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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.

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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.

Medical University of South Carolina Helped Patients with Free Virtual Visits During Hurricane Florence

Medical University of South Carolina logo

At Zipnosis, we talk a lot about clinical efficiency, quality, and reducing unnecessary visits to the ER for simple conditions. And these are all valuable outcomes of launching a virtual care platform. What is incredibly meaningful, however, is hearing how our customers deploy virtual care to help people in communities where there are particularly challenging situations. This is exemplified by one of our newer customers, Medical University of South Carolina (MUSC). When hurricane Florence was recessed out in the Atlantic, MUSC made the swift decision to offer South Carolina residents free virtual visits during the storm.

Free online visits in the aftermath of natural disasters aren’t a new thing – for big companies. Many of the major consumer-facing telemedicine service providers have offered free visits following some of the big hurricanes that left people stranded and unable to reach their doctors. But I believe MUSC’s fast actions signal a new phase in how virtual care can be used for disaster relief.

During the storm, patients who needed assistance with common conditions had access to care from their trusted, local providers. And providers could easily care for patients with common conditions in a fraction of the time, leaving them free to care for more complex or urgent cases face to face. MUSC even used their newly-deployed phone service to help current patients receive medication refills. And, because the virtual care platform is integrated with the EMR, patients’ records remain complete.

During the course of the storm, approximately 80% of MUSC’s more than 150 virtual visit patients throughout South Carolina used promo codes to receive free online care. These patients had health concerns ranging from upper respiratory infections and bronchitis, to bladder infections, to asthma inhaler refills.

According to Dr. Ed O’Bryan, Chief Medical Officer, Business Health at MUSC, “Conditions like bladder infections or bronchitis don’t wait because there’s a hurricane. Patients who weren’t able to come in due to flooding – or even evacuation to other parts of South Carolina – could get treatment easily.”

This deployment of MUSC’s virtual care platform highlights why many of us at Zipnosis come to work everyday. As our CMO, Dr. Lisa Ide says, “We are about more care for more people.” I’m proud to support and work with an organization like MUSC that is so clearly dedicated to supporting their community.

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

Meet Cold & Flu Season Head on with Virtual Care

Summer is slowly ending in the Northern hemisphere, meaning short, crisp days, bright foliage and bonfires. These signs of the season also presage something less pleasant: cold and flu season.

There’s good news though – launching virtual care now can help you more effectively manage increased volume, curtail waiting room infection, and maximize the opportunity to create patients for life.

Virtual Care and Cold & Flu Volume

Brick and mortar locations, including primary care practices, retail clinics, and urgent cares, bear the brunt of increased volume that comes with cold and flu season. Virtual care can help alleviate that burden by routing patients to a convenient online access point, taking the strain off clinicians and support staff and freeing up appointment slots for higher value, more complex conditions.

Minimize Waiting Room Infection

Health systems go to great lengths to prevent waiting room infection. Nonetheless, when cold and flu season strikes, all bets are off. Offering a virtual care solution where patients can receive diagnosis and treatment recommendations for highly infectious diseases like cold and flu helps keep patients out of the waiting room and reduces the likelihood of waiting room infection.

In an article on Health IT Outcomes last fall, Zipnosis’ Chief Clinical Officer Kevin Smith noted, “one of the best ways to be a good healthcare citizen and avoid spreading germs to others in overcrowded waiting rooms at clinics, urgent care centers, and emergency rooms is to take advantage of online virtual visits.”

Create Patients for Life

Cold and flu season is more than a challenge for health systems – it’s an opportunity.  With the uptick in volume that comes along with cold and flu season comes the potential of adding patients to your health system. With more and more patients seeking convenient options and looking for care online, a virtual care service is a fantastic way to attract those patients to your health system. What’s more, a recent white paper from Carrot Health found that approximately 25% of virtual care users converted to health system patients within one year of their virtual visit.

Imagine the impact if even a fraction of your cold and flu visits could be addressed through a virtual care solution. Your clinicians and support staff would be freed up to better serve patients, the decrease in infectious patients in your clinic would lower the likelihood of your staff and patients becoming sick, and you have the opportunity to create lasting relationships with new patients. Win-win-win.

How to Prevent Your Emergency Department from Becoming an Urgent Care

The Challenge:

Across the country, emergency departments (EDs) are experiencing, well, an emergency – specifically, overuse. Patients – for a variety of reasons – are treating emergency rooms like urgent care facilities. A report from the New England Healthcare Institute estimates that this overuse of EDs is responsible for $38 billion in wasteful spending each year. Additionally, a literature review published in the American Journal of Managed Care found that on average 37% of ED visits were judged to be non-urgent. The CDC’s numbers match up, finding that of the 130 million ED visits in 2013, only 8 percent could be classified as “immediate” or “emergent”.

Little girl in the emergency department with a broken arm

Patients treating the emergency room as an urgent care can cause problems for hospitals and health systems. ED use can cause fragmentation, and even with an efficient EHR, can make effective care coordination challenging. What’s more, an ED being used as an urgent care for non-emergencies may increase wait times for all. Using “broken bone” as an example, ProPublica’s ER Wait Watcher shows an average wait time of between 38 and 72 minutes.

Another major concern for health systems related to ED overuse is uncompensated care. Patients treating the ED like an urgent care my receive a rude awakening when they find that their visit cost is only partially covered by insurance or is exponentially higher than a PCP or true urgent care visit. According to an article in the Annals of Emergency Medicine, only 50 percent of ED charges are reimbursed – including reimbursements through Medicare, Medicaid, and private insurance.

With the mean cost of care delivered in the ED over $2,000 per visit (approximately 300% the cost of primary care) according to research published in the Journal of Medical Internet Research, that adds up quickly – for both health systems and patients. A study in the American Journal of Medicine found that medical debt is a contributing or primary factor in more than 40% of personal bankruptcies. This creates a financial strain on health systems, and has the potential to result in ED closures, which in turn compromises access for patients experiencing a true emergency.

Why Patients Choose the ED – Access, Access, Access

There is no doubt that many patients go to the emergency department due to a bona fide emergency. But an article in the Journal of Emergency Nursing found that the reasons for going to the emergency department for non-emergency care were centered around access and inappropriate referrals. Specifically, patients visited the emergency room because they were unable to obtain a PCP appointment, were told by staff (not physicians) to go to the emergency room, or felt that it would take less of their time.

A review in the American Journal of Managed Care found similar reasoning around convenience, access, and cost. But the inability to access quality care elsewhere was the foremost reason for patients visiting the ED for non-urgent conditions. This is a particular challenge for uninsured and underinsured individuals and families, as well as those classified as having a low income, and why the top strategy for reducing ED overuse is broadening access to primary care services, according to the Centers for Medicare and Medicaid Services.

Ultimately, many patients go to the ED because they think it is easier than the alternatives. Younger patients, in particular, view the emergency department as a reasonable alternative to a primary care clinic for receiving care. This is part of the larger trend of consumerism in healthcare, in which patient choice is driving change in how and when care is delivered.

So, What’s the Answer?

Unfortunately, there’s no magic bullet to the challenges of supporting efficient use of an emergency department. The good news is there are things health systems can do to help reduce overuse. And one of those things is launching a virtual care service line and driving patients to the online access point in lieu of the ED.

For patients who are unable to obtain a PCP visit, virtual care offers an alternative access point. Available 24/7, unlike primary care clinics or even urgent care facilities, virtual care gives patients unprecedented access to care. Patients who can’t afford to or are otherwise unable to take time away from work to seek care during normal office hours can use the virtual care service to get the care they need. And, when using a virtual care platform that incorporates  evidence-based algorithms and best practice-driven protocols patients are only directed to the urgent care or emergency department visits when clinically appropriate.

Improve Patient Access with Zipnosis Virtual CareWhat’s more, patients seeking convenience in addressing non-urgent needs will likely find virtual care more appealing than the emergency department. They no longer have to leave their home, drive to the hospital, and sit in the waiting room. And virtual visits take a fraction of the time a primary care visit or even a trip to the emergency room would take.

The low cost of virtual care can also help steer patients away from the ED. Patients who don’t have insurance, are underinsured, or are taking on a larger portion of risk with a high-deductible health plan may struggle to pay for emergency care, leaving health systems with higher rates of uncompensated care. Patients who cannot cover a several-hundred dollar (or higher) emergency visit (see the shocking ED price tag example above), may be better able to pay the $30 or $40 for a virtual visit, about the cost of a typical copay.

Most importantly, with a virtual care service, health systems are expanding access to care. That means common conditions can be treated quickly before complications develop and the danger to the patient increases. This can be the difference between a simple urinary tract infection and a kidney infection or an upper respiratory infection and pneumonia. That means, getting patients treatment early could help reduce ED visits and improve patient outcomes.

Follow the Data to the Real Virtual Care ROI

I am a firm believer in the power of data – not surprising considering my role as CEO of a data analytics company. In my experience, successful business decisions don’t happen by accident; they’re a direct result of careful evaluation of a large amount of information.

Recently, my company, Carrot Health, had the opportunity to work with a large health system to explore their virtual care service. Historically, the impact virtual care service lines and technology have on a health system hasn’t been very clear and there’s been a lot of debate about virtual care’s return and long-term financial sustainability. So, when a client came to us wanting help in evaluating their virtual care service, we were intrigued by the opportunity. What we found was surprising.

Virtual Care ROI – The Data Has Spoken

Beyond insight into who was using the service, we stumbled onto data that showed the behaviors of patients following a virtual visit – and then, the downstream impact on the bottom line. But first, let me share our methodology.

Looking at all virtual care users over a 12-month period, we narrowed down our pool to those who met the following criteria:

  • Men and women over 18 years old
  • Had not received care from the health system within the 24 months prior to their virtual encounter
  • Could be matched to a patient record in the health system’s EMR

Ultimately, we ended with a cohort 974 virtual care users. Of that cohort, 24.8 percent, or 242 virtual care users, had converted to in-person care within 12 months of their virtual encounter. By tracking the services these patients received through EMR data, we found that on average, these new patients had 3 in-person visits and generated $2,972 in revenue. That translates to more than $708,000 in incremental annualized revenue.

Virtual Care Revenue Potential

At first glance, $708,000 may not seem like a significant number. But looking purely at the conversion percentage and average revenue per patient, this impact potential for virtual care becomes much greater.

Remember, we took a very conservative approach in the creation of our data set. Let’s say that we’re looking at 10,000 virtual care users, 30% of whom are not current health system patients. At the 24.8 percent conversion rate and $2,927 average annualized revenue, that translates to approximately $2.2 million in incremental revenue.

Driving Conversions with Data

So, how does a health system get 3,000 new patients to use their virtual care service so they can see those kinds of revenue returns? The answer is, of course, data. Understanding consumer behavior using social, behavioral, and clinical variables enables health systems using virtual care to acquire patients to more effectively target marketing efforts at demographic segments most likely to use virtual care.

Health systems today are at a crossroads: Today’s data-rich environment gives health systems an unprecedented opportunity to make informed decisions that produce successful results. The organizations that take advantage of the information and technologies available are those that will be best positioned to thrive now and in the future.

About the Author

Carrot Health CEO, Kurt Waltenbaugh

Kurt Waltenbaugh, Founder and CEO, Carrot Health

Kurt has built successful analytic solutions, products, and companies in the healthcare, retail, manufacturing, education/credentialing, and fundraising industries. His previous companies were sold to Oracle and Pearson Education. Most recently, Kurt was responsible for product strategy at Optum, Inc. (United Health), building data analytic businesses for the provider, payer, and employer markets.

Virtual Care and Public Health: Helping Manage a Measles Outbreak in Minnesota

You may have heard that our home state of Minnesota is in the grip of a measles outbreak – primarily in the Twin Cities metro area, though there are several cases in outlying counties. As I write this, there are 78 confirmed cases of measles, and the number is growing. I’m not going to get on a soap box about vaccination (though, the vast majority of patients were, unsurprisingly, unvaccinated). Instead, I’ll use this example to illustrate the role of virtual care in a public health crisis like this one.

How Virtual Care Can Help

When managing certain outbreaks of infectious conditions, the value of virtual care is two-fold. First, it provides a unique channel for evaluating potentially contagious patients, taking them out of the waiting room and limiting the opportunity for infections to spread. This is particularly important when a communicable disease is active (think cold and flu season). By directing patients to the virtual visit, rather than into clinics, virtual care can help health systems curtail the spread of illnesses like influenza.

Second, and most important in this recent measles outbreak, it offers a front-line communication channel for health systems to share critical information with their patients and the community.

The early symptoms of measles are very similar to those of an upper respiratory infection – one of the top conditions patients seek treatment for via the Zipnosis platform. We collaborated with one of our Twin Cities clients to find a solution that we could deploy quickly to help manage communication about the outbreak. This is particularly important, since Minnesota medical regulations allow any person to seek virtual care or telemedicine; some states require a person to have an established relationship with a clinic to be eligible for virtual care.

Through collaboration with our health system client, we rapidly developed and deployed an online messaging feature enabling health systems using the Zipnosis platform to share important information about the measles outbreak for patients using the virtual visit system. Accessible and editable by staff within the health system, our Minnesota clients are now using this functionality to provide important patient alerts about the measles outbreak and to educate them about early symptoms, dangers, and the steps they should take if measles is a possibility.

This new feature goes beyond this one outbreak or use. Health systems can now relay information about other things their patients may need to know: updates on allergen and pollen levels, reminders to get a flu shot prior to flu season, or information on seasonal diseases like Lyme disease and other outbreaks.

Public Health and the Potential of Virtual Care

Virtual care is more than a technology – it’s a digital care delivery channel, just as important to supporting health outcomes as a nurse line or clinic. And, as patients continue to adopt virtual care in greater numbers, its value as a channel for communication, education, and care delivery will increase too.

Today, we see nearly limitless possibility for virtual care to support health systems and providers as they work to drive positive health outcomes for their patients and communities. Health systems are just beginning to understand how they can use virtual care to do more than treat common conditions, and we are excited to help them realize this potential. While this particular feature may not be a groundbreaking industry disruptor, it gives our health system clients another option for supporting the health of their communities – and to us, that’s huge.

About the Author

Kevin Smith, Zipnosis Chief Clinical Officer

Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

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

Still Testing with Telemedicine? Virtual Care Offers Viability

A few months ago, my beloved car, Brynhyld (Bryn for short; I name all my cars), started to show signs of needing more significant repairs: New clutch, new tires, new brakes – about 50% of the value of the car. But I LOVED Bryn. She had been with me through some amazing times in my life. It’s not all the time I’m grateful for my dad’s brainwashing me into liking cars, but this was one. I had already test-driven a dozen cars—just for fun. As a car nerd, I knew exactly what it would take to replace Bryn – pricing, options, and financing terms. So, on a snowy December night, I said goodbye to my beloved Bryn and brought a new car, Petra, into my life.

Most people don’t spend an hour each day reading car blogs, so buying a car can be a stressful experience. The same is true in telemedicine. It nearly impossible to understand what “models” exist, what the right prices are, which vendors are reliable, what ROI to expect, whether patients will use it, etc. So, we do a lot of test-drives with telemedicine.

Telemedicine is Testing

Testing features; testing care delivery models; testing value propositions, patient preference, regulations, and reimbursement. The industry has been using telemedicine to test-drive the next generation of digital care delivery tools for 70 years. This testing has been vital. In healthcare, it takes those 70 years to get to a point where we are ready for a more mature, durable set of tools – ready for substantive change. But now, we’re ready.

Virtual Care is Viable

The most important thing about virtual care is that it’s more than just technology. Virtual care is a movement – a shift in how healthcare organizations and consumers view care delivery.

Virtual care incorporates the data gleaned from all that telemedicine testing to create a dynamic and personalized healthcare delivery experience – not a “one-size-fits-all” telemedicine corral to video or phone.

Virtual care is more amorphous—and durable—by its nature. The excitement virtual care offers isn’t improved patient access (that’s table stakes) – it’s all the ways technology can improve care delivery for patients and health systems. Like linking Smart on FHIR apps for seamless navigation between systems and data sources.

Virtual Care incorporates an endless and ever evolving set of devices that can help providers more accurately and rapidly diagnose and treat their patients – and help patients receive treatment in a way that better fits their lives.

Virtual care is not anchored to a single department or moveable cart – it’s on iPads, in the pockets of nurses, on the screens of your smart TV.

Telemedicine regulations dictate a specific mode (phone or video) that limits patient and provider choice. Virtual care regulation is mode-agnostic and upholds the standard of care as the basis for regulation.

The Time for Testing is Past

It’s been incredible sitting at the tip of the spear in healthcare transformation the past decade. When I started Zipnosis, people told me no one would ever get a diagnosis without going into the clinic. Today, we’re part of a rapidly growing industry.

It’s time to stop testing with telemedicine. Telemedicine is the analog past.  Virtual care is the digital future of healthcare; a future dominated by data and devices that permeate the fabric (literally) of our society.

So, when the brakes on your telemedicine cart start to fail, when the telemedicine engine seizes up at scale, and when the promises of a real ROI lose traction, consider upgrading to virtual care. It’ll be a much better ride.

Telemedicine = Testing

Virtual Care = Viable

  • Hardware: Specialized, expensive, additive
  • Hardware: Agnostic, in hands of consumers, existing
  • Regulations: Mode-specific, special standards of care
  • Regulations: Mode agnostic, standard of care
  • Payment: Right price per visit x utilization
  • Payment: Inclusion in value-based care models, $0.00 transactional costs
  • Utilization: 1 or 2 options – limited clinical use cases and patient/provider preference matching
  • Utilization: Highly personalized options for patients/providers – unlimited clinical use cases over time

Transforming Telemedicine into Virtual Care

There is a long-running discussion on what to call this next generation of healthcare tools. Is it telemedicine? mHealth? Virtual care? Connected care? For the time being, “telemedicine” is in the ascendency, but that appears to be changing.

I have always been challenged by the term “telemedicine,” and I’m going to spend a little time in the coming weeks framing up a way to look at the difference between the term and delivery model that has been prevalent for decades, compared to the care delivery tools and models that will carry us forward.

At the heart, Telemedicine is a term born in the 1960’s, a Brubeck-esque fusion of tele-matic modes of communication (phone and video) and medicine. This history is important to understand so we can better usher in the new generation of tools and nomenclature.

Let’s start with “tele.” It sounds like “8-track” to me. It harkens back to a time when I would look up Domino’s Pizza in the phone book. To when I had to avoid tripping over the phone cord as my mom talked in the hallway. It feels like green vinyl in a Pinto. Like the anti-Mackclemore leisure suit at the Salvation Army. It’s stale and, let’s be honest, out-dated.

I’ll frame this up with a few simple word associations:

Telemedicine = Testing
Virtual Care = Viability

For some, having a healthcare encounter over the phone is novel and new – but it’s not state-of-the-art. This is an important distinction between our first EXPERIENCE with telemedicine and its relevance as a term for future experiences. I would make a significant wager that the majority of our healthcare interactions over the next 10 years will not be the phone calls or 1-1 video visits with a healthcare provider the industry has been testing since the 60s. Instead, we will experience of stream of healthcare that disposes of the analog shackles, unlocks new economic models not built around transactions and delivers durable value.

Telemedicine = Analog
Virtual Care  = Digital

The telemedicine gene pool is analog. The other day, I took a cab from downtown Miami to the airport. The cabbie was genial enough, but when we got to the airport, he frowned when I wanted to use my credit card. He manually typed in my card info onto his terminal, submitted for approval (queue dial-up noises) and waited for the print-out. The printer ran out of paper – so he had to dig through his glove box for a replacement roll, re-thread it and re-print. It was a stark reminder of a time—not long ago—when getting an analog ride to the airport was common place. Telemedicine is like that transaction: labored and inefficient.

Telemedicine = Transactions
Virtual Care = Value

Finally, there’s a transactional feel to the term: I “do” telemedicine; I “practice” telemedicine. It implies a direct connection between a patient and provider – or the healthcare ecosystem. We’re at an important transition in healthcare delivery. The combination of moving care from brick-and-mortar to the digital world and changing payment from fee-for-service into value-based care is forcing healthcare providers and the innovators who support them to develop new ways of providing value.

So there you have it. Telemedicine is dead – well, on life support. Virtual care is the future, and the future looks bright.

Next time, I’ll dig a bit deeper into the testing and viability differences between telemedicine and virtual care. Until then, don’t trip on the telemedicine cords in the hallway.

Walk Before You Run: Driving Success with a Scalable Virtual Healthcare Business Model

When it’s time to pull the trigger on a new technology investment, particularly one with the potential to revolutionize care delivery in your health system, it’s tempting to shoot for the moon and include all the shiny bells and whistles. Like many large-scale improvements where change management is present, that is not always the best strategy. When developing a virtual healthcare business model, health system leaders need to balance the desire to employ the latest growth strategies with a systematic approach. A phased approach facilitates effective change management and the necessary checkpoints to support success.

Virtual Care Scalable Business Model

 

Change Starts from Within

Health systems frequently start their foray into virtual care by offering the service  internally to their employees. This strategy helps build acceptance and understanding of virtual care. It also helps get employees excited and become more knowledgeable about the service. Once your employees experience virtual care as a patient, they feel more comfortable recommending it to patients later on.

In addition to gaining buy-in from key employees, launching internally provides time to monitor the service and make any needed adjustments to the workflow. This means that when you are ready to expand to a broader population, your service is dialed in and working on all cylinders – for both patients and providers.

Grow With Confidence

After the initial phase, it’s time to grow your virtual care service by expanding your patient population. This may include current patients and/or the broader marketplace, depending on your acquisition and retention strategies as well as your regulatory environment.

This phase is the time to begin scaling your service beyond current patient population targets. Use your organizational strategy and virtual care goals to create a comprehensive growth roadmap.

Your plan may include adding employer and health plan contracts, integrating virtual care technology with internal systems, adding access points, or expanding the number and types of conditions that can be treated.

Whatever your scaling and integration plan includes, a methodical, step-by-step approach will serve you best. This supports analyzing the impact of each new addition and gives you the flexibility to make adjustments and optimize staffing to meet organizational goals.

Hit Your Stride

Being part of the virtual care revolution can be exciting – after all, you’re a pioneer on the forefront of innovative healthcare delivery. And, once you have a fully realized, mature virtual care service, innovation is the next step.

Virtual care is a rapidly evolving industry, and the sky’s the limit to its potential impact to your health system. Leading virtual care technology companies are beginning to expand into serving varied needs along the care continuum. For example, support for longitudinal care, such as chronic care management and post-operative care.

The growth and advance of technology is enabling ever-deeper systems integration, helping to eliminate silos and support greater connectivity throughout health systems. And expanding interoperability of your virtual care software is another way to be on the leading edge of healthcare information technology.

Moreover, by collaborating with your virtual care partner to offer the next generation of online care as a pilot site, beta tester or innovation partner, you give your clinicians and patients a voice in the future of care delivery.

Move at Your Own Pace – This Is Not a Sprint

Steady doesn’t necessarily mean slow. Following a phased plan for your virtual healthcare business model enables you to move as fast as makes sense for your health system. Healthcare leaders gain three main benefits from this strategic approach:

Change management: A systematic approach to launching, growing and optimizing your virtual care service can minimize the challenges that come with implementing a new service line. Effective change management relies on this type of phased approach. Being methodical and gathering information and feedback at every step will help set the stage for virtual care success.
Budget management: Launching a new service line means up-front investment – whether you’re going for traditional telemedicine access points like phone and video, or pushing into new frontiers with virtual care. Starting small, with a clear roadmap for scaling means more effective budget management, including the ability to strategically time capital investments.

Risk reduction: Innovation in healthcare is always a bit of a risk, but by starting small and scaling your virtual care service, you are mitigating the risk that comes with investing in something new. Starting small reduces risk by lowering up-front investment. And, using a documented plan to grow your service enables careful monitoring, which limits the likelihood of making an investment that doesn’t pay off.  

Find out how one leading health system successfully employed a measured approach to launching their virtual care service. Get the case study.

Where’s the Return? How to Find Virtual Care ROI for Health Systems

For early adopters of telemedicine, the excitement of new care delivery technology (e.g., video conferences) was enough to build a business case. These days, online care has gained acceptance by both patients and healthcare organizations – it’s no longer just early adopters being lured by something shiny and new. Health systems are being tasked with meeting patient demand for online care and justifying this investment by showing its impact on their organization.

Traditionally, determining the return on telemedicine investment hasn’t always been clear. As a newer way to deliver care, it’s taken some time to develop and validate ROI models and some telemedicine companies continue to struggle with proving ROI to health systems.

Virtual care, which includes traditional telemedicine tools in addition to its suite of transformative digital health solutions offers an alternative. Leading health systems are building out their digital healthcare programs with virtual care and seeing the organizational and financial benefits.

Beyond the Bottom Line

As with other strategic initiatives, virtual care’s return is not just financial. Patient perception in the marketplace and brand positioning are both impacted by launching a virtual care service line. Health systems that offer virtual care and communicate that offering effectively to the marketplace are more likely to be seen as a leader in patient access and technology. With 46% of consumers in a recent survey stating they would choose a health system that offers virtual care over one that doesn’t, this can have a big impact on position in the marketplace and your bottom line.

Virtual care and telemedicine can also play a big role in supporting long-term organizational strategy and building a foundation for the care delivery of tomorrow. The contribution of virtual care to achieving, say, improved patient access or greater operational efficiency goes well beyond any financial returns. Additionally, launching virtual care in support of long-term, strategic objectives can mean that the true financial impact takes time to materialize – think lifetime value.

How to Find Your Virtual Care ROI

Virtual care ROI has many lenses. The best return on investment approach is the one that fits your goals and organizational strategy. Effective goal setting, identifying the right KPIs to measure performance, and developing a reporting process and cadence are vital steps to understanding and measuring the success of your virtual care program.

Metrics like total visits, number of new patients, clinical guideline adherence, clinician work time and patient satisfaction combine to tell the story of a virtual care service. Is it helping bring new patients to the health system? Is it providing high quality medical care? Is it driving operational efficiencies? Do patients like it? These are some of the true measures of virtual care success.

Finding Financial ROI

Of course, there are the numbers…

Calculating the financial return on investment is more than just subtracting costs from revenues. If you want to see the impact virtual care could have on your bottom line, check out our interactive ROI calculators:

ROI through preventing patient leakage

ROI through cost shift in a value-based environment

And, download our latest eBook, Measuring Virtual Care Success: Your Complete Guide to ROI, for more information on quantifying the impact virtual care could have on your health system.

Virtual Care in a Trump America: Making Care Great Again

So, there was this election last November. You might remember it or you might be trying to forget, but either way a new president was sworn in January 20th. Ever since the results were tallied, I’ve been inundated with a barrage of predictions for what the new administration means for the healthcare industry – in particular, for virtual care and telemedicine.

The one thing everyone can agree on is that with Trump in the White House, healthcare policy is going to change. So, what place does virtual care have in a Trump America?

No One Really Knows the Future

OK, it might seem kind of counterintuitive to say that after I just wrote about my forecasts for virtual care in 2017, but bear with me. Speculation about how lawmakers at the federal level approach healthcare policy can be well founded. It can be based on campaign promises (we all know how those go), party politics and previous voting records. But, our democracy is complex and unpredictable. And despite speaking Russian, I have no real insight into the policy direction the Trump administration will take with regards to healthcare.

Here’s What I do Know

While I can’t tell you precisely what legislative changes will come with the new Congress and President, I can tell you that there are macro-level trends in the healthcare industry that will continue to influence digital healthcare, telemedicine and virtual care, regardless of who’s in office. (Tweet)

And that’s where I can effectively make predictions. Like tiny snowballs starting downhill, the following trends have become avalanches in the healthcare mountainscape. Their momentum – more than federal policy – will be the major influencers of virtual care over the next several years.

The Transition to Value-Based Care Will Continue to Gain Momentum

Value-based reimbursement is here, and it’s here to stay. You can check out my post on Becker’s Hospital Review for a primer on value-based care and its impact on virtual care. Suffice to say, virtual care offers health systems a real means to cope with the changes the shift to value-based payment is producing.

Right now, value-based care is still gaining traction, but a number of factors make this shift inevitable. For one, healthcare costs are continuing to rise. Value-based reimbursement can help curtail those costs while supporting high quality care. A recently published study in JAMA found that using bundled payments for joint replacement decreased Medicare costs between 13% and 21% and produced fewer readmissions, emergency visits and prolonged hospital stays.

With insurers seeking to improve the bottom line and the move to high deductible health plans (HDHPs) and health savings accounts (HSAs) leaving patients paying more out-of-pocket, the transition to value-based care is only going forward.

Predicted Primary Care Physician Shortages and Patient Access Remain Challenges

Back in 2013, the Health Resources and Services Administration predicted a primary care physician shortage of more than 20,000 by 2020. Just this past year, the American Association of Medical Colleges issued a report projecting a shortfall of between 14,900 and 35,600 PCPs. This report went further and noted that if all barriers to care were removed, the U.S. would need an additional 96,000 doctors to meet patient needs – today.

All signs point to the population expanding relative to the number physicians available, meaning that improving patient access to care is only going to be more important going forward. I anticipate virtual care – with its increased clinical efficiency – is going to be a critical piece to solving these challenges.

Patient Demand for Virtual Care isn’t Going Anywhere

In our infographic, Virtual Care by the Numbers, we outline how patient demand for virtual care is impacting the industry. Some of the highlights include 76% of patients rating access over in-person care, and 62% of patients stating they’d be willing to replace an in-person visit with an online visit.

This demand is only going to increase as technology becomes more embedded in people’s lives.

People are Increasingly Spending Their Time Online

So, show of hands: Who has a Facebook account? Twitter? LinkedIn? Instagram? How about Netflix or Hulu? The world is more digital than it was even a few years ago. We shop, access entertainment, and even build and maintain our friendships and business relationships online. According to the Pew Research Center, 38% of all adults’ primary news sources are online – a number that goes up to 50% between the ages of 18 and 49.

This shift to a virtual world is only going to grow as more and more resources are available via digital channels. And, this holds true for healthcare, as well.

Virtual Care’s Place Going Forward

These trends may have started as a tiny shift in the snow cover, but they’re full-blown, unstoppable avalanches now. While I can’t predict policy, I feel confident that moving forward, virtual care has an important role in helping health systems and patients deliver and receive care as the landscape changes.

Forecasting the Future of Virtual Care in 2017: 5 Mystical Predictions

So long, 2016, we’ve officially begun a new orbit around the sun. It’s becoming a new year’s tradition for me to don my mystic robes, gaze deep into my son’s Magic 8 Ball and come up with predictions for the future of virtual care in the year ahead. (If the new year has you feeling nostalgic, check out my forecasts for 2015 and 2016.) So, let’s dive in.

1. Demonstrable ROI will be a requirement
Magic 8 Ball response: “Signs point to yes”

To date, the return health systems receive from their virtual care investments has been shadowy and not clearly understood. In fact, when I asked my Magic 8 Ball about the ROI of traditional telemedicine, it said, “Reply hazy try again.”

Some of this ambiguity is due to the relative newness of patient-to-provider virtual care. During the early stages of adoption, throwing things at the wall to see what sticks isn’t an unreasonable strategy. Alternatively, ROI has been a smoke and mirrors game with traditional telemedicine companies decreasing health system investment and inflating adoption hopes. But as virtual care becomes increasingly mainstream, clouding ROI in mystery or promoting unsustainable models will no longer be acceptable (tweet this).

In 2017, Health systems are going to expect a holistic, clear view of the return on their virtual care investment. That will include elements like how virtual care is helping to attract and retain patients and produce positive health outcomes.

2. Health systems will have higher expectations for care quality
Magic 8 Ball response: “Without a doubt”

2016 saw several high-profile telemedicine quality studies published, and traditional telemedicine did not come out looking great. Hospitals and health systems understand the need to increase access by offering online care, but are unwilling to launch services that could negatively impact their quality ratings. As a consequence, quality will become a much larger evaluation factor in areas including:

    • Clinical quality: Health systems will require hard data on clinical quality for care provided via digital channels. If not already in place, telemedicine and virtual care companies will need to find ways to collect and make this data available to their clients.
    • Interoperability: Electronic Medical Record (EMR) integration is no longer a “nice-to-have;” it’s a requirement for maintaining continuity of care and effectively tracking patients’ health data.
  • Data, reporting and analytics: Real-time data will be increasingly important, and health systems will require means of accessing and analyzing the performance of their virtual care service.

3. Driving internal adoption of virtual care will be a priority
Magic 8 Ball response: “Most likely”

Patient demand for virtual care continues to rise. My Magic 8 Ball says, “You may rely on it.” If that’s not enough for you, a recent survey by Rock Health found that 46% of consumers are active digital health adopters, up from 19% the previous year. The upshot is health systems will need their providers fully engaged and supportive of this mode of care delivery.

This year, health systems will focus on change management, provider engagement and making a cultural shift toward embracing virtual care and other digital health technologies (tweet this). Fortunately for health systems, online channels are gaining traction as a mode of care delivery. For example, a study by the Robert Graham Center found that 85% of physicians would consider using telehealth. This acceptance by physicians should make change management and the cultural shift toward embracing virtual access points much easier.

4. Policy support for digital health including virtual care will increase
Magic 8 Ball response: “Outlook good”

2016 saw a great deal of legislative movement in the area of digital health and virtual care. According to the Center for Connected Health Policy, more than 150 pieces of telemedicine-related legislation had been introduced in 44 states as of August. I anticipate a lot more movement on the legislative front for the coming year. It doesn’t hurt that a recent survey by the Federation of State Medical Boards identified “telemedicine” as “the most important medical regulatory topic to state medical boards.”

I also expect that, similar to recent legislation that passed in Wisconsin and Michigan, the policy we’ll see coming in 2017 will be friendly to digital health in general and virtual care in particular. Much of this policy will be driven, or at least influenced, by health systems seeking the best option to bring high quality, convenient care to their patient populations in a way that meets their business objectives.

5. Leading virtual care providers will expand to support more service lines
Magic 8 Ball response: “Signs point to yes”

Virtual care is increasingly venturing out of the acute urgent care space and into supporting a wider range of service lines. This means that virtual care providers will need to identify ways of meeting a wider array of health system needs, likely including forays into longitudinal care such as chronic condition management and/or post-operative care.

Health Systems Move Into the Driver’s Seat

Going through my list, you might have noticed a theme (beyond my surprisingly positive run with the Magic 8 Ball): Health systems are increasingly impacting the direction of this industry. Decision makers at leading health systems are getting more sophisticated about technology; have greater insight into patient and provider satisfaction, engagement, and expectations; and will require real value from their virtual care partner(s). And I, for one, am looking forward to it. “It is decidedly so.”

Want more information on virtual care? Check out our guide to best practices!

Why Virtual Care Should be Part of Your Health System’s 2017 Growth Strategy

As 2016 comes to a close, health systems—like most businesses and non-profit organizations—are deep into planning their growth strategy for the new year. Faced with rising consumerism in patient populations, increasing competition from traditional and non-traditional healthcare companies, and the continued transition to value-based reimbursement, leading health systems are looking to virtual care as a means of supporting organizational growth strategies.

Aligning Virtual Care with Health System Growth Strategy

Any way you slice it, adding a virtual care service line is a strategic business decision. Your virtual care strategy should reflect your health system’s big-picture growth strategy. But how, precisely, do the two tie together?

The Virtual Care SWOT

Every health system is different, with unique cultures, competitive environments and goals. However, many health systems face similar challenges and opportunities. When it comes to health system strategic growth planning, virtual care can help make the most of strengths and capitalize on opportunities while shoring up weaknesses and mitigating external threats.

Leverage Strengths

With a virtual care platform in place, health systems can:

    • Offer patients online access to their clinicians by staffing the virtual care service internally
    • Increase patient engagement and satisfaction through convenient access and digital tools that fit into their lives
    • Maintain high levels of clinical quality and capture structured data to support quality initiatives

Capitalize on Opportunities

Launching a virtual care service line can help health systems:

    • Attract and retain new patients – particularly younger generations who have yet to settle into a primary care relationship
    • Build a foundation for continued innovation and partnership with a virtual care provider committed to keeping clients on the leading edge
    • Strengthen or develop new contract relationships with large employers, insurers and/or educational institutions to drive revenue

Address Weaknesses

Virtual care can help health systems work within internal constraints by:

    • Leveraging marginal capacity to treat more patients with current staff
    • Meeting patient demand for convenient care and improve access without adding physical locations
    • Offering virtual care at a free or reduced cost to employees and their dependents to reduce overall healthcare costs

Mitigate Threats

Offering virtual care supports health systems through:

    • Staying in step with – and/or offering a point of differentiation from – competitors’ online service offerings
    • Supporting patient retention by offering a convenient, online access point
    • Creating a lower-cost channel to provide care to patients in value-based reimbursement populations

For more information on how virtual care can support organizational growth strategies, check out our free Best Practices Guide to Virtual Care  – your handbook for successfully launching, operationalizing and growing a virtual care service.

virtual-care-best-practices

5 Unexpected Benefits Integration Brings to Your Virtual Care Service

Offering virtual care is a great way to meet market demand and attract new patients. But to get the most out of your virtual care service, integration with your internal IT systems is a must. Benefits of integration, like enhancing the value of your patient portal and ensuring continuity of care, are just the tip of the iceberg. Choosing a virtual care partner who offers advanced integration with your internal IT systems can bring you some surprising advantages.

1.  Enhance patient experience

Patient experience is a major focus in healthcare these days. Health systems are launching virtual care services in an attempt to improve patient experience, but when the virtual care experience is disconnected from other care delivery systems, this goal is hard to attain. Integrating virtual care with your patient portal and EHR, however, can tie a virtual care offering to patient experience objectives.

    • A CCDA integration with your EHR can help make the online adaptive interview more personalized by accessing information from the patient health record, including medication allergies and health history.
    • Offering single sign-on (SSO) from the patient portal to your virtual care service means patients experience a seamless handoff when moving between these systems

2.  Improve patient retention

The healthcare landscape is becoming more competitive, and patients are making healthcare purchasing decisions differently. This combination means that healthcare consumers are increasingly likely to seek care outside of their primary care provider or medical home. Offering virtual care can help attract and retain these patients, and integrating with your patient portal through SSO can foster closer ties with your health system. Integrating with your appointment scheduling system can help prevent patients from seeking care elsewhere by making scheduling follow-up care or other appointments quick and easy.

3.  Seamlessly transition between virtual and in-person care

Systems integration can help marry the virtual visit with in-clinic services. Integrating your virtual care platform with your patient scheduling system, as well as with systems like labs, can help fit virtual care into the overall care continuum. Pairing virtual visits with in-clinic services can also increase the number of conditions your health system can safely treat through your virtual care platform. Start by pairing virtual visits with in-clinic services such as lab testing or imaging, and grow your virtual care service by incorporating follow-up care or referrals. Our ZipTicket® workflow and integration with lab systems brings the virtual visit and in-clinic services together in a process that saves patients time and adds depth to clients’ virtual care services.

4.  Reduce physician time spent on EHR data entry

Let’s face it, your health system has spent good money on your EHR system. But recent studies show it’s eating into patient interactions and physicians’ personal time, and that EHR-related data entry is a major cause of physician burnout. Effective integration, however, can reduce time spent entering data into the EHR. A standard EHR integration with a store-and-forward virtual care platform like Zipnosis can map information from the virtual visit directly to the EMR, eliminating the need for double documentation. Advanced integrations can take things even further. HL7 and other EHR integration options can create patient records in the EHR, eliminating the need to create a new record when the patient comes in for an office visit. And, by pairing EHR integration with certain patient scheduling integrations, your health system can add an adaptive interview to the front end of an office visit. This provides the clinician with a structured clinical note already added to the EHR, giving them more time to interact with the patient and minimizing the amount of data entry necessary per visit.

5.  Get ready for the future

Moving forward, consumer driven data from wearables and the “internet of things” is going to inform health decisions – both from a patient and provider standpoint. The healthcare industry is poised to see numerous benefits from this transition, according to a recent CIO article. However, flexibility and communication are going to be increasingly important to reaping these benefits, particularly as technology moves forward. Effective integration between virtual care and your IT systems can tighten workflows, improve communication and give your health system the foundation to adapt as your patients further embed technology in their lives.

Put integration to work for you

At Zipnosis, we offer advanced integration options to effectively connect your existing systems with our leading-edge virtual care platform. We interoperate effectively with any EHR, and offer advanced options including:

    • HL7 integration, covering use cases for patient registration, transcriptions, billing, results, and more
    • CCDA integration with your EHR provides a more streamlined workflow and personalized adaptive interview
    • Advanced EHR integrations reduce the need for double documentation, since information is securely transferred from one system to another
    • Single sign-on (SSO) – both patient and provider portal options offer a more seamless experience
    • Integration with your patient scheduling system removes barriers to care and ties patients more closely to your health system
    • ZipTicket effectively provides service continuity between virtual visits and in-clinic services, increasing the number and type of conditions your virtual care platform can address

Want more information on virtual care? Check out our guide to best practices!

Do You Have to Sacrifice Clinical Quality for Convenience?

People are busy these days. And making a trip to the doctor either eats into working hours or free time. That’s why patients are demanding alternatives to the ways they access care.

This demand has forced health systems to take a leap of faith and offer telemedicine services. Some of which are based on outsourced clinical support. But can health systems depend on outsourced telemedicine vendors to provide quality care that adheres to national best practices? Can patients be certain the diagnoses and treatments they receive are accurate and clinically adherent?

JAMA Study Finds Guideline Adherence in Live Video Visits Spotty

Capturing quality metrics for the telemedicine space has been tricky. But researchers at the University of California at San Francisco decided to try anyway. They evaluated the care provided by eight telemedicine vendors against national best practices. It should be noted that Zipnosis was not part of the study.

Results of this 2-year study were published in the May edition of JAMA Internal Medicine, and were not encouraging. Over the 599 virtual visits studied, adherence to national best practice protocols for care ranged from 34.4 to 66.1 percent. The variation range increased for treatment of viral pharyngitis and acute rhinosinusitis (sinusitis), with clinicians adhering to guidelines anywhere from 12.8 percent to 82.1 percent of the time.

So, what did all eight of the companies evaluated have in common? All were direct-to-consumer telemedicine providers that exclusively use synchronous – or live – video technology, apparently lacking the use of effective clinical decision support tools to ensure guideline adherence, to treat patients.

Convenience without Compromise

While the results of this study don’t bode well for outsourced and direct-to-consumer telemedicine vendors that rely primarily on video, high quality virtual care is within reach. An internal review of more than 1,700 asynchronous patient encounters through two major health systems for treatment of acute sinusitis on the Zipnosis platform had contrasting results to the JAMA study – a guideline adherence rate of 95 percent.

The backbone of this success is the adaptive online interview embedded within the Zipnosis platform, which guides patients through a structured interview grounded in evidence-based national best practices. Once the interview is complete, clinicians receive a comprehensive clinical note and are then guided through curated diagnosis and treatment options based on patient inputs – the final diagnosis is issued by a local provider, not an outsourced clinician.

The whole process leaves little room for error; harried clinicians won’t miss a question and organically designed clinical decision support means patients get the right care quickly and consistently. Best of all, since Zipnosis’ partners use their own clinicians, they can directly monitor and improve clinical quality without the hassle of working through a 3rd party clinical team.

Patients are demanding more convenient access to healthcare. The data is clear: Traditional, direct-to-consumer, outsourced telemedicine services that address patient convenience face challenges in the area of clinical quality. In the absence of a better alternative, this would be fine. But it is time to stop compromising and expect virtual care to improve access and quality at the same time. At least, that’s what we believe and are proving here at Zipnosis.  

2016 Telemedicine Predictions

Another banner year in virtual care/telemedicine.  Last year I ventured out with some predictions [read here]…you be the judge on my accuracy, but I think I could potentially play baseball for some minor league amateur softball team with my average.  If it was slow pitch.  Maybe.

So time to sharpen my dull pencil again and commit to some good laughs at 2017’s New Year’s party!

1. The Whole Virtual Care Kitchen includes Async:

Consumers and physicians have spoken clearly that video is not the preferred method for virtual interaction for simple conditions; this despite some massive legislative machinations from industry insiders to orient telemedicine legislation around video-based encounters.  As I have preached for years, this video fad is just that – it will pass as the economic value of asynchronous visits becomes mainstream.  Look for 2016 to be the year when asynchronous visits account for more than 25% of all virtual encounters across the country.

 2. #value is Telemedicine v2:

As the market matures around telemedicine and virtual care, so will the ability to calculate a true ROI around virtual care.  With so many companies grappling for consumers, providers and payers, having just another video solution with a clinical network won’t be enough.  Vendors who can’t demonstrate an ROI will be left in the dust.  The handful that can will find receptive buyers.  The hashtag for ATA this year won’t be #features but #value.

3. Prove it! Series A Investment will Wane:

The VC community will pull back for a bit on higher risk Series A investment in virtual care/telemedicine companies as they evaluate how the market begins to settle.  Start-ups that are in a proof of concept/beta phase will need to demonstrate true market adoption or transformative product differentiation to attract growth capital.

4. The Yellow Brick Road to Profitability:

Some telemedicine companies are touting adoption rates 3-5x actual utilization.  This will start to backfire on them as more transparency around adoption becomes available to the market.  Healthcare providers and payers will hone in (per #2) on facts/data in 2016 and orient investment/partnerships accordingly.  The halcyon days of hope will become a distant memory.  To this end, there is no wizard of Oz for driving consumer adoption – but there are viable business models that will weather this transition.  The companies investing in basic economics and product/market fit will survive or be acquired at a premium.

There you go.  Perhaps a little more vague than last year, but I sense the market truly maturing in 2016, especially on the health system side.  Of course, I’ll look forward to being surprised along the way.  Agree/disagree?  Love to hear your thoughts.  Here’s to a dynamic 2016!

Attracting Millennials Through Virtual Care

Today’s millennials are adept at all things mobile and look to technology as a starting point for most things in their digital lives. As healthcare systems work to build their future patient base, it is imperative to meet these digital natives where they are by offering clinical care options that are convenient as well as effective.

Virtual care is a perfect conduit for health care providers to build a relationship with millennials, however it can be difficult to instigate the initial relationship. The current medical regulatory environment often requires that patients establish a relationship with a provider via a bricks and mortar site before enabling them to offer virtual care options.

And while this may be seen as a hurdle, it is one that is easily scalable and well worth it. This demographic is keenly aware of the digital landscape and more often than not will choose a provider that will enable them to have the equivalent of a clinic in their pocket via a mobile device.

In addition, in marketing your virtual care offering to millennials and beyond, it is important to position it as a natural extension of your mission – versus an either-or alternative to the traditional clinic. Not only will this build your reputation as a provider that offers an array of options to its patients but it also further strengthens your identity in the community.

Given that more and more healthcare systems are transitioning from a fee-for-service to a fee-for-value proposition, millennials will not only appreciate the trend but embrace the options that are available to them.

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.

Non-Traditional Competition for Health Systems

We all know that healthcare is local.  And the backbone of the U.S. healthcare system is local physicians and hospitals. Currently, health systems are under immense pressure from non-traditional competitors: retail pharmacy chains. Times have changed and this new insurgent threat is chasing the coveted digital patient

Large retail pharmacy chains are opening hundreds of new walk-in clinics and forming broad telemedicine partnerships with the ultimate goal of becoming traditional primary care providers. They’re following the trend of consumerization in healthcare and betting that patients want speed, convenience and easy-to-understand prices over a hospital-affiliated doctor to handle all of their medical issues. Often times, these competitors are targeting the younger, healthier patients that feed health system growth for years to come. This rapid growth of non-traditional competitors suggests hospital-based health systems have a growing market relevance challenge.  As a health system, what are the different strategies to respond to this competition? How can you move not just quickly but in the right direction to compete for and capture this new digital patient?

Patient Leakage vs Patient Stealage

Patient leakage has been top of mind for healthcare providers for years.  Even more so now that health systems are taking on risk for patient populations.  Patient leakage may occur because of convenience, change in health insurance plan or old referral patterns. That’s changing now.  “Stealage” is the new reality.  The partnership between large retail pharmacy chains and major outsourced telemedicine vendors means that patients now can choose to go completely outside the traditional care network.  This has potentially profound implications, not just for the business of healthcare providers, but for patient safety and care on a long-term basis.

Although retailers may have a lot of clinics, they do not have the infrastructure or ability to properly care for patients on a long-term basis. They are betting that health systems aren’t going to be able to move quick enough to provide the ready access and convenience to care that the new healthcare consumer is demanding…so instead of patients simply leaking out of a provider’s network, they are stolen.  The result is retailers capture all the easy value and control referrals and access points.  Provider networks are saddled with expensive, high-risk patients while negotiating with retailers for patient referrals. So how do health systems respond to this threat and prevent patient “stealage” from becoming a reality?

Strategies to Prevent Stealage

There are two key strategies that allow health systems to respond immediately with their own convenient access points while building sticky experiences for patients over the long-term:

  1. Rapidly enter your market with your own convenient access point
    Health systems need to respond immediately with a virtual care service that promotes their brand and clinical services. Retailers and outsourced telemedicine vendors are betting that health systems will move too slowly to react to this threat. By responding quickly, health systems can put the foundation in place for their convenient access points where they can begin to build stickier experiences over time.
  2. Appeal to digital consumers by extending your brand digitally
    Healthcare is still local and about trusted relationships. National retailers and outsourced telemedicine vendors are pursuing the digital consumer, but will have difficulty competing with health systems who are using the power of their local brands to build sticky relationships with digital consumers. This is a long-term strategy that will take years to play out. For it to succeed, health systems need to shift their marketing dollars from internal, traditional channels to external, digital channels.

So – two strategies to help health systems respond to the “stealage” threat. If systems can compete for convenience, they will win long-term because healthcare is still local and about trust. Neither strategies are all it takes, but both are great first steps in responding to non-traditional competitors.