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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.

Back to School – Virtual Care Education for Students, Residents and Practitioners

Back to school supplies

As a new school year approaches, students will be gearing up to begin (or continue) studying medicine. This is an exciting time for them. No matter how great their institution, and no matter how dedicated their studies, there is still one thing missing from their schooling: virtual care education.

Dr. Ide’s Experience
As a mentor through the Yale School of Medicine alumni program, I recently showed the Zipnosis platform to my mentee. She was impressed by the technology and underlying clinical integrity (a big pat on the back is due to our engineering and clinical teams). What I primarily took away from the conversation was that she had not been exposed to any form of telemedicine or virtual care as part of her studies. As technology becomes a more integral part of care delivery, I believe it’s a disservice to medical students not to expose them to these care delivery channels.

It’s not just students that are feeling the lack of training in telemedicine and virtual care. Active healthcare practitioners also need access to training on how to be effective delivering care online. A study by the AAFP’s Graham Center found that education was one of the top two barriers to physicians using virtual care technology in their practice.

Virtual care – whether video, chat, store-and-forward or some other modality we haven’t even dreamed of yet – is an increasingly important element in care delivery. And, this trend is only going to continue. That means this gap in education and training needs to be closed.

Closing the Virtual Care Education Gap

Back in 2016, the AMA announced their backing for undergraduate and graduate students to be trained on how to use telemedicine. More recently, our chief medical information officer Kevin Smith was involved in developing a telemedicine accreditation program through the Clear Health Quality Institute.

College student studying

Both these things are steps in the right direction, but we believe it needs to go further. What we need is a comprehensive, standardized curriculum around online care delivery. Dr. Kevin Fickenscher of CREO Strategic Solutions agrees, stating, “There is a need to define the core curriculum for training clinicians at all levels in the appropriate use of tele-technologies to support effective care delivery. Simply placing clinicians into telehealth environments without sufficient training is akin to having radiologists use MRI scanners or surgeons using robotics without requiring training. And, the training is not just about the technology. It’s also about the way we communicate, how patients respond, the use of informatics, the use of social media and a whole array of considerations which are important for educating the health care virtualist.”

While it’s crucial the standard of care remains the same regardless of care delivery channel, setting clear standards around virtual care is vital to ensuring it is safe and effective. These standards will also increase providers’ comfort with delivering care online and give patients a more consistent experience.

What About Medical Virtualists?

One idea around how to train healthcare providers on using virtual care technologies is the concept of a “medical virtualist” specialty. This idea sprang from an opinion piece in JAMA last November. Shortly after it came out, we published a rebuttal. The long and short of our stance on the idea is that every provider will need to be able to deliver care via virtual care / telemedicine technology in the future.

Likewise, Dr. Fickenscher rebutted the original opinion piece, calling for a virtualist training of all clinicians working in telecare environments in a post on the Health Affairs blog. He noted that while a virtualist specialty will likely be worthwhile in the longer term, “basic virtualist knowledge will become a requirement for all practitioners.”

In our opinion, focusing on a new specialty at this point could leave a large portion of providers without the tools or knowledge they need. Right now, we need to find ways to effectively train everyone—from pre-med students to practicing providers—on virtual care delivery, rather than building out the infrastructure needed for an entirely new specialty.

What’s Next for Virtual Care Education?

No one can fully see the future, but the demand for virtual care education is increasing. That means schools – both undergrad and graduate, health systems, virtual care companies and other stakeholders need to collaborate on developing channels and standards for virtual care education.

Leading the Charge in Virtual Care Education
One of the first distributed or virtual universities in the nation is Fielding Graduate University, established in 1973 as a not-for-profit university focused on graduate education. Fielding has taken up the challenge of developing a “Health Care Virtualist Certificate” program focused on training health care professionals who will be working in virtual environments. The unique character of the program is that Fielding is bringing together the leadership and expertise of a number of schools by forming an educational collaborative of like-minded universities. These schools intend to work together to form a unified curriculum and training program in virtual health. Each school’s unique expertise will create a composite program to provide a premier educational experience for clinicians. To date, the University of North Dakota, noted for its expertise in rural health, and the Regenstrief Institute, an internationally known informatics program, are participating with Fielding in the collaborative. It is anticipated that a certificate program will be available for enrollment in early 2019, with the intent to offer a Masters level program in the near future and a doctorate program over the longer term.

We’re very excited about what the future holds for virtual care, and how we can help encourage and support educating both this and the next generation of healthcare providers on the uses and benefits of virtual care. We’ve shared some of our thoughts on why virtual care education is important. Next time around, we’ll offer up more specifics on the things we think are important for all providers to learn about providing care online.

Winter is Coming: Prepare for Cold and Flu with Virtual Care

For most people, the end of summer is characterized by back to school ads, discounted swimwear and the promise of crisp autumn air. In healthcare, it’s more than stacks of new notebooks – it’s time to plan for managing cold and flu season.

Cold and flu season can strike anywhereEach year, health systems and providers brace themselves for an onslaught of stuffy noses, hacking coughs and spiking fevers. And this year, as staffing plans are made and vaccine doses ordered, the question on everyone’s minds will be, “What do we do if we see a repeat of last year?”

If you work in healthcare (and unless you were, say, living off the grid in the Alaskan tundra last winter) a repeat of the 2017-2018 flu season likely strikes fear—or at least concern—into your heart. While not as terrifying as the white walkers in Game of Thrones, the onset of cold and flu season requires similar preparation to withstand a viral invasion. So, how can health systems deal with the visit volumes, the potential for infection to spread in waiting rooms, and overwhelmed clinic staff?

Virtual Care Can Help

Having a virtual care service in place can help mitigate some of the challenges that are part and parcel with cold and flu season. It’s not the only answer, certainly, but virtual care adds real value where it counts.

Support Vaccination

“An ounce of prevention is worth a pound of cure,” as the saying goes. It’s no secret that the best way to reduce influenza cases is vaccination, and health systems often have well-developed strategies for promoting annual influenza vaccination. A virtual care service can add value by creating an additional channel for patient communication.

Providers can remind patients to get their flu shots during video visits. Health systems can include a note about getting vaccinated in patient education materials. And, Zipnosis customers can use their virtual care platform to incorporate flu shot reminders into their virtual visit (a feature successfully deployed during last summer’s measles outbreak in Minnesota).

Manage Provider Time

Here’s where virtual care really shines. A store-and-forward / asynchronous virtual care model enables providers to diagnose and treat patients in a fraction of the time as an in-person visit, as noted by our VP of Customer Success, Catherine Murphy, a couple weeks ago.

In a look at data from six customers over the course of last flu season (October 1, 2017 to March 31, 2018), the average provider work time per asynchronous virtual visit was just shy of 2 minutes and maintained high quality standards. During that time, these six customers completed close to 12,000 visits, amounting to less than 340 provider hours. For comparison, 12,000 in-person visits at 15 minutes each would total about 3,000 hours. On average, virtual care saved each of these health systems 440 hours of provider time. That’s nothing to sneeze at.

Mitigate Waiting Room Infection

One of the biggest challenges about cold and flu is that they are just so darn infectious. A study in Infection Control and Hospital Epidemiology found greater than 3% increase in influenza-like illnesses in children and family members within 2 weeks of annual wellness visits.

Hospitals, health systems and clinics have a variety of tactics to help stem waiting room infection – from handing out face masks to regular sterilization procedures. Virtual care can be added to the list. By offering a remote option for treating highly infectious conditions like influenza, patients don’t have to come into their doctor’s office for treatment. Plus, patients with common conditions like urinary tract infections or pinkeye can also get treated at home, lessening the chance they contract an influenza-like illness at the doctor’s office or urgent care.

Take the 2018 On-Demand Virtual Care Benchmark Survey

Now’s the Time

This isn’t Game of Thrones, and we aren’t facing an influx ofwhite walkers, but winter is coming. Getting a virtual care service launched now will go a long way to help health systems manage the impact of cold and flu season on their providers and patients. Starting now will mean your virtual care service is up and running when it counts. Pair that with some smart marketing tactics, and you’ve got winning combination to combat the coming cold and flu season. 

 

3 Reasons to Benchmark Your On-Demand Virtual Care Program

Virtual Care ROIHealthcare in the U.S. is a rapidly-shifting, highly demanding industry. From the shift toward value-based care to the quadruple aim to the dense regulatory landscape, health systems are repeatedly faced with thorny issues and complex challenges. Healthcare organizations deploying virtual care meet similar objectives and obstacles, but are doing so without the body of data and benchmarks available for other care delivery channels.

There’s a fair amount of industry research looking at telemedicine or virtual care, but it is primarily patient-focused. While a few look at providers or organizations, those are often focused on satisfaction. Organizations like KLAS, for example, do a great job of rating how companies like us are doing to support health systems. When it comes to actual deployment, modes of care, conditions treated, and other important data, we just don’t have a lot. And that’s a shame because benchmarking is critical to making informed, data-driven decisions.

To help address the lack of industry standard virtual care program success measures and usable data, we launched the 2018 On-Demand Virtual Care Benchmark survey. This study is intended to explore the challenges and opportunities of on-demand virtual care, while gathering valuable data to help health systems and other healthcare organizations measure their virtual care programs against aggregate peer-group data.

Why would health systems want to benchmark their virtual care programs? The benefits of benchmarking are numerous, but we’ve boiled it down to the top three:

Reason 1: Understand the Current State

In his 2001 book Good to Great, business coach, teacher and writer Jim Collins notes that “brutal honesty”is one of the key characteristics of “great” companies. He goes deep into the reasons for this, but the crux of his argument is, you can’t make good decisions without a healthy dose of reality.

Benchmarking can help your health system achieve that level of brutal honesty by generating a clear picture of how your program measures up against industry standards. This gives you insight into things like:

    • Gaps, strengths and opportunities 

 

    • How your program compares to peers

 

    • Whether you are effectively measuring success

 

    • Current competitive position

 

  • Effectiveness of your current strategy

Reason 2: Be Strategic in Planning and Growth

Visibility is an important part of planning. Objective, independent data about the industry, the current state of your program and how the two align gives you the information and confidence to make sound strategic decisions.

Those gaps? You can develop a roadmap to close them. Strengths? Build a strategy to leverage them. Opportunities? Craft a plan to go after them. Benchmarking also gives you the opportunity to clearly define (or redefine) goals and objectives, develop a standardized process for reporting and effectively monitor performance.

Planning with clear, real-world data is even more beneficial for organizations looking to launch virtual care. You’ll be able to see where gaps and opportunities exist, and set yourself and your on-demand virtual care program up for success from day one.

Reason 3: Performance Improvement

Far and away, the biggest benefit to benchmarking is the ability to improve performance, and gain strategic advantages. Virtual care has proven to be a useful patient acquisition channel, but with more healthcare organizations (and non-traditional competitors like consumer-facing telemedicine companies) offering this service, understanding the market is key to success.

The action plan you can develop from benchmarking takes into account the independent, objective and brutally honest view of the current state, the strategic planning and optimization that comes from it, and prepares your organization to take on the market with a high-performing, patient-satisfying virtual care service.

Lend Your Voice: Virtual Care Benchmarking

Benchmarking doesn’t happen in a vacuum. If you’re reading this as a healthcare organization and haven’t taken the 2018 On-Demand Virtual Care Benchmark survey, please consider doing so. Not only will you get an early summary of the results – you’ll be adding to the body of data available and helping to create clear standards for virtual care programs throughout the country.

Benchmark survey

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.

Avoid the Avoidable: 5 Common Virtual Care Mistakes and How not to Make Them

You may have heard the latest news coming out of Texas – A major piece of telemedicine legislation has just been signed into law that will change the game for health systems looking to deploy virtual care. This bill abolishes the requirement that patient-physician relationships be established with an in-person visit before telemedicine or virtual care can be used. For health systems, that means they can now offer virtual care to the broader marketplace, rather than just to current patients. With virtual care proven to add patients to health systems, this presents an opportunity to employ virtual care as part of a patient acquisition strategy. Game-changing.

In Texas (and elsewhere), health systems new to telemedicine and virtual care are now looking at launching their own services to support patient acquisition. But without a foundation in virtual care, health systems moving quickly to take advantage of the new environment may be making decisions that have potential long-term implications for their organizations and patients. More good news for Texas health systems: By avoiding these 5 common virtual care mistakes, success is within reach.

1. Lack of organizational support

Often, health systems will decide there’s a need for virtual care, and begin with the best of intentions, delegating a department or individual to work on finding and implementing a solution. But without a clear plan, regular communication, and stakeholder engagement, the virtual care project does not get the proper attention and true buy-in needed to create a successful, long-standing virtual care offering.

The Fix

Think of virtual care as a large, strategic technology investment – something that can support organization-wide objectives and strategies while adding value to your patients’ experience and your providers’ work. Make sure you have a clear plan around launching, and assemble a steering committee of leaders throughout the organization to guide the implementation and growth of your virtual care service.

After launch, maintain a communication plan to help keep virtual care front-of-mind throughout the organization. From clinical operations through marketing, your team should understand why virtual care is an important part of your strategy and how they can help make it a success.

2. Unclear reporting structure

Traditionally, telemedicine and virtual care service lines have been subject to a surprising lack of oversight. Health systems that don’t set up a clear reporting structure or determine which metrics to track will never be sure whether their virtual care service is meeting its objectives, and won’t have the insight needed to improve or grow the service.

Virtual care mistake: Unclear reporting structure

The Fix

This is an easy mistake to avoid – just make developing a cadence of accountability part of the implementation process. Understand what data your partner can capture and report on and what data you have access to. Decide on a reporting schedule—and identify who will be responsible for assembling and who will be responsible for reviewing reports.

If you need help identifying metrics or developing a reporting structure, our eBook, Measuring Success in Virtual Care, has the information you need to get off on the right foot.

3. Lack of marketing support

“If you build it, they will come” only works in baseball fantasy movies. But some health systems think that just having the service is enough. The truth is that patients won’t use your virtual care service if they don’t know it exists. And, in the digital age, marketing techniques need to be updated to match your audience.

The Fix

It’s not enough to buy billboard space. When launching a virtual care service, you need a multi-channel, long-term marketing plan to drive virtual care adoption. This may include elements like a press release and local media strategy, prominent website placement, social media strategy, direct mail, email marketing, and in-clinic marketing. Likewise, an initial introductory push will only do so much for the service. If you want to see long-term success with virtual care, create a continuous cadence of communication, including seasonal marketing pushes around things like cold and flu or seasonal allergies.

Internal communications are also key. Providing training and information to nurse line and front desk staff to help them direct patients to the virtual care service can do a great deal toward driving adoption. Additionally, getting physicians, physician assistants, and nursing staff on board with talking about and recommending virtual care can make a tremendous difference in virtual care adoption.

4. Not understanding big-picture value

People are people, and people get locked into old ways of thinking. This is particularly true when looking at payment and revenue. Health system finance departments sometimes view the return on a virtual care investment by subtracting revenue from cost – but that’s not how virtual care adds value. The true value of virtual care lies in downstream revenues and cost savings as evident in a recent study.

The Fix

Virtual care’s organizational impact can appear in any combination of the following:

    • Increased patient acquisition
    • Reduced patient leakage
  • Lower cost of delivering care – or cost shift

If you want more information about the potential revenue impacts of virtual care on your health system, our revenue calculators can give you a starting point:

ROI Calculator

Cost Shift Calculator

ROI Calculator

Patient Acquisition Calculator

ROI Calculator

Patient Leakage Calculator

5. Choosing the wrong partner

Not all telemedicine and virtual care companies are created equal – the technologies, business models, support, and product roadmaps can vary widely. For example, many telemedicine companies have a direct-to-consumer model, meaning that they have the potential to create a relationship with your patients that could lead to those patients circumventing your system altogether in the future.

Many health systems rush their decision due to pressure from increasing competition or fail to perform their due diligence in the belief that telemedicine and virtual care companies are all the same. Often, healthcare organizations will find that their partner isn’t providing what they need six months to a year into a multi-year contract. Concerns can be as simple as workflow alerts, to low utilization, to lack of flexibility and scalability in the technology. And then they’re stuck. Fortunately, with planning and care, it’s possible to select the partner best suited to your health system’s needs.

The Fix

First, talk to your stakeholders – understand patient and provider needs so you can choose the partner that is best suited to meet those needs. Don’t assume. Next, take a look at your organizational strategy and understand how virtual care fits into your overarching goals. Finally, develop your criteria for selecting a virtual care partner, including technology, support, staffing, and integration, to name a few.

Virtual care mistake: Choosing the wrong partnerThe partner you choose should offer technologies that meet your patients’ needs, while fitting seamlessly into their lives. They should also offer solutions that fit into provider workflows to maximize clinical efficiency and support a positive provider experience. Your virtual care partner should also be able to demonstrate support for providing the highest levels of care quality that your patients expect from your health system. Finally, find a partner that will be just that – a partner. Find a company that will work alongside you to help create a successful virtual care service line – from launch through growth, scaling, and innovating.

Get Set for Virtual Care Success

Virtual care holds the potential to bring health systems a lot of value. Keep your eyes peeled, put in some effort in planning on the front end, and avoid these five virtual care mistakes, and you’ll be in a great position to win – whether you’re a Texas health system taking advantage of the new regulatory environment or just ready to take the next step in launching an online care delivery service.

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