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3 Reasons to Benchmark Your On-Demand Virtual Care Program

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

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

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

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

Reason 1: Understand the Current State

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

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

    • Gaps, strengths and opportunities 

 

    • How your program compares to peers

 

    • Whether you are effectively measuring success

 

    • Current competitive position

 

  • Effectiveness of your current strategy

Reason 2: Be Strategic in Planning and Growth

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

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

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

Reason 3: Performance Improvement

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

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

Lend Your Voice: Virtual Care Benchmarking

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

Benchmark survey

Virtual Care and the Quadruple Aim

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

Achieving the Quadruple Aim

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

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

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

Aim: Improve Patient Access

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

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

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

Aim: Improve Health Outcomes

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

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

Aim: Lower Overall Healthcare Spend

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

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

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

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

Aim: Reduce Physician Burnout/Improve Physician Engagement

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

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

Healthcare Going Forward

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

 

About the Author

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

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

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

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

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

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

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

Telemedicine = Testing; Virtual Care = Viable

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

Telemedicine = Analog; Virtual Care = Digital

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

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

Telemedicine = Transactions; Virtual Care = Value

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

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

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

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

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

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

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

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

The Telemedicine Switch: Taking Healthcare Delivery from Analog to Digital

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When telemedicine was born, making a phone call required an operator from one of the Bells to physically switch lines in her circuit board. To buy another “line” literally meant running a phone line from that switching board to your house through the ground and air.

Analog healthcare delivery

Today, we have a “standard” of telemedicine that is still phone calls. Yes, we have video, but if the data from the industry is valid, it’s still #2 to phone calls by a long shot. (And, if you read my other posts you know that video won’t be the standard in healthcare because…well…it’s not the standard in any other industry).

Previously, I noted that it’s important to distinguish between a new healthcare experience in telemedicine and embracing telemedicine as the future. It’s true that most patients have never engaged in telemedicine (though that’s rapidly changing), so the analog still feels fresh. We perceive telemedicine as being state-of-the-art. But it’s not.

This is especially true for regulators and payers who are just now beginning to embrace alternative care models. They are tied to the mode of care that looks most like what care has always been – so a bit of an “innovation bias” still exists in the industry.

Telemedicine 2.0The trouble is that telemedicine’s DNA is the same as Blockbuster’s or Ma Bell’s: it’s analog. It’s tied to physical objects or locations, like cathode ray tubes, cords, carts, and call-centers. Improvements touted in telemedicine are higher definition screens and faster call-back times. Imagine if Steve Jobs had not released the iPhone but instead released a flip phone that simply had a faster speed-dial with a prettier display – that’s “Telemedicine 2.0.”

 

The Digital Age is Here

Unfortunately, Telemedicine’s analog DNA has reached its evolutionary pinnacle. Call-back times and call centers can only scale so far; their flawed unit economics collapse; their data silos crumble.

As digital technologies become more and more commonplace, the old telemedicine models are beginning to show their age.

Virtual Care: The Next (Digital) Frontier

Just like cell phones and WiFi are the natural digital successors to land lines and dial-up modems, we have virtual care as a digital progenitor of telemedicine. Where telemedicine grew out of hard-wired, analog telecommunications, virtual care’s roots are digital, meaning that it has almost no reliance on physical objects. Instead, virtual care is logical, device agnostic, and data-driven. Virtual care connects systems and data by nature, not exception. APIs and SDKs frolic between platforms.

What this means for healthcare cannot be understated.

The transition to virtual care will usher in wide-spread adoption by patients, it will break down data silos that muck up efficient and effective healthcare delivery, and it will uncork pent up economic innovation in the industry. This is certain – how fast this it all happens depends on, well, the switching costs.

Telemedicine = Analog Virtual Care = Digital
  • Equipment: Hardware-specific
  • Equipment: Device-agnostic
  • Connection: Call center
  • Connection: Cloud-based
  • Quality: Proprietary data
  • Quality: Standards-based
  • Integration: One-off interfaces
  • Integration: API & SDK
  • Efficiency: Limited difference from in-person
  • Efficiency: High for patient and provider

About the Author

Zipnosis CEO and virtual healthcare delivery visionary, Jon Pearce

Jon Pearce is co-founder and CEO of Zipnosis. As a healthcare entrepreneur with experience in med-tech start-ups and as a venture analyst, he is focused on leveraging the power of technology to improve the way health systems engage with and treat their patients.

Financial Sustainability: How to Add Revenue to Your Health System with a Virtual Care Service

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Recently, KPMG released a survey that found the number one barrier to health systems launching virtual care is lack of financial sustainability. Simply put, health systems aren’t seeing how virtual care produces returns. And in an environment where budgets are tight and expenditures are closely monitored, justifying the investment in virtual care technology can be challenging.

There’s just one problem with this barrier—it’s not real. The perception that virtual care doesn’t produce a sustainable financial return is rooted in the old “telemedicine” mode of thinking. In reality, health systems are seeing the financial benefits of offering a virtual care service today. This isn’t just a pipe dream – it’s backed by data.

Finding Financial Sustainability

I’ve had virtual care financial returns on the brain lately, trying to figure out how health systems are missing the ROI virtual care produces – and I think I’ve hit on an answer. The reason such a large misunderstanding around the true value of virtual care persists within the healthcare community is the focus on transactional revenue and outsourced telemedicine networks. I touched on this a recent blog post. Measuring returns by looking exclusively at transactions is an outdated way of viewing virtual care’s impact. It’s consistent with the fee-for-service mentality most health systems are rapidly leaving behind – not with modern, value-based reimbursement and digital care delivery.

Unlike traditional telemedicine, the financial return from virtual care goes beyond the individual transaction, appearing as downstream revenue impacts. This is evident in areas like diminished patient leakage, reduced cost of care delivery, and most importantly, patient acquisition.

The Real Virtual Care Value

Recent research from healthcare analytics company Carrot Health demonstrates exactly how virtual care is increasing the revenues for one Zipnosis health system client. Carrot Health followed a cohort of 974 virtual care users who had not received in-person care in the 24 months prior to their virtual encounter – matching the health system’s definition of a new patient.

In a new white paper, Carrot Health revealed that this large, integrated health system saw 25% of new virtual care users convert to health system patients by using additional, in-person services within 12 months of their online encounter. With an average annualized per-patient revenue of close to $3,000, these conversions translated to more than $700,000 in additional revenue over the study period.

In a recent article I wrote for Becker’s Hospital Review, I noted that this is just the tip of the iceberg. Applied over a longer period, or for a larger population, the revenues increase exponentially. For example, a population of 2,000 new virtual care users at the same conversion rate would produce revenues of $1.5 million. How’s that for financial sustainability?

And, the Market Says…

Have you wondered about the venture money funneled into virtual care and telemedicine software companies over the past few years? The data suggesting patient preference for online care, while interesting and valuable, isn’t enough to sway investors. It’s the ability to see the potential financial impacts virtual care can have on health systems that gets venture firms excited.

When asked about the reasons for investing in Zipnosis, Matt Hermann of Ascension Ventures noted, “In today’s environment, compelling ROI data like Carrot Health has compiled about Zipnosis’ virtual care offering will help health systems parse through the innovation noise and have confidence in making critical business decisions. We think every health system should be deploying multi-modal virtual care solutions like Zipnosis for both short term and long term success.”

And long-term success is really the name of the game. Virtual care is transitioning from being an interesting but unimportant feature to a vital care delivery channel. Health systems are using virtual care to find financial sustainability by adding patients and revenue today. And as this transition builds steam, the returns health systems will see are only going to grow.

When it Comes to Virtual Care Technology – Think Twice, it’s Alright

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More and more, health systems are looking to telemedicine and virtual care technology to improve access by connecting patients with clinicians. It’s no secret that providing care online is critical to remaining competitive and meeting patient demand. With online healthcare hitting the mainstream, health systems are moving faster than ever into the direct to consumer market. Sounds easy, right?

Don’t Get Stuck with Betamax

Let’s take a walk down memory lane to the early 80s. Video was busy killing the radio star, and two competing technologies were vying to be the king of video: VHS and Betamax. Ultimately, VHS won the videotape format wars, and Betamax technology (and tapes) disappeared from store shelves. The people who purchased Beta machines and video libraries were left with a choice: forgo video entirely until the next big technological advance comes along or purchase a whole new system and video library.

There was no real way for consumers in the post-disco era to hedge their bets about video technology. VHS and Beta were both expensive new technologies and were wholly incompatible. Fortunately, health systems moving into online care aren’t in the same boat.

Telemedicine is Today; What’s Tomorrow?

Traditional telemedicine tools, including video consultations, have been around since the 60’s, though they’ve only been available to patients for the past 10 years or so. Those tools definitely have their place. They enable patients and providers to connect in real time and are typically embraced by today’s high-value patients – people over 65 and those with chronic conditions. A recent Deloitte survey showed that those high value patients were significantly more likely to only use digital health tools to connect with their regular healthcare provider. But less than ⅓ of millennials would put the same restrictions around online care.

Similarly, baby boomers and the older members of generation X are more inclined to want a real-time, personal interaction with a healthcare provider. Overall, younger generations are less interested in a personal interaction and more interested in making the whole healthcare experience quicker and more efficient. That means that the high value patients of tomorrow aren’t as interested in video consultations or phone calls with their providers. So, how is a health system supposed to meet the needs of today’s patients and tomorrow’s?

Where do We Go from Here?

The optimal option for health systems looking to make a safe online healthcare bet is combining traditional telemedicine with transformative virtual care technology. This pairing gives health systems and their patients the best of both worlds: personal interaction through a real-time consultation and efficient virtual care. Working together, these access points create a digital “front door,” making it easy for health systems to provide the care individual patients need, when and how they need it.

Just like investing in a Beta machine was a safe bet for 1980 (it was developed by Sony, after all), investing in a traditional telemedicine solution alone is a safe bet today. It means you’ll be able to effectively help today’s patients with today’s needs. But true safety doesn’t lie exclusively in what consumers want right now – the safest choice is preparing for what they’ll want tomorrow, too.

Best Practices Guide to Virtual Care

5 Unexpected Benefits Integration Brings to Your Virtual Care Service

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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!

Launching Virtual Care: Myth vs. Reality

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If you are interested in launching a virtual care service, you are not alone. While market estimates vary, one thing all analysts agree on is that virtual care, also known as telemedicine, is growing rapidly and will continue to do so for the foreseeable future. This growth – past, current and anticipated – has flooded the marketplace with companies that offer telemedicine services, as well as three big myths related to launching a virtual care service.

Myth: You don’t have the clinical capacity to support virtual care.

Reality: You can manage thousands of virtual visits annually with your current staffing.

Outsourcing may initially seem appealing, but with external clinicians serving your patients, you lose control over clinical quality and may experience greater patient leakage. By leveraging marginal capacity through a virtual care platform, you can actually increase the number of patients treatable by your current clinical staff.

Myth: If you build it, patients will come.

Reality: Virtual care is a service, not a technology.

If you build in-house, you’ll have ultimate control. But that comes at a premium cost and with significant time investment. And, you don’t have any guarantees that the tool you build will match patients’ needs and expectations.

Myth: Embedding virtual care in your organization will be too hard.

Reality: Integrating virtual care takes as little as 60 days.

Buying a virtual care platform offers a middle road for cost and control, and the software as a service model makes for a quick launch. By starting small, securing organizational buy-in and scaling appropriately, you can grow your service to meet additional patient needs and maximize clinical efficiency.

Balancing the costs and rewards of your options can be challenging. How is a health system to decide what model of virtual care is best for them?

Start by checking out our ebook To Outsource, to Build or to Buy? for valuable information that will help get you started on the path best suited to your health system.

Killing the Video Myth

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There’s a pervasive myth in the telemedicine space that video might be necessary for effective virtual treatment of patients – for any condition. Proponents argue that there’s no way clinicians can fully understand a patient and provide a diagnosis without a face-to-face interaction, even if that interaction is digital. This is simply not true.

Virtual care using adaptive online interview technology gives clinicians the ability to effectively diagnose and treat patients without a video encounter. How effectively? A Zipnosis review of more than 1,700 virtual encounters for sinusitis found that clinicians provided guideline-adherent care in 95.4 percent of cases.

Sometimes called asynchronous visits or “store-and-forward,” adaptive online interviews offer the patient benefits of convenience and access, while providing high levels of clinical quality, efficient diagnoses and a streamlined provider workflow.

What is an Adaptive Online Interview, really?

Maybe it’s best to start by stating what an adaptive interview isn’t. An adaptive online interview isn’t an online questionnaire like the Epic toolkit provides. Rather, it is a powerful expert system that uses branching logic to intelligently interview a patient about their symptoms. This smart approach asks patients only relevant questions determined by demographic information and previous responses, just like an interview with a provider during an inpatient visit.

Zipnosis Online Adaptive Interview

Adaptive online interview (also called structured asynchronous or store-and-forward) collects patient data and sends electronically to the provider.

What’s so Great About the Adaptive Online Interview?

On the Zipnosis platform, we leverage the adaptive online interview to gather patient-entered information in a structured and efficient way. Our adaptive online interview asks the same questions a clinician would ask during  in-person visit – but never forgets a question. The information collected is packaged into a comprehensive clinical note and sent to the clinician for diagnosis and treatment. The result is a totally digital diagnosis and treatment process. Unlike any other platform on the market, Zipnosis unlocks immense benefits:

Time savings: On average, patients complete their adaptive online interview in a fraction of the time taken by an in-person visit. No travel time, no waiting rooms – just convenient access anywhere, anytime.

Clinical quality: The adaptive online interview is grounded in clinical best practices, and the Zipnosis platform leverages patient responses and clinical guidelines to offer clinical decision support, including curated diagnosis and treatment pathways. This helps clinicians provide high quality, guideline-adherent care.

Clinical efficiency: On average, providers trained on the Zipnosis platform can review the provided clinical note and make a diagnosis and treatment recommendation in approximately 2 minutes. And patients typically receive diagnosis and treatment recommendations within an hour of completing their virtual visit.

Provider experience: Providers appreciate the comprehensive information provided, the ease of use and the ability to focus their time on patients with more complex needs, while still offering high quality care for common conditions.

Reporting and analytics: The adaptive online interview model captures a great deal of visit and program data. Using our Statnosis™ reporting and analytics tool, health systems can follow trends related to conditions treated, visit timing, guideline adherence, and triaged patients. All data is de-identified and HIPAA compliant.

But Don’t I Need Video?

Short answer: maybe. But the efficiencies of virtual care are best realized when tasks are shifted from the clinician to the patient. Leading health systems understand this and leverage the adaptive online interview in concert with video to reap the benefits of clinical quality and efficiency while meeting patient or regulatory needs. And with Zipnosis’ intelligent video capabilities, you can, in fact, have it all.

Some health systems incorporate video as an additional step to help treat some patients that would otherwise be triaged to physical locations. Others operate in a regulatory environment that requires video; they leverage the adaptive interview on the front end of the encounter to help save time for both clinicians and patients. Still others choose to launch an adaptive online interview platform alongside their existing video telemedicine service as an additional entry point to their system.

As for video alone? Well, our CEO Jon Pearce says it best: “When’s the last time you ordered something from Amazon with a video call?”

So, what you’re saying is…

Whether employed alone or alongside a video or telephone encounter, adaptive online interview technology offers both patients and providers a quicker, more effective diagnosis and treatment option. Adaptive online interview technology is the future of virtual care; welcome to the future.

Shopping the System by Zipnosis

Can Virtual Care Reverse Clerical Burden Induced Physician Burnout?

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The healthcare industry is faced with a crisis: physician burnout. An article in the September/October edition of Family Practice Management labeled physician burnout an “epidemic.” And this epidemic is costing health systems in a major way.

Physicians experiencing burnout are less engaged, leading to higher levels of turnover and an increased likelihood of medical errors – both of which can dramatically affect a health system’s bottom line. Moreover, burnout may lead to increased substance abuse, depression and suicide among medical professionals.

While there is no one single cause of burnout, recent research published in Mayo Clinic Proceedings indicates a correlation between use of EHR/EMR systems and physician burnout. Mirroring findings from a report issued in 2013, this new research indicates that things have not improved over the past several years.

The link between EHR/EMR systems and physician burnout is the amount of time spent on administrative or clerical tasks, such as data entry. The more time physicians are required to spend entering data into their EMR, the lower their job satisfaction and the higher their likelihood of burnout.

Traditional Telemedicine Falls Short

Traditional telemedicine, where physicians interact with patients via telephone or video chat, doesn’t lessen the burden of data entry. Physicians must still spend significant time on documenting the encounter. This type of telemedicine service requires a physician be waiting at a computer terminal for a patient to request a virtual visit. Consequently, physicians supporting telemedicine may be tasked with additional clerical or administrative work to fill the time between patient calls.

Far from lessening administrative burden, this may actually put greater strain on clinicians who support a direct-to-video telemedicine service.

Technology May Still be the Answer

While traditional telemedicine doesn’t offer a solution to physicians’ ever-growing list of administrative tasks, technology applications can still offer some respite. QuantidaMD, a community and educational resource for physicians, suggests that mobile health and virtual care might offer a solution to combat burnout. They indicate that technology can empower patients to take control of their health, as well as offering physicians simple means of capturing patient data.

Mobile health (mHealth) and virtual care have the potential to significantly decrease the amount of data entry required of physicians. In a recent whitepaper on mobile technology, Athena Health noted that mobile devices and apps can help optimize clinical workflows and patient care through clinical decision support, enhancing clinical efficiency, and providing tools for engaging patients and supporting population health.

So, How Does that Work in Practice?

At Zipnosis, we view virtual care technology as a means to meet patient needs while making life easier for physicians. We leverage an online adaptive interview, which asks the same questions a clinician would and records patient responses. Clinicians then receive a comprehensive clinical note, along with clinical decision support in the form of curated diagnosis and treatment options. Physicians can diagnose and prescribe treatment for common conditions with just a few taps on their smartphone or tablet.

The best part? All data from the virtual visit is securely transmitted to the health system for inclusion in the EMR, eliminating the need for physicians to spend their time entering information into an EMR. And, we offer health systems deeper integration options, which can further simplify the process and enhance physician experience.

People don’t seek out a career in medicine because they want to spend hours each day on data entry. Rather, they want to solve problems and help patients. At Zipnosis, our goal is to offer innovative access to mainstream medicine, while easing the burden on providers. We’re gratified to find that our obsessive focus on ease of use has created a platform that can help address this growing cause of physician burnout.

A Step in the Right Direction – New AMA Policies Will Benefit Virtual Care Telemedicine

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The virtual care and telemedicine industry is evolving quickly. Over the past several years, we’ve seen major shifts in how care is delivered, increased adoption by both health systems and healthcare consumers, and a number of new companies entering the market. And these shifts are just the beginning. It’s vital we remain focused on how to manage what is coming next – because it’s coming quickly.

At their most recent meeting, the American Medical Association (AMA) addressed the telemedicine industry with new ethical guidance on telehealth and telemedicine, recommendations for including telemedicine training in medical school and residency programs, and a promise to advocate for parity laws that require insurance to cover telemedicine and virtual care services.

We believe these guidelines are a step in the right direction, and offer a jumping-off point for moving virtual care telemedicine forward.

Ethical Guidance

These guidelines are aimed at bringing consistency in quality care delivery to virtual care. As noted in our recent industry call to action, there are some serious issues facing our industry – not the least, a huge gap in quality reporting standards.

Key elements of the AMA’s ethical guidance included informing patients  of the limitations of services provided, advising them on how to arrange follow-up care, and encouraging them to inform their primary care doctor when they engage with a telemedicine provider.

What does this mean? Well for one, physicians can leverage the AMA’s guidance to help them determine whether a diagnostic evaluation and prescribing therapy through telemedicine technology is viable and appropriate. It also provides a clear set of industry standards that can help health systems effectively evaluate vendors as they seek to launch a virtual care service. A definite step in the right direction.

Training

Health systems count on undergraduate and graduate schools, as well as residency programs, to ensure new clinicians have the tools and skills necessary to care for patients. Increasingly, this means use of technology, including virtual care and telemedicine solutions. It is a very welcome development that the AMA is now calling  for greater incorporation of technology training in these programs. With greater knowledge and understanding of virtual care, new clinicians will be well positioned to help health systems take the necessary steps to meet patients’ evolving needs.

Insurance Parity

Lack of reimbursement for virtual care and telemedicine services is often listed as one of the prime barriers to greater adoption. We’ve been advocating for parity for years as we seek to help our clients offer virtual care telemedicine to their patients. While more than half of states have laws requiring insurers to reimburse telemedicine-delivered services, the reimbursement landscape is still disjointed.

The AMA’s promise to advocate for insurance parity can help even the playing field and bring greater consistency to reimbursement from state to state. In support of insurance parity, the AMA said it would develop model legislation to achieve parity at the state level and work with state medical boards to draft model state legislation defining telemedicine for inclusion in state-level medical practice laws and regulations.

Going Forward

Virtual care and telemedicine continue to be the future of healthcare delivery. This forward-thinking gives our industry the guidance it needs now, and the long-term support to continue our current trajectory.

From bringing consistency and standardization to quality of care in the telemedicine industry, to giving the next generation of clinicians the tools they need to effectively navigate virtual care, to leveling the playing field to enhance access to virtual care and telemedicine services. We applaud the steps taken by the AMA, and are excited to be part of building the future of the virtual care industry using the foundation they’ve provided. And we hope our industry peers and the AMA will join us in leveraging evidence-based policy in this process.

Do You Have to Sacrifice Clinical Quality for Convenience?

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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.  

You Say Access, I Say Convenience

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

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

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

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

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

  1. Add new patients

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

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

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

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

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

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

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

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

  1. Avoid “stealage”

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

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

The future is fast upon us

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

Resources

Report: 2018 On-Demand Virtual Care Benchmark Survey Report

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2018 On-Demand Virtual Care Benchmark Survey Report

Virtual care is increasingly critical in healthcare delivery, and numerous surveys and studies have been done evaluating everything from effectiveness to patient readiness to provider adoption. This body of research is lacking in one crucial area: how health systems are deploying and using virtual care. The 2018 On-Demand Virtual Care Benchmark survey is our attempt to fill that gap.

The results of this report are organized into three key categories: virtual care operations, technology and clinical.

Virtual Care Operations

This section explores how virtual care is set up and supported in healthcare organizations.

Topics include: Patient populations and utilization, strategy and operational responsibility, budget and finance, goals and challenges, and future plans.

Technology

This section looks at the technology used for on-demand virtual care, as well as how virtual care fits into the digital health landscape.

Topics include: Modalities, integration, other telehealth solutions in place, other patient-facing technologies in use.

Clinical

This section delves into clinical uses and outcomes from on-demand virtual care programs.

Topics include: Staffing and efficiency, conditions treated, and clinical quality.

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