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.

Value-Based Care: It’s Here and Virtual Care is Part of the Equation

We’ve all seen the news. Value-based care is coming, it’s inevitable, it’s here. But many health systems have yet to see major impacts from value-based reimbursement models such as accountable care organizations (ACOs), bundled payments, or patient-centered medical homes. Consequently, it’s easy to think that the hype around value-based care is just that: hype. We need to think again.

It’s not Hype

Value-based care really is coming, and soon health systems won’t be able to escape it. In early 2015, the Healthcare Transformation Task Force announced that 20 major health systems and insurers committed to moving 75% of contracts into value-based arrangements by 2020. The U.S. Department of Health and Human Services (HHS) expects that by the end of 2018 half of Medicare payments will go to alternative payment models, such as ACOs and healthcare organizations that accept bundled payments. And, a 2014 study by Avility revealed that more than 60% of providers expected value-based payment models to become dominant going forward.

What is Value-Based Care?

Traditionally, reimbursement has been volume-based. Under this model, providers are paid based on the number and type of visit. At its core, value-based healthcare encompasses a series of alternative payment models designed to support the triple aim of better patient access, lower healthcare costs and improved clinical quality. These models include accountable care organizations (ACO), patient-centered medical homes (PCMH), pay-for-performance and bundled payments. Under each of these payment models, health systems and providers are rewarded when they deliver quality care using fewer resources.

So, how can health systems who still operate in a volume rather than value-based reimbursement environment get ready for the shift? Look to virtual care.

The Impact of Virtual Care in a Value-Based Environment

Health systems looking toward the transition from volume to value-based care can benefit from launching a patient-provider virtual care solution. Virtual care can help health systems reduce costs by transitioning patients to a lower-cost access point, minimizing office visits, urgent care encounters and even trips to the emergency room. Health systems can also see the benefit of enhanced patient health outcomes, including stronger patient engagement and population health management.

Dr. Deborah Greer of John Muir Health discusses the online adaptive interview from the perspective of value-based care. 

Lowering Cost of Care

The online access point in a virtual care service offers health systems and patients a lower-cost diagnosis and treatment option. Using a “store-and-forward” solution like the Zipnosis online adaptive interview enables providers to diagnose and treat common acute conditions quickly and efficiently. Provider time per visit on the Zipnosis platform is typically around 2 minutes to diagnose and treat, compared with 15-20 minutes for an office visit.

Improving Patient Outcomes

Patient engagement isn’t just an industry buzzword. According to, people who are actively involved in their health and healthcare tend to have better outcomes. Offering a convenient, online access point can help increase engagement by making healthcare fit into patients’ lives. Additionally, patients may seek treatment through a virtual access point when they might otherwise decide against seeking care. That could be the difference between a routine UTI and a serious kidney infection.

Health systems and patients can also use virtual care as a population health tool. Online health assessments, for example, can help identify patients who are at risk for chronic conditions before those conditions become problematic. And, using an online access point for follow-up visits can help keep patients engaged in their care by making it quick and easy to provide their physicians with health information in between office visits.

Act Now to be Prepared for the Future

In the 2016 HIMSS Cost Accounting Survey only 3% of respondents indicated their health systems were highly prepared to to adopt value-based care reimbursement and leave behind volume-based, fee-for-service payment models. A full transition to value-based care may seem distant, but leading health systems are taking steps to prepare for the inevitable transition to value-based reimbursement.

Health systems who launch virtual care as a means for providing cost-effective care in a value-based environment will have the time to:

    • Work through change management and build clinician buy-in across their organization
    • Develop and implement a strategy that ties together online care delivery across departments and specialties
    • Monitor and enhance their virtual care service to ensure it meets the needs of both patients and the health system
    • Fully integrate virtual care with internal IT systems to promote a seamless patient and provider experience

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


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