionally viewed as a siloed point on the care continuum. In the digital age, virtual care is a delivery channel that supports a large breadth of services – from low-acuity conditions to more complex services such as chronic care management, and from primary to specialty care.

Even better, virtual care complements other elements of the digital health ecosystem, making it stronger and more unified. Paired with ePrescribing, virtual care fosters convenient, complete treatment of a variety conditions. It can be used alongside traditional telemedicine video visits to reach more of your patient base. And, virtual care gets both patients and providers comfortable with online care, making it easier to accept digital health technology in higher-acuity situations.

Your Digital Health Strategy

Health systems need to keep pace with changing consumer needs and the shifting demands of the dynamic healthcare industry. According to research firm Gartner, 40% of primary care visits will be virtual by 2018. With direct-to-consumer telemedicine companies vying for patients and growing numbers of health systems launching virtual care solutions to meet growing patient demand, virtual care is a vital piece to your health system’s success and your overall digital health strategy. Are you ready?

Solving the Patient Engagement Puzzle with Virtual Care

Patient engagement is becoming increasingly important, and virtual care offers health systems a solution to meet patient needs while fitting healthcare into their lives. Kevin Smith, Zipnosis’ Chief Clinical Officer and innovative healthcare pioneer, discusses how virtual care can help health systems better engage with patients to boos patient retention and minimize patient leakage.

Beyond telemedicine: When was the last time you placed an Amazon.com order by phone or video?

Value-based care is driving the evolution from traditional telemedicine models to virtual healthcare

Say the word telemedicine, and most people think of patient encounters that start with live, direct-to-video or phone visits between patient and provider. However, with value-based care driving new reimbursement models, quality, efficiency and cost are more important than ever. As a result, the market is rapidly moving away from traditional telemedicine and embracing virtual healthcare—a more modern, innovative approach that connects the online experience with the brick-and-mortar and benefits health systems, providers and patients.

The digital delivery of modern virtual healthcare, done correctly, uses structured data in the form of online, adaptive interviews to guide patients through their healthcare encounters. Providers, following evidence-based pathways, leverage this structured data to create an online diagnosis and treatment plan with high rates of clinical guideline adherence. While these encounters always include online, adaptive interviews as their foundation, they allow for appropriate escalation of care, including supplemental photos, videos and/or phone calls (ONLY when needed)—and/or referrals for in-person care.

You Say Access, I Say Convenience

The big argument for telemedicine is that it will improve access to care. But is access what consumers really want?

If providers think about telemedicine as just another channel for giving patients access to their services, they’re missing the bigger picture. When it comes to meeting consumer expectations, traditional health systems and physician clinics aren’t competing against other providers, they’re actually battling Amazon, StubHub, Netflix and every other service that customers already love and rely on.

Amazon just launched “Amazon Prime Now” in the Twin Cities where I live. Do I need day-or-night two-hour delivery for household items and groceries? Probably not, but the convenience blows my mind. I had a similar feeling when I discovered recently that I can use an app to feed my parking meter by our downtown Minneapolis office. Whether it’s the ability to binge-watch entire seasons of TV shows on Netflix or listen to almost any album ever recorded on Spotify, consumers are now primed for (nearly) instant gratification.

Healthcare still operates under a different set of expectations. Patients are viewed as a fixed population with few options for seeking care. Telemedicine and other virtual technologies theoretically expand those options. Coming from a traditional system in which access is tightly controlled, many providers I meet still see new technologies like telemedicine or virtual care either as a threat to their existing delivery model or a cumbersome add-on. I argue that they should view consumer-facing technology platforms as an opportunity to access patients in ways that those patients already expect in other areas of their lives and will increasingly demand from healthcare, too.

Here are three benefits healthcare providers can realize when they leverage a workable telemedicine strategy to do a better job providing patients with service they will value.

  1. Add new patients

If you ask people what telemedicine looks like, they describe a patient sitting in front of a computer screen talking to a doctor. When’s the last time you ordered anything on Amazon that way? Never. We do it by app when the need arises.

What would that sort of convenience look like in healthcare? It may be hokey but I picture a parent in his or her minivan initiating a doctor visit for the kids while waiting for them to finish some after-school activity.

Telemedicine strategies that force patients and doctors to meet through a screen are awkward interruptions of our lives. But if you can devise a system where patients can initiate a visit by app, and then direct them to a physical healthcare location, e-visit, or virtual diagnosis as needed, you’re helping them manage their care conveniently like they manage every other aspect of their lives.

In our data, we’ve observed that over 50 percent of patients who use this sort of approach are new to that particular health system or provider network. In other words, technologically savvy patients are migrating to convenient access points. And once they’re hooked on that ease, they tend to rely on that healthcare provider for the plurality of their care.

  1. Provide care in the right place at the right time

As value becomes a priority over volume, providers are being forced to develop strategies to steer patients away from higher cost locations like urgent care or primary care facilities. We’ve noticed that around 60 percent of patients who use virtual care services would have gone to urgent care or primary care facilities instead if they hadn’t had a virtual option.

Employers love virtual care because their employees can receive care when and where they need it without undue expense or disruption to their work lives. Patients love it because it puts an end to the age-old waiting room question, “Why am I here?” We’ve all experienced the frustration of sitting endlessly in a waiting room for a diagnosis or course of treatment when we already know exactly what we need.

And physicians appreciate the opportunity to have meaningful visits for challenging problems rather than cramming their day with patients who could be treated faster and easier elsewhere.

  1. Avoid “stealage”

The big retailers and pharmacy chains are making a major competitive push for the patients of traditional health systems and provider networks, and they have some big advantages on their side. They already understand customers well and are used to delivering compelling value. What’s more, nearly everyone in the country lives only a few miles from a Walgreens, CVS, or Walmart making it very convenient to shift toward those pharmacists and walk-in clinics.

Providers can combat those advantages if they move quickly. Patients still see health systems and traditional physician clinics as the best source for care. If you counter the convenience factor with a robust virtual care strategy rather than just building e-visits into an EMR, you can retain or recapture patients otherwise inclined to stray. Patients would still prefer to meet the totality of their needs in one system.

The future is fast upon us

Consumers and clinicians expect technology to make things easier and faster. Healthcare is lagging in providing people what they need and want when it comes to convenience, ease and value, not because the technology isn’t there but because managing change is hard. Yes, traditional processes and payment models are burdensome legacies to fight through but customers and clinicians are going to gravitate quickly to better options. You really have a limited time to figure out the right strategy to keep them happy and committed. Start by thinking like a consumer and find partnerships and services to build the capabilities you need.

Maintaining Quality in Healthcare Continuum

Imagine having the equivalent of a clinic in your pocket without the concern that the quality of care would be less than you want or deserve. When done well, virtual care can improve access, decrease cost, and save time without sacrificing quality and continuity of care.

As the market becomes crowded with organizations offering various iterations of telemedicine, healthcare organizations must consider several key factors to determine whether a particular offering is right for the organization. For instance, will clinicians within your network field the inquiries of your patients or will they be handled by clinicians outside the network? Another key factor is whether you will have the ability to integrate information about a patient’s visit into your electronic health records (EHR) system – a key element for providers who strive to utilize all information about a patient in their encounters.

Through its virtual care solution, Zipnosis patients receive treatment for minor medical conditions quickly and safely from healthcare providers within their own network. Patients are treated using its pioneering software-guided online interview that mimics the questions physicians would ask in a clinic. An in-network clinician reviews the interview and either offers a treatment protocol, triages the patient into a phone or video encounter or directs them to visit a clinic.

The entire process is grounded in evidence-based medicine and complies with national best-practice guidelines. If at any point the patient provides information indicating a serious illness, Zipnosis will determine that virtual care is not appropriate and direct the patient to the most appropriate level of care. For example, if a patient believes she/he has a sinus infection and also indicates a fever of 103, the Zipnosis platform will stop the virtual visit and recommend an appropriate in-person site, such as the health system’s urgent care clinic.

With its white-labeled, fully integrated virtual care platform, Zipnosis also offers the technology that will enable you to seamlessly integrate patient visits into your EHR.

Virtual care, if designed to fit not only into the slipstream of your patient’s life, but also into the continuum of care your organization strives to provide, can make clinical care more convenient while maintaining quality – one patient at a time.

The Future of Telemedicine Will Be Different Than You Think

Like jetpacks and flying cars, telemedicine has been part of our collective vision of the future for a long time. Has that future finally arrived?

I haven’t seen any cars flying by lately, but I did gaze heavenward in July when Teladoc achieved a dreamy billion dollar IPO. While that kind of market validation is reassuring for those of us working to transform healthcare delivery, I can’t help but wonder whether investors and the media are buying into a vision of the future that won’t quite match reality.

Why am I skeptical? Because when it comes to telemedicine – unlike flying cars and jetpacks – it’s not technology holding us back. The barriers are economic. Can telemedicine make it easier for patients to get treatment and also provide a sustainable economic benefit to providers?

Telemedicine’s Jobs-To-Be-Done

Telemedicine has been available since the early days of the space program. 60 years ago NASA could diagnose and treat astronauts on space flights via video consultation. Today, video is available on any smartphone or computer, people are starting to record their personal biometric data obsessively, and connectivity is ubiquitous, so it would seem that any remaining barriers to telemedicine have finally been eliminated. Then why are we not using video en masse for diagnosis and treatment?

The simple answer is that it’s still not convenient for patients or economical for providers.  Unfortunately, few of those heralding the next great advance in healthcare delivery take the time to really pencil out the ROI and the value add. We’re so infatuated with sexy video screens and the novelty of telemedicine, we gloss over the cold, hard facts.    

Where’s the Volume?

So let’s run the numbers.

The going price for a video consultation with a clinician runs about $40 to $50. From the consumer’s or payer’s perspective, this price is outstanding since emergency visits cost about $500 and a trip to urgent care runs about $250. Most of those visits are for minor ailments treatable by any primary care doctor or nurse practitioner. That’s why, if telemedicine was widely adopted, estimates of system-wide cost savings run as much as $25 billion.

Cost containment, however, does not a healthy market make. There’s a flip side to any exchange. Is it financially worthwhile for clinicians to perform primary care visits via video, and does the revenue model work for telemedicine businesses?

The short answer is no. Currently, most clinicians doing video visits handle about 100 to 500 a year, and the overall volume in the market is insufficient to keep clinicians working at their capacity, let alone earning the pay they would otherwise make through in-person consultations.

That reality is reflected in Teladoc’s IPO filing. A billion dollars in market capitalization notwithstanding, Teladoc’s expected revenues for the year are only around $74 million while costs are rising faster than revenue and the projected volume of customers will not make up the difference.

Although expectations around margins and profitability are generally different for emerging technology businesses, healthcare is in the throes of wrenching change to its business model. It’s unlikely that clinicians will embrace an approach that earns them even less money than they make now. It’s also hard to imagine outsourced telemedicine services like Teladoc, MDLive, American Well or Doctor-on-Demand driving growth that way, or investors continuing to back such ventures given the immense investments in marketing and infrastructure.

The Social Side of Telemedicine

Economics aside, there’s also an engagement factor to consider. Will consumers and clinicians find reasons to be drawn to telemedicine?

There’s no doubt that patients are more willing to engage with clinicians by video than they were a few years ago. Every busy parent I know likes the idea of avoiding the doctor for simple care. However, actually using video during the course of a normal hectic day is a barrier. Imagine trying to do a video call while juggling sick kids or sitting in your car. Now compare that to the ease with which you can order an Uber car or buy something on Amazon. In other industries, no thriving mobile service relies on video to conduct transactions.

And what about clinicians? Personally, I can’t imagine one 15 minute visit every four days or so providing enough activity to keep even an easy-going semi-retired healthcare professional content.

In my experience, physicians and nurse practitioners want to actively practice medicine and help patients. Their job satisfaction already wanes from struggling with crushing paperwork and cumbersome EMR data entry. Sitting in front of a row of video screens waiting for one or two visits a week would only exacerbate their dissatisfaction. Clinician satisfaction and engagement is key to any successful delivery model. Unhappy, under-paid clinicians are an anathema for change in healthcare.

The Search for a Better Answer

Instead of gazing heavenward, waiting for flying cars, let’s ground ourselves in solid economics and an understanding of what healthcare consumers and providers need to make telemedicine work.

In the next few blog posts, I want to show you how a new model for telemedicine, rooted in evidence-based care, is proving its ROI with health systems across the country. In the vision I’m going to lay out, patients get access to cost-effective, quality care in the right setting, providers are fully engaged within their workflow, and health systems get a boost to their bottom line and their market share. In the process, telemedicine starts to look a lot less like science fiction and more like another valuable convenience in our connected world.

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