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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.

Our Take: Net Neutrality, Virtual Care, and the Deregulation Demolition Derby

HTML Code: Photo by Markus Spiske on Unsplash

Photo by Markus Spiske on Unsplash

In a 3-2 vote December 14th, the FCC decided to overturn its rules around net neutrality. But, what does this deregulation mean for virtual care?

While no one can truly know the future, some very real concerns have been raised about the impact of internet deregulation on virtual care. As an industry, healthcare relies on the internet to support numerous technologies and services. Particularly when it comes to virtual care, maintaining a basic level of access is critical.

The intent of net neutrality regulations were to help ensure a level playing field for internet users (we call them patients) and businesses and other organizations by banning paid prioritization. That means internet service providers aren’t able to modulate speeds based on the destination. FCC Chair Ajit Pai has stated that eliminating this ban will enable the ability to prioritize healthcare services, though others responded that the regulations allowed for internet “fast lanes” for healthcare and other critical services.

Many thought leaders, however, believe that the repeal of net neutrality has a high likelihood of diminishing access to online care delivery and actively harming small practices. Hematology and oncology publication Healio noted specifically that individual providers and those in rural areas are vulnerable in a tiered pricing system. A pre-overturn piece in Modern Healthcare also noted that, “Prohibitively high Internet costs could exacerbate health disparities between high- and low-income people and between people in urban and rural areas.”

Deregulation’s Impact

I’m less concerned about the impact of deregulation on the internet service provider (ISP) industry than I am about the downstream effects. Healthcare has traditionally been local, with the patient-provider relationship at the heart of care delivery. The regulatory environment already poses challenges to health systems and providers, and healthcare systems throughout the U.S. are facing well-documented financial challenges. This deregulation adds a further layer of complexity and potentially cost for providers and health systems already facing unprecedented challenges.Photo by Deva Darshan on Unsplash

Eliminating the ban on paid prioritization and moving to a tiered pricing system has the potential to unleash a “demolition derby” effect. Smaller organizations like rural providers and critical access hospitals with fewer resources may find themselves crushed and pushed aside. Non-profit health systems which are on increasingly tight operating budgets and are facing a negative outlook for 2018 according to Moody’s, may need to route limited resources away from clinical services and into purchasing connection speeds. Industry monster trucks could end up with free reign to roll over the competition.

Managing Risk in the Demolition Derby

Where telemedicine stands to lose the most is in the modalities that truly require bandwidth like video-based care delivery. And this is important because, as much as I may have railed against the over-reliance on video in the past, it is an important modality for certain patients and use cases. It’s vital that video-based care be able to flourish, along with other bandwidth intensive telehealth needs such as diagnostic imaging.

While a knee-jerk reaction is never a good idea, as citizens and members of the digital health community, it’s important that we monitor how this repeal impacts patient access to care and the ability for all providers and healthcare organizations to deliver care online. Chairman Pai believes that eliminating net neutrality restrictions will improve access to online care for patients. While I’m not fully convinced, I am adopting a hopeful attitude. Organizations like the American Telemedicine Association are closely watching and ready to mobilize if patient access is threatened.

In the interim, providers and healthcare organizations can mitigate their exposure posed by the repeal of net neutrality regulations by leveraging technologies that require lower bandwidth to provide online care. Store-and-forward technology, like our online adaptive interview, provides access to care that doesn’t require the same bandwidth as face-to-face video visits, while maintaining a high standard of care. In fact, it was the use of mobile phones in rural Africa, over super thin bandwidth cell networks, that inspired me to start Zipnosis. One of my maxims is that constraints are where innovation occurs. With new regulation comes new constraints and also new innovations to maximize our potential for better access to healthcare.

What the Net Neutrality Repeal Won’t Do

We don’t have a clear picture of precisely what this deregulation will do, but the one thing it won’t do is slow the adoption of online care. Offering a virtual care solution, tiered bandwidth or no, is going to be critical to the success of health systems and providers going forward.  As such, we need to do our best to manage risk, support care delivery online, and work together as an industry to help ensure that providers and patients are in the driver’s seat.

Healthcare Regulation: Virtual Care Goes to Washington

Healthcare regulation: It’s a challenging, complex, and fascinating thing. And it becomes even more so when new technologies like virtual care are added to the equation. We all know that technology moves at the speed of light – after all, people are now entering the workforce who never lived in a world without the internet. Regulation, however well-intentioned, just can’t keep up.

Fortunately, telemedicine and virtual care are increasingly on the radar of legislators. After attending a gathering at the Senate Broadband Caucus and the American Telemedicine Association’s EDGE conference, both in Washington D.C., I can confirm there is significant interest in the benefits that virtual care can bring to all healthcare stakeholders: Patients, providers, and payers.

The Senate Broadband Caucus

Dr. Hafner-Fogarty demonstrates the Zipnosis platform for Senator Amy Klobuchar

Particularly in rural areas, one of the key challenges to making telemedicine and virtual care accessible is reliable, fast internet. This is particularly important for more bandwidth-intensive modes of care like video, but even our online adaptive interview does require an internet connection to function. I was able to present to a number of Senators, staffers, and other interested parties, sharing how the Zipnosis platform works and outlining the benefits that virtual care can bring to both rural and urban populations.

ATA EDGE

The ATA’s fall event this year was held in D.C., and had a distinct regulatory focus. Discussions focused on virtual care and telemedicine challenges like reimbursement, standard of care, and geographic limitations. It was gratifying to connect with fellow ATA members and hear their perspectives on the current state of virtual care regulation.

Federal Healthcare Legislation Today

Another topic of focus at these meetings and in the virtual care and telemedicine industry, is the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2017, also known as the CONNECT Act. This is important bipartisan, bicameral legislation that removes CMS barriers to using telehealth for Medicare and Medicaid patients. As a consequence, this bill has industry-wide support—HIMSS named it as one of their 3 Congressional “asks” for the 2017-2018 legislative session.

A conversation with Senators Heidi Heitkamp and Shelly Moore Capito at the Senate Broadband Caucus meeting

Currently, the CONNECT Act is with the Senate’s Finance Committee. However, there is clearly an appetite for this type of legislation on the hill. Last month, the Senate unanimously passed the CHRONIC (Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care) Act of 2017, which among other things, addressed expanding access to telehealth for Medicare populations. It’s still early in the legislative process, but I’m hopeful that the CONNECT Act will receive the same support in the Senate, and that both bills will clear the House.

A recent article on the Health Affairs blog noted that access to care is a universal challenge – not just a rural one. Using healthcare policy changes to remove barriers to virtual care and telemedicine is an important aspect of my work at Zipnosis, and I’m pleased to see support for legislation that will do just that.

About the Author

Rebecca Hafner-Fogarty, Zipnosis Chief Medical Officer

Rebecca Hafner-Fogarty, MD, MBA, FAAFP, Senior Vice President of Policy and Strategy

In addition to being a primary care physician and serving as Senior Vice President of Policy and Strategy at Zipnosis, Dr. Hafner-Fogarty has extensive experience in medical regulation, serving on the MN Board of Medical Practice from 1998-2003, 2004-2010, and 2012-2016. She served as board president in 2009 and has also been involved in medical regulatory activities at the national level.

Telemedicine Regulation: Then and Now

Zipnosis’ Chief Medical Officer, Dr. Rebecca Hafner-Fogarty, goes back to the early days of telemedicine and follows the path of regulation. From the early days of rogue internet pharmacies, to the complex challenges of today’s regulatory environment, this post for the Southwest Telehealth Resource Center is a primer on the history and future of regulation for telemedicine and virtual care. Read more.