Howdy pardners. A few weeks ago, I introduced you to the new Wild West: digital health. In this new Wild West, boardroom M&A discussions take the place of pistols at high noon, pioneers are creating rather than traversing the landscape, and a gold-rush mentality is luring companies from fresh startups to large tech giants to the frontier.
There’s Gold in Them Thar Hills!
Like the California gold rush of the 19th century, the 21st-century digital health rush is awash in prospectors looking to make their fortunes. Healthcare is a $3 trillion (and growing) industry, so it’s no wonder the likes of Amazon, Google (Alphabet, technically), Apple, and wagon loads of other companies are looking to stake a claim on the digital health frontier. With every expectation of striking gold.
This gold rush mentality in healthcare is changing the competitive landscape. Traditionally, healthcare organizations haven’t had to think much about competition. But, today they’re facing an onslaught of non-traditional competition in the form of retail pharmacies, tech giants, and new entrants – including telemedicine service providers, health and wellness apps, and other patient-facing health startups.
How the West Will Be Won – By Health Systems
Health systems are in pole position (not to mix metaphors) to come out on top in the digital health Wild West. But, that necessitates embracing both the new environment and adapting to it. Success on the 19th-century frontier was governed by equal parts hard work and luck, but in healthcare’s digital Wild West, there are clear paths to success.
Understanding the Digital Frontier
Patient expectations aren’t shaped by their previous experiences with your health system – they’re shaped by all the other brand interactions they have in their lives.
I know I harp on the Amazon effect a lot, but it’s truly relevant to healthcare. Amazon has done an amazing job of streamlining their customer experience. A huge part of their success is tied directly to how easy they’ve made shopping for, well, everything.
Your patients use Amazon. And Lyft. And talk with their friends and colleagues via instant message. These interactions directly influence how they expect to interact with your health system. That means, you need to embrace digital interactions – and yes, the plural is intentional. Across your organization, look for ways to streamline patient experience by making things accessible online. Which brings me to….
Making Care Patient-Centric
Are you sick of hearing about consumerism in healthcare? That’s too bad, because it’s not going away. Instead of taking care of cattle or horses, homesteaders on healthcare’s digital frontier need to focus on their patients. That means more than just looking at star ratings. Health systems need to understand every step of the patient journey – even the portions that don’t involve direct interaction with a provider. Then, they need to find the rough patches and fix them.
For example, say scheduling is a patient pain point. You launch an online scheduling tool to help address that pain. Great, you’ve embraced the digital frontier, but it doesn’t address wait times. Or the difficulties that people who can’t or won’t use an online tool have. Or patients’ need to coordinate child care, work or even a ride to and from the clinic.
Closer to home (for us), let’s talk virtual care. Having online access is great, but is your platform flexible to meet the needs of a wide variety of patients? Does it integrate with your EMR and other systems to support continuity of care? Are you thinking of how digital interactions across specialties and patient needs blend into a unified experience?
Your digital patient interactions need to be part of a seamless experience, and you need to provide both the flexibility and ease of use that patients expect. Online experiences and in-person experiences need to feel connected. Patients need to see the quality, empathy, and yes, convenience with every interaction.
Spread the Word
Finally, we get to marketing. Not to beat a dead horse, but spreading the word about your digital services is critical to your success. Patients increasingly expect digital interactions, and are inclined to choose providers and care organizations that can meet that need – BUT they can’t make an informed decision unless you let them know what you can do for them.
A while ago, our former Digital Marketing Specialist shared a post about how digital healthcare needs digital marketing. The tried and true healthcare tactics (billboards, bus stops, and banners) are useful for awareness, but they won’t drive action. Let your marketing teams run free and find creative ways to share your new patient-centric, digital focus.
Welcome to the Frontier
We’re at an inflection point in healthcare. Things are changing: new competition is entering the marketplace, patients have shifting expectations, and technologies are altering the way care has always been delivered. But the ambiguity that comes with these changes means opportunity for health systems to take the reins and chart a path through this new Wild West that will lead to success.
A First for the Industry, ZipPlus Gives Health Systems the Flexibility to Build and Launch Nearly Any Virtual Care Service
Minneapolis, MN – April 16th, 2019 — Zipnosis, a leading virtual care software company, today launched ZipPlus, a services and tech enablement program that creates a multi-year, integrated virtual care roadmap for health systems using Zipnosis’ virtual care chassis while leveraging 10 years of virtual care leadership and experience.
“We continue to hear from our health system customers that virtual care deployment is narrow and integration is a challenge and in many cases prohibiting widespread adoption,” said Jon Pearce, CEO, Zipnosis.
“ZipPlus breaks down these barriers in two ways. The first barrier is technology. Within the ZipPlus program, we can fully integrate the patient and provider experience via FHIR or API’s into Epic, Cerner and Athena. The second barrier is an aligned strategy for virtualizing care. With ZipPlus, Zipnosis and our partners sit down to create a multi-year roadmap for clinical business lines, such as behavioral health, post-surgical follow-up, travel medicine, hypertension – or any service using our powerful virtual care technology platform as the foundation. These unique roadmap partnerships are truly a first for the industry and position us well as the undisputed standard in virtual care.”
Research from Zipnosis’s recent benchmark report shows that health systems are not fully realizing the benefits of virtual care as they struggle to overcome disparate technologies that are designed without the patient at the center and implemented without provider workflow and integration considerations. Specifically, 54 percent of health systems say they expect integrating virtual care with existing technology solutions to be a challenge and 61 percent expect roadblocks when it comes to gaining provider acceptance. That’s in addition to the 64 percent who report that patient utilization has been a challenge since deploying their virtual care solution.
ZipPlus directly addresses these challenges by combining Zipnosis’ leading edge technology with unparalleled consultative support. “We’re leading the transition from siloed, cumbersome telemedicine, into integrated value-driven virtual care. ZipPlus will accelerate our partner’s success in building their digital front door,” added Pearce.
To learn more about ZipPlus and how it can help transform health care organizations, visit Zipnosis.com.
Zipnosis offers health systems a leading virtual care platform that pairs traditional telemedicine with next-generation online virtual care tools to drive exceptional clinical quality, significant clinical efficiency and durable financial returns. A trusted innovator in the industry, Zipnosis pioneered online adaptive interview technology, which is built on a foundation of clinical best practice guidelines. This smart alternative to traditional telemedicine allows providers to diagnose and develop a treatment plan for patients in just two minutes. With Zipnosis’ unique platform approach to virtual care, patients can be treated through the online adaptive interview, video and phone technology, or when appropriate, referred to in-person care via the platform’s advanced routing capabilities. Based in Minneapolis, MN, Zipnosis helps health systems keep pace with the changing demands of healthcare consumers.
Digital-health company Zipnosis Inc. has closed on a $3 million financing round.
View the full article here.
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 care, 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:
- Integration – 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.
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.
The other day, the Zip team attended the MSP Business Journal Healthcare Update Forum at the Hyatt Regency in downtown Minneapolis. It was a well assembled panel of MN healthcare leaders:
- Dr. Kenneth Holmen, CEO of CentraCare Health
- Barbara Joers, CEO of Gillette Children’s Specialty Healthcare
- Philip Kaufman, CEO of UnitedHealthcare of Minnesota, North Dakota and South Dakota
- Dr. Craig Samitt, CEO of Blue Cross and Blue Shield of Minnesota
- Troy Simonson, CEO of Twin Cities Orthopedics
Early in the discussion, Philip Kaufman made a comment about how consumers need better health data to improve engagement/costs/etc.
Data is important, but I was struck by how disconnected this sounded. Philip isn’t alone – many leaders in the healthcare space carry this perspective about the role of data in our lives. But after years of working with provider organizations, and knowing or being a patient, it just doesn’t feel applicable to most healthcare decisions.
Health Data for Comfort
I asked myself “when was the last time I used a white-paper or clinical trial data to make a healthcare decision?” Not once. Now, maybe when I need a heart transplant I would do research on the best options for me (like my uncle is doing now…), but much of it isn’t about the data. It’s about “where’s the best place?” or “who’s the best doctor for…”
If you unpack this a bit, it’s really about emotions. Trust. Stopping the pain. Grappling with the sobering fragility and finiteness of our lives. Fear of the unknown. Human responses to uniquely human afflictions.
Candidly, I’ve never once run to my database or spreadsheet when I’m scared or hurting. I run to someone I love & trust. I hug my mom. I reach out for my wife. I turn to my friends.
Which gets at, what I believe, a perspective flaw in digital health experience design: data and logic over empathy and humanity. And I’m not leaving us out of the accountability pool. I, too, suffer(ed) from the same bias in designing Zipnosis as Philip suffers as he seeks a more engaged patient population.
At Zipnosis, we’ve come a long way in terms of incorporating empathy into our platform, but today, I’m challenging us to go further. It’s time to take the reins and build experiences rather than technologies.
As we make product choices, we must ask ourselves what fundamental, human emotional need does it meet at that moment in the patient’s journey. It may not be elegant – but it will be effective.
When a customer (patient or provider) requests a feature, their reasons aren’t typically logical but emotional. A provider who needs to ask one more question has an underlying sense of duty to treat a patient as best as possible. A patient who wants to give context around their symptoms or health history wants to get the care they need.
As our team works toward our vision of making Zipnosis the undisputed standard in virtual care, we must acknowledge that we won’t succeed unless and until we put human and emotional needs first.
As with many challenges in healthcare technology, there are no quick fixes here. But I believe that we – not just Zipnosis, but companies all across the healthcare space – have a duty to put patients’ needs first. That means addressing their clinical concerns with quality and precision (hello, data!) and meeting their emotional needs with empathy and understanding.
‘Cause even the hottest data model in the world can’t hug it out with you.
What comes to mind when you think about the Wild West? Clint Eastwood swaggering through swinging saloon doors? Stagecoach heists and train robberies? Whatever you learned about pioneer life playing The Oregon Trail in elementary school?
These are all intrinsically linked with the Wild West’s zeitgeist, but I see it a bit differently. Discarding the concept of manifest destiny, this was THE era of unbridled American opportunity. Homesteading pioneers, ranchers, and gold-rushers—the entrepreneurs of the mid-1800s—all flocked to the American West with dreams of making their fortunes. And many succeeded.
Virtual Care’s Wild West
Virtual care is the digital frontier. Smartphones are our stagecoaches. Cloud-based services are our picks and axes; reliable in their errand but indifferent to the outcome. Sleek apps and user interfaces are the 6-shooters brought into battle. True, no one is dying of dysentery (hopefully) on their virtual care journey. But, the gunfights at high noon are just as real (if not as bloody). The early prospectors must always watch their backs or have the smell of another, sexier app, be their last.
Analogies aside, an article in the December issue of Health Affairs paints a wild-west landscape clearly – from innovation, to competition, to opportunity. It got me thinking about how this retailization of telemedicine is changing the face of healthcare—and how this disruptive shift in competition is likely to impact health systems.
Go West, Well, Everyone!
The other day, I read an article in Vox about how CrossFit is “amassing an army of doctors to disrupt healthcare.” Seriously. CrossFit. And that is just the latest in established players outside the healthcare space looking for ways to upend healthcare delivery. Amazon, Apple and Google have all thrown their hats into the healthcare ring.
Earlier this year, Amazon announced a healthcare focused partnership with JPMorgan and Berkshire Hathaway aimed at streamlining care for their self-insured populations. Apple increasingly offers health tracking functionality in their wearable and personal technology products and has been hiring doctors—as many as 50 over the past few years, according to CNBC. And Google’s parent company Alphabet recently moved to combine its DeepMind AI and healthcare businesses. Even social media platform Facebook made waves this spring with its foray into healthcare with its heavy handed, but certainly interesting exploration of how they could link social health determinants to actual patient health records.
These industry outsiders aren’t the only ones making waves in healthcare. Closer to home for health systems, retail clinics and pharmacies are working to grab a bigger piece of consumers’ healthcare spending. Retailers like CVS and Walgreens were early to jump on the retail clinic bandwagon, and are branching into other convenient care avenues, including telemedicine and virtual care.
For example, this summer, Walgreens launched a digital health service geared toward patients that connects them with direct-to-consumer telemedicine companies and a few regionally select provider organizations. And just the other day, I read an article in Becker’s about how they’re partnering with Verily – Alphabet’s life sciences subsidiary. Likewise, CVS’ Minute Clinic now offers video visits through the CVS app – a service that connects exclusively with their telemedicine vendor, and Walmart launched a telemedicine initiative just this past October.
The Healthcare Disruption Gold Rush
These organizations are moving quickly to grab a piece of the action in healthcare for one specific reason: there is opportunity here. Healthcare in the U.S. is a $3 trillion (and growing) industry, and one that hasn’t yet reaped the benefits of the digital revolution. That means the race is still open to become the Amazon of healthcare – in fact, if you read the last section, you know Amazon is interested in becoming just that.
It may sound daunting, but it’s also exhilarating. The prairies of perverse economics are wide and hostile; the mountains of data silos foreboding. And technology giants, retail pharmacies, and non-traditional care delivery systems are all crowding the dusty trails of the true pioneers. Next up, I’ll give you my two cents on how health systems can evolve to maintain their primacy – and win in the new Wild West.
Measuring return on investment – whether that comes from realized cost savings, direct revenue or long-term revenue – is important when building a business case for virtual care. If you want to get into that, we’ve got plenty of material for you (here, here and here).
A lot of time is spent discussing hard numbers with customers, so it’s easy to lose track of the softer side of ROI – what’s known as “blue sky” or “soft” value. While more difficult to measure and quantify, the softer side of ROI is just as important for organizational success. Soft value includes things like market perception, brand reputation, employee engagement and customer (or patient, in this case) satisfaction.
Virtual Care and Soft Value
So, what does that have to do with virtual care? A lot. Virtual care is a key component in strategies that impact those less measurable, but still incredibly important, value drivers, including brand positioning, provider satisfaction, and patient satisfaction and experience.
When I’m speaking with customers, they often tell us that how their brand is perceived in the marketplace is of enormous importance to them. A well-publicized virtual care offering can help healthcare organizations position themselves as patient-friendly, convenience-focused, and technologically savvy. With a recent survey of patients finding that more than half of millennials would choose a provider who offers virtual care over one who does not, the brand impact of a virtual care solution can be the difference between patient acquisition and patient attrition.
In a world where provider burnout is front and center, finding ways to maximize provider satisfaction is critical. Providers remain skeptical about virtual care and adoption is slow—just 18% of physicians are interested in adding virtual visits to their practice, according to a recent Deloitte survey. However, patients are increasingly interested in virtual visits, with 57% indicating interest in online doctor visits, according to the same survey. Finding virtual tools to facilitate patient care that don’t add to providers’ workloads is critical. Virtual care, specifically store-and-forward or asynchronous modes of care, can lighten providers’ workloads while still enabling them to care for more patients. At Zipnosis, we’ve seen customers with provider satisfaction rates as high as 100% (top 3 box on a scale of 1-10).
“Zipnosis allows me to provide excellent treatment for patients with low-acuity health issues that can safely be managed without an in-person provider visit.”
-Virtual Care Provider
Patient Satisfaction and Experience
Spoiler Alert: In our soon-to-be-released On-Demand Virtual Care Survey Report, our team found that patient satisfaction was the most selected success metric across all respondents. Moreover, looking at the virtual care program goals, patient experience and satisfaction were the most selected reasons for launching a virtual care service. By launching virtual care health systems are demonstrating commitment to making healthcare work for their patients, instead of making patients work to get healthcare. This is vital in enhancing patients’ experience with the health system and their overall satisfaction.
Maximizing Value from Virtual Care
One of the things we tell customers is that their virtual care service is only as good as the marketing behind it. Realizing the benefits of soft value – as with hard ROI – means spreading the word about virtual care, with the greatest success coming to health systems that combine seasonal marketing campaigns with providers recommending the service to their patients in-clinic.
After all, it’s impossible for patients to experience the convenience and satisfaction of a virtual encounter if they don’t know it’s available. Your health system’s brand won’t be known as an innovative leader in care delivery if the marketplace isn’t aware of the innovative services on offer. And, your physicians, NPs and PAs won’t find satisfaction with a platform that their patients aren’t using.
Soft value is a real, if less tangible, benefit of launching virtual care. Health systems that want to build their brand, enhance patient experience, and support provide satisfaction would be wise to consider adding virtual care or leveraging their existing service to meet their goals.
Increasingly, health systems working to assemble high-functioning steering committees to guide their virtual care strategy and service, but overall the industry is lagging behind in creating the cross-functional teams needed to drive virtual care success. Part of what is holding health systems back may be the challenges surrounding identifying and assembling a virtual care steering committee. Great news: here are a few simple steps you can take to make sure your steering committee is set up for success.
1. Get Representation from All Key Stakeholder Groups
Virtual care is optimally part of a larger digital health and patient experience strategy, and bringing together key stakeholders across the organization is key to ensuring the right voices are heard. At a minimum, this means representation from any effected care specialties, clinical leadership, IT/technology, strategic leadership, and a liaison from the day-to-day operations team.
2. Identify and Invite Your Champions
In every organization there are people who are excited about new initiatives. Seek out your virtual care champions for your steering committee. The people who see the possibility and potential of virtual care are fit guardians for your virtual care service and strategy. They’re also the people who will go to bat for virtual care, and be willing to spend the time necessary to make sure your organization gets it right.
3. Have Clear Goals and Responsibilities
Clarity is the key to your steering committee’s success. Do you want your steering committee laser focused on strategy or do you want the members to hold responsibility for operations? Do you want them to make decisions or provide recommendations? Will the committee set goals for your virtual care program or merely be responsible for achieving them?
To help make sure that your organization and committee members know what’s expected, create a committee charter that outlines the precise level and limits of authority, areas of responsibility, and committee objectives. Then, review the charter on a regular basis – annually works well – to make sure it still aligns with what your organization needs.
4. Include Decision-Making Power
A committee that can’t take action isn’t going to do your health system or your virtual care service much good. Within the defined goals and responsibilities, make sure that there are members empowered to take action and affect changes. Virtual care is an investment, and a steering committee needs to have the authority to allocate budget to achieve your health system’s virtual care goals.
5. Avoid Groupthink
This ties back to best practice #2, but make sure you have different voices on your steering committee. A group working closely together needs to include diverse opinions and ways of thinking to avoid the dreaded groupthink. While champions are valuable, so are voices of doubt – even dissent. When assembling your virtual care steering committee, make sure to include at least one person who will pressure-test ideas and ask the tough questions necessary to ensure your program’s success.
Last week, JAMA Internal Medicine published a research letter from Kathryn A. Martinez, PHD, MPH, et al on the intersection of telemedicine, patient satisfaction and antibiotic prescribing practice. The study found that approximately 66% of patients who had video visits for respiratory tract infections (RTI) through a major telemedicine service received an antibiotic prescription. The researchers also found that patient satisfaction, based on a star system of 1 (lowest) to 5 (highest), strongly correlated with antibiotic prescriptions.
So, the question is, can telemedicine, antibiotic stewardship and patient satisfaction co-exist?
Telemedicine, Outpatient Care and Antibiotic Prescribing
A 66% antibiotic prescription rate seems high for RTIs, particularly when the majority of RTIs are viral rather than bacterial, as noted by the authors. But, that doesn’t tell the whole story. RTIs are frequently used for measuring antibiotic prescribing rates, in part because they are common, in part because the prescribing guidelines are incredibly clear, and in part because most RTIs are viral in nature. That means, there is actually a significant body of research around best practices related to antibiotic prescribing for RTIs.
A 2016 report by the Pew Charitable Trusts stated that acute respiratory conditions account for 44% of antibiotic prescriptions given in outpatient settings. These include: sinusitis (25%), otitis media (22%), pharyngitis (20%), viral upper respiratory infections (12%), bronchitis (12%), and pneumonia/asthma/allergies (9%). Additionally, a 2015 study published in JAMA compared antibiotic prescribing for RTIs in telemedicine and physician office visits and found them roughly equal (58% for telemedicine visits vs. 55% for physician office visits).
Achieving Antibiotic Stewardship through Virtual Care
With all the above, you’d be forgiven for throwing your hands in the air and giving up entirely on antibiotic stewardship, but, at least for online care, there is a better way. While we can’t be certain, our team suspects that there are a couple factors in play:
Antibiotics and Patient Satisfaction
The key takeaway from last week’s research letter is the correlation between antibiotic prescribing and patient satisfaction. The researchers found that 72.5% of patients who did not receive an antibiotic prescription for their RTI visit rated the encounter at 5 stars, compared with 90.9% of patients who did receive an antibiotic prescription. The correlation was further cemented by finding that physicians who prescribe antibiotics more frequently have higher overall patient satisfaction ratings than those that do not.
We also see the link between patient satisfaction and prescriptions through our post-visit patient surveys at Zipnosis, as well. Looking at patient survey responses, we see a dramatic difference in satisfaction between those who received a prescription (not necessarily an antibiotic) and those who did not. When asked how the virtual visit met their expectations, 89% of patients who received a prescription said it met or exceeded expectations. And, when asked to rate overall satisfaction on a scale of 1-7 (with 1 low and 7 high), 84% rated their satisfaction at 6 or 7 when they received a prescription compared with 36% among those who did not get a prescription.
As healthcare becomes an increasingly consumer-focused industry, health systems and providers are under pressure to achieve positive patient ratings, creating an imbalance in incentives, choosing to either satisfy patients or provide appropriate care. This is potentially even greater in direct-to-consumer telemedicine companies who rely extensively on patient ratings and reviews to attract new customers.
Of note, the JAMA study found that patient satisfaction remained higher for visits where patients received a prescription that was not an antibiotic. And in our experience, there is little difference in satisfaction between patients receiving antibiotic and non-antibiotic prescriptions. Offering patients non-antibiotic prescriptions may be an option for supporting patient satisfaction without overprescribing antibiotics.
Antibiotics and Visit Time
A concurrent article by the same researchers published in the Annals of Internal Medicine, identified a correlation between visit time and prescribing. Telemedicine visits resulting in an antibiotic prescription were approximately 20 seconds shorter than those where nothing was prescribed and more than a minute shorter than those resulting in a non-antibiotic prescription. The researchers concluded that because telemedicine visits were already short and providers employed by major telemedicine companies are often compensated by volume, implementing antibiotic stewardship practices that increase visit length may be challenging.
Antibiotics and Mode of Care
The one thing that has been left out of all the studies about antibiotic prescribing and telemedicine visits is the difference made by mode of care. Dr. Martinez and her co-authors acknowledge that their data may not represent all telemedicine visits, due to studying visits from a single direct-to-consumer telemedicine service company. Previous studies about antibiotic prescribing rates in telemedicine visits have also focused solely on direct-to-consumer video visits where the providers are employees or contractors of a telemedicine service company, rather than delivering care to their own (or their health system’s) patients. And mode of care can make a difference.
At Zipnosis, we monitor antibiotic prescribing adherence for visits on the asynchronous platform very closely. This adherence criteria is one of the metrics tracked and discussed with our Clinical Quality Advisory Council, as well as shared with individual customers for continuous quality improvement. We set aggressive antibiotic adherence targets for our most common protocols used via the asynchronous online adaptive interview and aggregate adherence data to evaluate performance. The table below shows both targets and actual adherence for three of our most common visit types
A third JAMA-published study, this one from 2016, found that approximately half of antibiotic prescriptions for acute RTIs diagnosed in outpatient settings were inappropriate based on prescribing guidelines. If rates of antibiotic prescribing are analogous, it stands to reason appropriateness would follow suit. In comparison, the percentage of visits on the Zipnosis platform that result in an antibiotic prescription but don’t match prescribing guidelines is less than 8%.
Zipnosis Asynchronous virtual care has two key benefits when it comes to antibiotic stewardship:
- The clinical algorithms, which incorporate organic, embedded clinical decision support, give providers the tools to easily and effectively make diagnosis and prescribing decisions based on national best practice guidelines.
- The modality is unlikely to allow patient expectations to influence provider decision-making. (A 2017 American Psychological Association paper found that when patients clearly expect antibiotics, physicians are more likely to prescribe them.)
What’s Next for Antibiotic Stewardship and Telemedicine?
We, as a clinical leadership team, believe the type of research and study exemplified by Dr. Martinez and her team is vital to telemedicine and virtual care. It produces the type of questions that need to be asked. At Zipnosis, we strive to be transparent with our quality and guideline adherence reporting. Our team would welcome researchers interested in exploring antibiotic stewardship to consider incorporating our data in future studies. As an industry, we should all embrace transparency – after all, high quality care and positive patient outcomes should be our number one goal.
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.
Last week, the Centers for Disease Control and Prevention announced that rates of chlamydia, gonorrhea and syphilis in the U.S. climbed for the fifth year in a row. The newly released data prompted a call for federal intervention at the 2018 STD Prevention Conference. This begs the question, how did we get here? And more importantly, what can we do about it?
STD Infection by the Numbers
In 2015, the American Sexual Health Association noted that rates of chlamydia, gonorrhea and syphilis reached a record high. And they’ve kept growing from there.
Preliminary CDC data from 2017 shows a 31% growth rate in diagnoses of these three common STDs since 2013. Individually, diagnosed cases of gonorrhea increased 67% and syphilis 76%. Chlamydia didn’t see quite the same rate of increase, but it remains the most common of these conditions with more than 1.7 million diagnosed cases in 2017.
Candy Hadsall, RN, MA, a prevention nurse specialist with the Minnesota Department of Health was at the conference and noted that the data wasn’t particularly surprising. “The CDC’s announcement that STD infection rates climbed again in 2017 just confirmed what we’re seeing in the field,” she said.
These numbers present a concerning – and initially, more than a little baffling – trend. After all, each of these infections is curable with appropriate antibiotic intervention, and the long-term effects of going untreated can be serious. So, why are infection rates continuing to grow?
The Root of the Problem
The factors influencing the increase in infections are complex and varied. A 2007 study in Sexually Transmitted Infections found an abundance of socio-demographic influences on infection rates, including race, income, gender, state of residence, age and history of incarceration. It also notes that attitudes toward sexual behavior and STD testing are prime factors in the diseases’ spread.
In the CDC’s recent announcement, Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention noted, “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”
At its core, the STD infection crisis is driven by this combination of attitudinal, demographic, economic and healthcare infrastructure influences.
Virtual Care’s Role in Fighting STD Infection
One of the best ways to stem the tide of STD infection is by reducing access barriers to testing and treatment, and here is where virtual care shows its value. The ways that virtual care can help patients overcome common barriers to care like geography, time and cost is well-documented. When it comes to sensitive issues like sexually transmitted diseases, virtual care can help mitigate emotional barriers, as well.
In an interview with MedCity News, Geri Lynn Baumblatt (then of Emmi Solutions from Wolters Kluwer Health) noted that patients tend to “engage in impression management” when seeing their doctor. What that means is, they try to paint themselves in the best possible light – consciously or unconsciously – in an attempt to avoid judgement and shame. While Baumblatt was speaking specifically about addiction concerns, this concept translates to sexual behavior. A solution that doesn’t require a face-to-face discussion can often produce more honest answers about sexual behavior and STD risk.
Hadsall concurs that the feeling of anonymity could help patients overcome the shame and stigma associated with STD infection. She also notes that adequate resources are a challenge in STD screening. “It’s just not possible to effectively screen everyone who should be screened,” she said. “Even at very high infectivity rates of 10-15%, that’s still 85-90 out of 100 people who are screened and test negative. With an online screening option, we could do a lot more and potentially make a real dent in STD infections.”
A Virtual Solution
Understanding the value of lowering barriers to STD testing and treatment, we developed evidence based protocols to support health systems as they work to manage steeply climbing STD rates for their patient populations. Our expedited partner therapy protocol enables patients whose partner has been diagnosed with chlamydia to get treatment. As the most commonly diagnosed STD across the country, and the one that is most frequently asymptomatic, this facilitates quick, discreet care for patients – without even requiring a test. By lowering barriers to receiving care for known chlamydia exposure, health systems can help reduce the continued spread of chlamydia.
We also recently created an evidence-based virtual care STD testing protocol that gathers risk assessment data and enables patients to access lab tests for chlamydia, gonorrhea and syphilis. This protocol leverages lab integration workflows to capture patient information and seamlessly route them to a lab location for testing. Our aim is to help health systems use the asynchronous patient interview to overcome the embarrassment patients feel talking about STDs, potentially increasing the likelihood of individuals to seek testing.
The continued rise of STD infections is a complex issue, impacted by everything from socio-cultural norms to poverty rates and education to healthcare access. It may feel overwhelming, but looking at individual pieces can still make a sizable impact. There are many factors virtual care can’t impact. What we can do is help take the strain off of the systems currently unable to manage this growing health crisis and lowering barriers to STD testing and treatment.
As a new school year approaches, students will be gearing up to begin (or continue) studying medicine. This is an exciting time for them. No matter how great their institution, and no matter how dedicated their studies, there is still one thing missing from their schooling: virtual care education.
It’s not just students that are feeling the lack of training in telemedicine and virtual care. Active healthcare practitioners also need access to training on how to be effective delivering care online. A study by the AAFP’s Graham Center found that education was one of the top two barriers to physicians using virtual care technology in their practice.
Virtual care – whether video, chat, store-and-forward or some other modality we haven’t even dreamed of yet – is an increasingly important element in care delivery. And, this trend is only going to continue. That means this gap in education and training needs to be closed.
Closing the Virtual Care Education Gap
Back in 2016, the AMA announced their backing for undergraduate and graduate students to be trained on how to use telemedicine. More recently, our chief medical information officer Kevin Smith was involved in developing a telemedicine accreditation program through the Clear Health Quality Institute.
Both these things are steps in the right direction, but we believe it needs to go further. What we need is a comprehensive, standardized curriculum around online care delivery. Dr. Kevin Fickenscher of CREO Strategic Solutions agrees, stating, “There is a need to define the core curriculum for training clinicians at all levels in the appropriate use of tele-technologies to support effective care delivery. Simply placing clinicians into telehealth environments without sufficient training is akin to having radiologists use MRI scanners or surgeons using robotics without requiring training. And, the training is not just about the technology. It’s also about the way we communicate, how patients respond, the use of informatics, the use of social media and a whole array of considerations which are important for educating the health care virtualist.”
While it’s crucial the standard of care remains the same regardless of care delivery channel, setting clear standards around virtual care is vital to ensuring it is safe and effective. These standards will also increase providers’ comfort with delivering care online and give patients a more consistent experience.
What About Medical Virtualists?
One idea around how to train healthcare providers on using virtual care technologies is the concept of a “medical virtualist” specialty. This idea sprang from an opinion piece in JAMA last November. Shortly after it came out, we published a rebuttal. The long and short of our stance on the idea is that every provider will need to be able to deliver care via virtual care / telemedicine technology in the future.
Likewise, Dr. Fickenscher rebutted the original opinion piece, calling for a virtualist training of all clinicians working in telecare environments in a post on the Health Affairs blog. He noted that while a virtualist specialty will likely be worthwhile in the longer term, “basic virtualist knowledge will become a requirement for all practitioners.”
In our opinion, focusing on a new specialty at this point could leave a large portion of providers without the tools or knowledge they need. Right now, we need to find ways to effectively train everyone—from pre-med students to practicing providers—on virtual care delivery, rather than building out the infrastructure needed for an entirely new specialty.
What’s Next for Virtual Care Education?
No one can fully see the future, but the demand for virtual care education is increasing. That means schools – both undergrad and graduate, health systems, virtual care companies and other stakeholders need to collaborate on developing channels and standards for virtual care education.
We’re very excited about what the future holds for virtual care, and how we can help encourage and support educating both this and the next generation of healthcare providers on the uses and benefits of virtual care. We’ve shared some of our thoughts on why virtual care education is important. Next time around, we’ll offer up more specifics on the things we think are important for all providers to learn about providing care online.
For most people, the end of summer is characterized by back to school ads, discounted swimwear and the promise of crisp autumn air. In healthcare, it’s more than stacks of new notebooks – it’s time to plan for managing cold and flu season.
Each year, health systems and providers brace themselves for an onslaught of stuffy noses, hacking coughs and spiking fevers. And this year, as staffing plans are made and vaccine doses ordered, the question on everyone’s minds will be, “What do we do if we see a repeat of last year?”
If you work in healthcare (and unless you were, say, living off the grid in the Alaskan tundra last winter) a repeat of the 2017-2018 flu season likely strikes fear—or at least concern—into your heart. While not as terrifying as the white walkers in Game of Thrones, the onset of cold and flu season requires similar preparation to withstand a viral invasion. So, how can health systems deal with the visit volumes, the potential for infection to spread in waiting rooms, and overwhelmed clinic staff?
Virtual Care Can Help
Having a virtual care service in place can help mitigate some of the challenges that are part and parcel with cold and flu season. It’s not the only answer, certainly, but virtual care adds real value where it counts.
“An ounce of prevention is worth a pound of cure,” as the saying goes. It’s no secret that the best way to reduce influenza cases is vaccination, and health systems often have well-developed strategies for promoting annual influenza vaccination. A virtual care service can add value by creating an additional channel for patient communication.
Providers can remind patients to get their flu shots during video visits. Health systems can include a note about getting vaccinated in patient education materials. And, Zipnosis customers can use their virtual care platform to incorporate flu shot reminders into their virtual visit (a feature successfully deployed during last summer’s measles outbreak in Minnesota).
Manage Provider Time
Here’s where virtual care really shines. A store-and-forward / asynchronous virtual care model enables providers to diagnose and treat patients in a fraction of the time as an in-person visit, as noted by our VP of Customer Success, Catherine Murphy, a couple weeks ago.
In a look at data from six customers over the course of last flu season (October 1, 2017 to March 31, 2018), the average provider work time per asynchronous virtual visit was just shy of 2 minutes and maintained high quality standards. During that time, these six customers completed close to 12,000 visits, amounting to less than 340 provider hours. For comparison, 12,000 in-person visits at 15 minutes each would total about 3,000 hours. On average, virtual care saved each of these health systems 440 hours of provider time. That’s nothing to sneeze at.
Mitigate Waiting Room Infection
One of the biggest challenges about cold and flu is that they are just so darn infectious. A study in Infection Control and Hospital Epidemiology found greater than 3% increase in influenza-like illnesses in children and family members within 2 weeks of annual wellness visits.
Hospitals, health systems and clinics have a variety of tactics to help stem waiting room infection – from handing out face masks to regular sterilization procedures. Virtual care can be added to the list. By offering a remote option for treating highly infectious conditions like influenza, patients don’t have to come into their doctor’s office for treatment. Plus, patients with common conditions like urinary tract infections or pinkeye can also get treated at home, lessening the chance they contract an influenza-like illness at the doctor’s office or urgent care.
Now’s the Time
This isn’t Game of Thrones, and we aren’t facing an influx ofwhite walkers, but winter is coming. Getting a virtual care service launched now will go a long way to help health systems manage the impact of cold and flu season on their providers and patients. Starting now will mean your virtual care service is up and running when it counts. Pair that with some smart marketing tactics, and you’ve got winning combination to combat the coming cold and flu season.
The other day, I saw the Advisory Board released new research indicating that healthcare executives’ primary priority is cost containment, even over revenue growth. This focus shouldn’t surprise anyone remotely familiar with U.S. healthcare. Increasingly, health systems are being asked to do more with less – more patients, less staff; more innovation, less budget.
Working closely with our customers, I see first-hand the budgetary constraints and financial scrutiny that are an everyday part of operations. That’s why our team has worked hard to provide health systems with a clear understanding of the financial implications of an on-demand virtual care service, starting with revenue.
Why Revenue Still Matters
The Advisory Board’s study didn’t say healthcare executives were uninterested in revenue, just that often takes a back seat to cost containment. When it comes to effectively managing the bottom line, a two-pronged approach addressing both revenue and cost containment is vital.
As mission-driven organizations, non-profit health systems need to think about revenue. Grants and donations can only cover so much of a health system’s operating budget. In order to effectively provide services for their communities, health systems need to have additional sources of revenue.
A quick Google search yields numerous articles, seminars, webinars and other resources for health systems looking to maximize payer contracts. With the growing trend toward value-based care, effective contracting is critical to healthcare organizations bringing in revenue. Many of our customers use their virtual care services to support and enhance local payer contracts.
Virtual Care’s Revenue Impact
Traditionally, virtual care has been viewed as a patient satisfier (and sometimes market requirement) first and revenue generator second. The trouble is that revenue is seen primarily as visit fees, which often can’t cover the cost of care delivery much less software licensing. In reality, virtual care’s ability to generate revenue and return on investment for health systems lies in its utility as a patient acquisition channel. I won’t go into the nuts and bolts today, because it’s been done extensively in previous blog posts (here and here), as well as in case studies (here and here).
Cost Containment with Virtual Care
While revenue is important, health system executives are right to make cost containment a priority. Last year, expense growth outpaced revenue growth by 1.2%. And, just as health systems can’t achieve their missions without revenue, they can’t effectively operate in a deficit.
I really view cost containment and revenue growth as two sides of the same coin. And, while Zipnosis has been vocally focused on revenue, we have also been focused on the flip side. So, how does virtual care support health systems’ cost control initiatives? Two ways:
Expense Reduction for Risk-Based Populations
Health systems are also big employers, and employee compensation is one of the biggest expenses they face. To help control compensation costs, health systems are often self-insured. This creates a somewhat ironic situation where healthcare costs are actually a major health system expense.
Virtual care offers health systems a low-cost access point for convenient care delivery. When focused on risk-based populations like self-insured employees, this can translate to a major cost savings. A recent study by Humana found video visit costs paid out at approximately ⅓ the cost of in-person care while producing comparable follow-up rates and lower incidence of antibiotic prescriptions.
Looking at data from across the country, we calculate the mean cost of in-person care at $320 per visit (note: we’ve seen this as high as $500-$600). Conversely, our customers see the cost of delivering care via the virtual care platform at approximately $5. That’s an average per-visit savings of $315. On an individual visit level that may not look like much, but imagine the savings possible across an entire self-insured population. Even with activation between 5% and 10%, significant cost savings is possible – enough to cover software costs and free up budget to support important programs.
Enhancing Clinical Efficiency
I alluded to this somewhat in the previous section. Virtual care, in particular asynchronous modalities, can produce significant clinical efficiencies. On average, providers spend 15 minutes per in-person visit and are saddled with the administrative overhead of documentation later in their day, often after hours. With Zipnosis’s asynchronous modality, the visit time is a fraction of an in-person visit and there is no documentation.
That efficiency is part of why virtual care can be an effective low-cost access point, but it also can help drive significant cost savings, since health system providers are able to grow their patient panels while avoiding the costs of adding staff, outsourcing, or the health system adding brick-and-mortar locations.
Healthcare 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.
In a 2015 survey of family physicians conducted by the AAFP’s Graham Center, family physicians cited education and reimbursement as the two leading barriers to telemedicine adoption by family physicians. Since that survey, not much has changed – particularly in the area of reimbursement parity.
Telemedicine reimbursement regulations remain complicated, complex and fragmented. And the notion of parity has been variably defined and interpreted within and across states. Today, reimbursement is often a key issue in pending telemedicine bills across the country.
One concerning trend is language included in telemedicine legislation that explicitly prohibits the state from requiring reimbursement parity. If this sort of “carve out” language becomes commonplace, we risk diminishing the ability to use virtual care to address the quadruple aim—improve cost, quality and access, and reduce physician burden.
The Current State of Reimbursement
Currently, 29 states offer coverage parity, which requires insurers to cover telemedicine/virtual care services the way they do in-person care, some with exceptions or restrictions. Only 3 states have legislation mandating both patient coverage parity and provider reimbursement parity, though several states offer provider reimbursement for specific specialties or circumstances. To date, 18 states either do not have legislative language or explicitly exclude parity for coverage and/or reimbursement.
The Trouble with the Current State
The current state of reimbursement parity is largely payer-centric. What I mean by that, is that individual payers determine reimbursement for virtual care and telemedicine services based on their contracts with healthcare organizations and telemedicine service companies. In my experience, this model isn’t in the best interests of patients and providers. Often, primary care providers get cut out of the care delivery process, limiting their ability to use virtual care and other innovative technologies to care for patients at the lowest cost, most appropriate point of care.
What Payer-Centric Reimbursement Looks Like
- Employer / health plan contract with telemedicine service company for online care delivery.
- Member is routed to telemedicine service company provider for care.
- Telemedicine service company receives any co-pay and is paid contract rates by employer/health plan.
- The visit record remains with the telemedicine service provider.
- The primary care provider is left out, and the patient record is often incomplete.
How Reimbursement Parity Should Work
In an ideal world, reimbursement will be fair and equal across all providers, giving primary care physicians and healthcare organizations the ability to effectively compensate providers who care for their patients online.
What Patient and Provider-Centric Reimbursement Looks Like
- Patient connects with provider’s virtual care service.
- Provider makes diagnosis & treatment.
- Provider submits for and receives reimbursement beyond co-pay.
- Information is retained in patient’s EHR.
This past week, I was at the American Telemedicine Association’s annual conference, and one of the things I heard over and over was the growing need for health systems and providers to offer virtual care. But health systems are often in a difficult position when it comes to technology investments like virtual care. They need, not only to prove it aligns with their mission and organizational objectives, but that it makes financial sense.
Healthcare organizations are increasingly being asked to do more with less—to think as businesses with an aim to expand and grow revenues. In fact, non-profit health systems are often caught between their business needs, the aims of their missions, and of course, delivering high quality care to diverse patient populations. The great news is that virtual care can help bridge that gap, supporting health systems in expanding access to care, both by increasing convenience and lowering costs while aiding in expansion and growth.
The Business Case for Virtual Care
When I say that building a business case is less clear that doesn’t mean it is difficult, more that, because the technology is relatively new and evolving, health systems sometimes find it challenging to pin down how they want virtual care to impact their business. While expanding access and enhancing patient experience are mission-driven goals, they also can create impacts on the bottom line. Other facets of virtual care, like increased clinical efficiency can bring a positive impact to the bottom line, particularly for populations where the health system owns a portion of their risk (e.g., self-insured employees or other owned health plans). But the real winner in building a business case has to do with gaining market share.
Virtual Care Meets Market Share
We recently published a study with MultiCare Health System in Washington that demonstrated the patient acquisition potential of offering a virtual care service to the marketplace. Through the study, we found that 34% of virtual care users who had not received care from MultiCare in the 24 months preceding their virtual visit sought in-person care in the 12 months after their virtual care experience – more than 3 times that of a control group.
So, how do you set patient acquisition goals relative to your market? Start by figuring out how much of the market you currently have—your market share.
To calculate market share, try this for a nice-round-numbers approach. You, or someone at your organization, probably have a relatively good handle on how many patients you treat per year, on average. Divide that by your approximate market size, which you can find this with a quick Google search.
Setting Market Share Goals
The 34% patient conversion rate MultiCare achieved is tied to the closely circumscribed study cohort, imagine what that could look like relative to a major metropolitan market. For example, imagine you have 12% of a market of 3 million – that’s a nice size patient panel of 360,000. But, what could increasing your market share just 1% do? Before you pull out your calculators, I’ll tell you that it would add 26,400 patients to your health system—or 1% of your market potential.
Once you know your current market share, set attainable goals. Start with an aim of increasing your market share .25%. Using our hypothetical scenario above, that translates to 6,600 new patients.
Working with the 34% conversion rate, how many virtual visits would you need to achieve that .25% increase? Once again, I’ll do the math for you. You would need just over 19,000 new patients to come through your virtual care service to gain your 6,600 new patients and .25% market share increase.
That may sound like a lot, but there are budget sensitive strategies to increase growth and virtual visit volume that can help you achieve your market share and patient acquisition goals.
From my perspective, one of the most interesting findings of our study with MultiCare is not the patient conversion rate but the market opportunity. The independent analytics firm who compiled and analyzed the study data found that understanding the demographics of patients who were likely to use virtual care meant that targeting just 20% of the market would yield 82% of the people most likely to use virtual care. That means highly focused, targeted marketing efforts could significantly increase virtual care utilization.
It’s exciting to hear from various health system customers about how they are leveraging virtual care to reach new patients and broaden access to care. Several of our health system partners are unlocking market potential by contracting with local health plans and employers to offer virtual care to their members and employees. Combined with targeted marketing, this approach can help accelerate your health system growth and put you well on your way to achieving your objectives.
One of the big compliments we receive from customers is around the strength of our proprietary clinical content that forms the foundation of our virtual care platform. This means a lot to our team. As individuals and as an organization, we maintain a rigorous focus on clinical quality, and that comes through in our algorithms and clinical protocols.
What you don’t necessarily get to see is the amount of work and expertise that goes into developing, maintaining and improving our clinical content. We have a full team of clinicians and informatics specialists devoted exclusively to creating and maintaining our protocols and clinical content – and their contribution to the Zipnosis platform is worth talking about.
Starting off with Clinical Content Development
When we launched the Zipnosis platform, we knew that the only way the technology would work is if it was backed by unassailable clinical content. Remember, this was 2008, and nothing like the Zipnosis platform had been available before. Store-and-forward virtual care was still considered the providence of provider-to-provider care, specifically in imaging for radiology, dermatology, pathology, etc. It definitely wasn’t considered a means for collecting patient-generated symptom and health history information for diagnosis and treatment of common, low-acuity conditions.
Our original clinical content was something truly brand new in the outpatient healthcare space. We started with an enormous quantity of clinical guidelines for in-person care and painstakingly translated them into a few targeted protocols for virtual care.
From those humble beginnings, we expanded our protocol library to support diagnosing and treating more than 90 conditions. Each one required not only research into the standard of care, but a reframing of what care delivery for that particular patient complaint means without lowering the standard.
Clinical Content: Care and Feeding
Considering the extensive amount of work that goes into developing clinical protocols, you may be surprised to learn that protocol maintenance and improvement is where our clinical content team truly shines. The truth is, once a protocol is built, that’s not the end of the work it requires. Like a pet, clinical content supporting virtual care requires constant care and feeding.
At Zipnosis we have a rigorous maintenance process that includes annual content reviews, during which our content team delves into the latest research to ensure that our protocols meet the standard of care and can offer the same or greater guideline adherence as in-person care.
We also closely monitor alerts and updates from the CDC, departments of health, and the FDA to ensure that the treatment recommendations are in line with the latest guidelines. These alerts don’t always align with our protocol review schedule, so we also update protocols on an ad hoc basis when guidelines change.
Clinical Content Beyond the Standard of Care
Our clinical content is the foundation on which the entire Zipnosis platform rests. That means its importance to the quality of care providers deliver through Zipnosis is critical, but it also means that clinical content has a major impact on patient experience.
We dig into how protocols are utilized by patients and consult with our customers to identify opportunities for enhancing our content. This is a more intensive process than our annual clinical reviews, looking at how patients experience the content.
- Is the language clear, conversational and understandable?
- Are we effectively conveying empathy?
- How many questions do patients have to answer at maximum and minimum? Can we reduce the number of questions?
- Where are patients being referred out of the online system and into our customers’ brick-and-mortar clinics?
- Do the patient education information and questions match health literacy targets?
A full protocol enhancement project takes 10 weeks, and involves the clinical content team as well as people throughout Zipnosis – and even our customers. We perform a deep dive into how patients are interacting with the content, and make modifications – sometimes minor tweaks, sometimes major overhauls – to ensure patients are having a positive experience. And, through it all, we maintain that laser focus on the standard of care.
What’s Next for Zipnosis Content
As we expand the platform into new areas like surgical care and behavioral health, our clinical team just keeps blazing new trails. And, with our Clinical Quality Advisory Council’s assistance and input, our team is even better able to monitor and report on adherence to clinical guidelines. Keep your eyes peeled – there’s always more on the horizon.
National Doctor’s Day is this Friday, and we want to take the opportunity to recognize all the healthcare providers who are using the Zipnosis platform to deliver high-quality care to patients across the country – from New York to California and from Minnesota to Dallas Texas.
We are fortunate to work with clinical leaders and front-line healthcare providers who are committed, not only to providing the best possible care, but to transforming healthcare delivery in a way that employs technology to put patients first.
In recognition of National Doctor’s Day, we want to say thank you to our 30+ health system customers and the 876 physicians, nurse practitioners and physician assistants who are actively caring for patients through the Zipnosis platform.
We want to particularly thank the 11 members of our Clinical Quality Advisory Council. These clinical leaders go above and beyond supporting virtual care in their organizations by devoting time and energy to help us make sure our clinical content and algorithms are effective in supporting healthcare providers and their patients. Their frontline experience and feedback is invaluable.
The clinical champions at each of our health system customers deserve a special thank you, as well. Their commitment to advancing innovation in care delivery is helping move our entire industry forward.
Happy National Doctor’s Day from the Zipnosis Clinical Team!
Becki Hafner-Fogarty, MD, MBA, MAAFP
Kevin Smith, DNP, FNP, FAANP
Lisa Ide, MD, MHA
Jenni Doble, RN, BSN
Spat Rajbhandari, MSR, RN
Question: What do car sales, tax preparation, and virtual care have in common? The answer – they all see greater success with a digital marketing strategy. These days, even durable goods and in-person services are finding that digital marketing is providing the greatest returns. And online services are even more likely to see value from employing digital strategies in their promotional efforts.
Why Market at All?
Before I launch into how to use digital marketing for virtual care, I want to touch on why you need to put energy – and even budget – behind marketing your virtual care service. Just having a service isn’t enough. Unlike digital care like telestroke or eICU, on-demand, urgent care-focused virtual care requires patient adoption to be successful. And patients can’t adopt a service if they don’t know about it. If you want to see success with your virtual care service, marketing is a must.
Digital Marketing for a Digital Service
In a digital world, not all marketing is created equal. In large part, life happens online. We get our news, entertainment and even a portion of our personal interactions online; many of us spend a good portion of our day at a computer, checking social media or doing some online shopping in our downtime. We use the internet to make appointments, book travel, and (of course) watch cat videos. With all this time spent online, it’s no wonder that digital marketing efforts are increasingly vital to all segments – healthcare included. With that in mind, here are the top digital channels to look at when building your virtual care marketing plan.
SEO / SEM
In digital marketing, we frequently joke that the best place to hide a body is on the second page of Google search results. And there’s some truth in that. The top 5 results in Google searches have a combined click-through rate (the percent of people who see the result and click to open the page) of 65.15%. Expanded to the top ten results, and the combined click-through rate is 99.88%.
To effectively capture patients who could benefit from your virtual care service, using keywords in your landing page and content along with paid search can help you drive traffic to your virtual care site. Paid search, in particular, is useful, since it can put your page in one of the top spots or just to the right of the top search results. You don’t need a huge budget – pick a few key search terms, add in some demographic information and set the amount you’re willing to spend each day – Google AdWords helps with the rest.
Yes, email. 61% of people prefer email promotions to other forms of small business communication – including direct mail, mobile apps, and other promotional channels. What’s more, a focused, structured email campaign offers patients an easy way to access your virtual care service – through hyperlinks embedded throughout your email. No other digital platform lets you target and capture engagement reporting to your known population of subscribers quite like email marketing.
Social channels offer different avenues to connect with patients and potential patients. Having a separate, but linked business page for your virtual care service can give patients a place to ask questions and get information about your offering. Likewise, using your primary Facebook or Twitter business account to share news and information about virtual care can help get those who are already engaged with your organization on board with your virtual care service.
Social media also provides an opportunity to purchase ads – often hyper-focused – to promote your service. Gaining understanding of the patients who are most likely to use your virtual care service can help you effectively target social media ads, giving you the best return for your digital marketing investment.
Last, but definitely not least, is your organization’s website. If it’s been a while since your organization last reviewed or updated its website, now is a great time to do so. This is your most important marketing asset – both for your health system and your virtual care service. I won’t go into overall web best practices in this post, but using your website to effectively promote your virtual care service requires three things:
- Make virtual care accessible in several ways – include it in your topline navigation, link to it from your primary care or urgent care page, and promote it in a banner ad. The more ways for people to find the service, the more likely it is they will use it.
- Make it easy to find – remember how the top search results have the greatest click-through rates? It’s because they are the first things you see. Put information about your virtual care service “above the fold” on your website – it should be easily findable without scrolling or a lot of clicks.
- Banner ads and video – “advertising” your virtual care service on your website may seem awkward, but an eye-catching graphic is likely to drive more traffic to your service than a mountain of text. Likewise, videos are promotional gold – 85% of internet users engage with video content, and an embedded video on your website can do a lot to help drive virtual care interest and utilization.
Traditional Marketing’s Role
When marketing virtual care, a digital strategy is critical, but that doesn’t mean there isn’t a role for more traditional marketing. Waiting room advertising, print ads, direct mail, and other more traditional elements help support your digital messaging and increase engagement. While not always the most important part of your marketing plan, these traditional avenues should not be ignored.
It’s hard to believe, but we’re exactly 2 months in to 2018. At Zipnosis we have a lot of big things coming for the year, so keep your eyes peeled, and Virtual Care Insider is no exception! Coming in 2018 you’ll see new features, new authors, and new topics, as well as the insights and thought leadership you’ve come to expect. As the virtual care industry continues to evolve, so do we!
New Features for 2018:
Under the Hood
Under the Hood is our new feature giving you a glimpse into what goes on behind the scenes to support the Zipnosis platform. From clinical to engineering to account support, get a peek behind the curtain and learn what goes into creating and maintaining and supporting the best darn virtual care platform out there.
Get to Know Zipnosis
One of the things we’re proud of is our amazing team, and we think it’s sad that most of our customers and prospects don’t get a chance to meet the talented group of people responsible for building and maintaining the Zipnosis platform. This new feature will give you a chance to get to know some of the people who work behind the scenes.
Trend Watch will be a deep dive into one of the key industry trends, giving you more detailed information and a better idea of the impacts to virtual care and health systems. We’ve already had our first Trend Watch edition (by Dr. Lisa Ide, focusing on employers’ use of virtual care as an employee benefit), and you can look forward to more in the coming year.
The Big Question
What is the Big Question in virtual care? That’s what we want to know! We want to provide an open forum where our virtual care experts (and we have a bunch of them) answer your burning questions about virtual care. So, don’t be shy – submit your question and have it answered on our blog.
Last week, Mobihealthnews published a piece providing one perspective on the legislative barriers for telemedicine. We were interested to see where the discussion would go, particularly considering Zipnosis’ significant role in supporting – and even drafting – inclusive legislation targeted at making online care delivery more accessible to health systems, providers, and patients. Our interest was rewarded with a piece that offered few solutions and much blame. That said, this piece did get some things right – albeit obliquely.
The Boogeymen of Telemedicine Legislation?
The Tower of Babel concept is a long-standing challenge in online care delivery. The language we use (telemedicine, telehealth, mhealth, virtual care – the list goes on) isn’t unified, and yet, somehow we manage to have valuable, informed conversations about the technology, direction of the industry, and value to providers and patients. More concerning than our lack of unified language, is the defining of “telemedicine” in legislation – an outcome more of general misunderstanding than lack of specific language.
The Congressional Budget Office (CBO) was also targeted as “having a hard time coming up with a number that says what’s going to happen when we allow technology to help healthcare delivery.” While strictly speaking accurate, this statement is more than a little misleading. The CBO’s purpose is to provide Congress with objective, impartial information about budgetary and economic issues. Its role includes supporting the finance, budget, and ways and means committees, as well as producing formal cost estimate for nearly every bill approved in committee. You’ll note that none of that includes forecasting a hypothetical economic impact for “[allowing] technology to help healthcare delivery.”
In fact, when called into action to score the CHRONIC Act, the CBO noted that the legislation, including the telemedicine provisions, would “reduce direct spending for the Medicare and Medicaid programs by $217 million over 2018-2022.” With the CONNECT Act, another piece of federal legislation that expands the reach of telemedicine, in the Finance Committee, we can likely look forward to further CBO scores related to online care delivery in the not-too-distant future.
Real Regulatory Challenges & Real Solutions
Just because we don’t see the items cited as the major challenges facing telemedicine legislation doesn’t mean there aren’t legislative barriers. For the past ten (or so) years, we’ve been diligently working with state boards of medicine, state legislatures, members of the U.S. House and Senate, and – really – anyone with clout to overcome the challenges in the regulatory landscape.
Zipnosis has been talking about regulatory fragmentation for years, and it will remain a challenge in the regulatory landscape for the foreseeable future. Between state and federal legislatures, boards of medicine, health departments and other governing bodies, there are just too many cooks in the kitchen for anything short of complexity. Rules and regulations differ from state to state, and even sometimes within different agencies in the same state.
That said, strong legislation at the federal level or improved rules and policies from the Centers for Medicare and Medicaid could help provide guidance for states, catalyzing some uniformity to regulation of online care. Barring this, it’s vital for virtual care and telemedicine companies, health systems, and even individual providers, to speak with regulators at all levels to educate them on the benefits of online care and help craft a unified strategy for regulating and reimbursing telemedicine.
Here is really where the “Tower of Babel” makes itself felt. Often, the legal definition of “telemedicine” ends up focusing on technology and modalities, rather than the standard of care. This creates challenges for health systems, providers, and regulators, as the rapidly changing nature of technology means legislation is often out-of-date as soon as the ink is dry.
Rather than focus on the mode of care delivery, regulations that address telemedicine and virtual care need to focus on upholding the standard of care. This not only creates opportunities for innovation, but future-proofs regulations, helping them remain relevant regardless of where technology takes care delivery.
We aren’t going to go heavily in-depth here because Zipnosis just published an in-depth piece about how regulation and reimbursement are impacting the adoption of virtual care. That said, there is a distinct tendency in regulation to focus heavily on patient reimbursement, leaving providers struggling to get paid for care delivered online.
Reimbursement also falls prey to the modality trap, with state Medicaid and Medicare policies focusing less on the standard of care and more on the technology by which care is delivered. According to the Center for Connected Health Policy, 48 states provide some form of Medicaid reimbursement for video-based telemedicine, while only 21 reimburse for remote patient monitoring and 15 for store-and-forward.
Here, too, movement has occurred at the federal level, through legislation like the CHRONIC and CONNECT Acts, both of which contain language expanding online care access and reimbursement for Medicare and Medicaid.
Continuity of Care
The final area where regulation has an opportunity to make appreciable, positive impact is through policy that supports continuity of care. Telemedicine is often looked at as a culprit in the fragmentation of care delivery, but it doesn’t have to be that way. In the current landscape, direct-to-consumer telemedicine service providers – companies who provide clinical services via telemedicine, not to be confused with technology companies who facilitate care delivery – are adding to fragmentation challenges by shifting care away from local caregivers. This is compounded by insurers and employers contracting directly with these companies, which adds to an already fragmented healthcare landscape, pushing employees and/or plan members to use clinicians with no relationship to or connection with their local healthcare resources – all in the name of cutting costs.
In some states, this has led to increased resistance to telemedicine as a whole, but that’s not the answer. Instead, we should craft telemedicine policy to encourage continuity of care and pursue regulatory policy that defines telemedicine as a tool that many, if not most, clinicians will eventually come to use, rather than a “service” or a specialty. By doing so, we can eliminate barriers to telemedicine and other technology-facilitated health care and provide patients and their clinicians new ways to connect, that support rather than circumvent the patient-clinician relationship.
Reason for Optimism
This response isn’t intended to be a smack-down. Rather, we truly want to open the dialogue in the telemedicine and virtual care space around what will help drive positive movement on the regulatory front. And we think there’s reason for an optimistic outlook for telemedicine regulation in 2018.
First, as we’ve mentioned before, there is great work being done at the federal level by Sen. Brian Schatz and others on the CONNECT Act. 2017 also saw a lot of movement toward more inclusive, forward-looking telemedicine legislation at the state level, exemplified by the well-publicized example of the new telemedicine regulations in Texas. We anticipate that this trend will continue into 2018, as boards of medicine and state legislatures, fuelled by greater knowledge and understanding of the benefits virtual care can bring to their states, work to make care more accessible, and address the challenges of today’s healthcare landscape.
Excerpted from remarks by Dr. Hafner-Fogarty at the C-Tel conference, December 1, 2017
Virtual care holds enormous potential to transform the healthcare landscape. Since you are here, you most likely agree that virtual care (and telemedicine) can be of great benefit for patients, providers, and health systems. In today’s digitally focused landscape, virtual care is truly on the cusp of having a dramatic, positive impact. But – and of course there’s always a but – there’s a big obstacle standing in the way: provider adoption, fueled by inconsistent virtual care reimbursement .
I’ve noticed huge disparity in statistics associated with provider adoption of “telemedicine”. For example, a KPMG survey earlier this year found that about 30% of clinician respondents were using some form of telemedicine. However, a 2016 AAFP survey showed only 15% of respondents had used telemedicine tools in the previous 12 months. Maybe most telling is that the KPMG survey listed provider reluctance as a top barrier to health systems implementing a telemedicine solution.
So with all the benefits that we know telemedicine brings to the market, why are providers balking? Market research is more consistent on this point. Among others, the AAFP survey listed the top reasons providers hesitate to embrace telemedicine is lack of education and lack of reimbursement.
Clinician education is important and worth discussing, but let’s focus today on the elephant in the room, which is reimbursement. This is where I personally believe strategic policy work can make difference.
Reimbursement and Regulatory Complexity
The first step toward eliminating reimbursement barriers is to understand why reimbursement is a barrier in the first place. One factor getting in the way of eliminating regulatory barriers is the federal and state regulatory environment is amazingly complex and extremely fragmented.
Currently, CMS offers little coverage for telemedicine and has been sluggish to respond to innovative telemedicine technologies, leaving it up to the states to address an evolving regulatory landscape as best they can. A majority of states have attempted to advance telemedicine-specific legislation in recent years; however, key elements, like the definition of telemedicine, establishment of a provider-patient relationship, allowable modalities, and e-prescribing differ from state to state. Even within the same state, one regulatory office’s telemedicine definitions may differ from another regulatory office. CMS’s Medicare reimbursement rules for telemedicine care can add yet another layer of complexity, and to further complicate matters, many states have a different set of Medicaid rules.
The hodge-podge of modality and site-based restrictions for reimbursement has only added to the complexity of the regulatory environment. According to the Center for Connected Health Policy, 48 states and the District of Columbia currently require reimbursement for video-based telemedicine visits, while only 15 states require reimbursement for telemedicine services provided on a store-and-forward basis. Not surprisingly, reimbursement is less clear for other modes of telemedicine.
Site-based restrictions on reimbursement offer even greater challenges. Such restrictions, designed in the days of telemedicine’s infancy and no doubt with the best of intentions, focus reimbursement on rural areas, leaving physicians and patients in cities and suburbs without a reimbursement mechanism for healthcare provided virtually. Furthermore, in a prime example of legislation that’s been outpaced by technology, some states have language requiring a healthcare professional be present on both sides of a virtual visit. These requirements create roadblocks because they fail to account for the explosion in use of personal mobile devices that allow patients to connect directly to their providers regardless of location.
Providers, quite understandably, look at the complexities of the regulatory environment and the likelihood of being reimbursed for virtual visits and say, “no thanks.” Fortunately or unfortunately, that’s not really an option anymore. Telemedicine and virtual visits are growing exponentially. According to the Advisory Board, more than 70% of patients are interested in receiving services by telemedicine. As patient expectations are increasingly set by other industries and online experiences – think Amazon, Facebook, or meal delivery services like our local Bite Squad – demand for online care delivery is only going to grow.
Policy Fixes for Virtual Care Reimbursement
Now, for some good news. There are several reasonable, non-controversial measures we can take on at the policy level that can reshape the regulatory landscape.
First and foremost, I want to note that there are policy makers at the federal level who are taking what I hope are the first steps toward addressing some of the challenges, specifically around CMS coverage and guidance. The good work Senator Brian Schatz of Hawaii has done on the CONNECT Act will hopefully signal a move to a more provider-friendly Medicare regulatory environment.
At the state level, boards of medicine and state legislatures still have a phenomenal opportunity to open the door to telemedicine and bring its benefits to their constituencies. Going forward, healthcare policy needs to reflect the eventuality that all providers will need to use telemedicine in patient care, the same way they use other tools of modern medical practice. Here are a few simple steps to developing policies that can help overcome the reimbursement barrier to provider adoption:
Appropriately Define “Telemedicine”
Policy that defines telemedicine should not limit it to specific modes of care; telemedicine definitions need to be inclusive and forward-looking. Technology moves quickly, and creating rules and legislation that stand the test of time is paramount to ensuring patients and providers receive the benefit of new technologies when they become available. Providers need to be free to choose the mode of care that best suits their practice and their patients, while maintaining the standard of care.
Allow Online Doctor-Patient Relationship Establishment
Regulations and policy around establishment of the doctor-patient relationship should focus on the care and service provided and not the technology. Again, the goal here is not to facilitate shoddy care, but to give providers the flexibility to meet individual patient needs within the standard of care.
Specifically Address Reimbursement
Legislation should explicitly include language addressing both coverage and reimbursement parity for all modes of care. It should also prevent insurers from requiring patients to receive online care from the insurer’s contracted telemedicine company in order to qualify for reimbursement.
Promote Continuity of Care
Policy makers and regulators can help drive physician adoption of telemedicine by supporting policies that promote telemedicine models that foster continuity of care, without impacting health systems’ ability to choose from innovative care delivery technologies.
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.”
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.
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.
A few days ago, an opinion piece in JAMA came to my attention. In it, Drs. Nochomovitz and Sharma called for a new medical specialty to be recognized: the medical virtualist.
As someone with a lot of experience in healthcare – years as a family physician, three terms on the MN State Board of Medical Practice, and my current role as Chief Medical Officer here at Zipnosis – I find this an interesting idea, but I’m unconvinced it’s necessary.
Why We Don’t Need “Virtualists”
First off, let’s talk about what virtual care (or telemedicine) is and is not. Virtual care isn’t a new type of healthcare, it’s a care delivery channel. This is an important distinction. The difference between healthcare services and technology that enables delivery of healthcare services is particularly vital when we look at tricky things like regulation. Typically, medical specialties are designated because of particular knowledge and skills needed for healthcare services, not the channel through which that care is delivered. We don’t have, for example, medical retailists who specialize in care delivery through retail clinics.
The biggest reason for steering clear of a “medical virtualist” specialty is simply that every care provider will need to have the skills and ability to provide healthcare services through online care delivery channels. The authors even recognize this, stating:
“Contemporary care is multidisciplinary, including nurses, medical students, nurse practitioners, physician assistants, pharmacists, social workers, nutritionists, counselors, and educators. All require formal training in virtual encounters to ensure a similar quality outcome as is expected for in-person care.”
I couldn’t agree more with this statement. Factors like healthcare consumerism, the shift to value-based care, and the need to address the quadruple aim will precipitate increased utilization and a growing need for healthcare providers to understand how to effectively deliver care online. It doesn’t, however, follow that a specialty is needed.
Further, their contention is that there will soon be a need for care providers to spend a majority of their time delivering care virtually. The trouble with this, though, is that there already are concierge medicine services, nurse lines, and telemedicine service companies that employ physicians, physician assistants, and nurse practitioners who work online full-time. Depending on the use case and mode of care, some hospitals and health systems may even have providers spending a good portion of their working week delivering care online or over the phone.
What We Do Need
Where Drs. Nochomovitz and Sharma really get things right is in their call for specific training – even certifications – for providers to support safe, effective online care delivery. The authors note:
“Physicians now spend variable amounts of time delivering care through a virtual medium without formal training. Training should include techniques in achieving good webside manner. Some components of a physical examination can be conducted virtually via patient or caregiver. Some commercial insurance carriers and institutional groups have developed training courses. [citation] These are neither associated with a medical specialty board or society consensus or oversight nor with an associated certification.”
Once again, I withhold support for a medical specialty board, but otherwise, I agree with the call for greater training and understanding of the specific skills needed to deliver care online. Up until recently, physicians and other care providers were trained exclusively on the medical and scientific elements of healthcare. Now, medical schools include courses on bedside manner and other “soft skills” that providers need to be effective in caring for patients. Many organizations, such as AAFP (of which I’m a member), offer and recommend training in areas like patient communication to support providers in their professional development.
Encouraging skill development in virtual care delivery would be a similar extension of the training medical professionals receive. The virtual care and telemedicine landscape currently has fewer options available, though that is changing with the AMA from last year stating its support for telemedicine training for medical students and residents. Most recently, the American Telemedicine Association partnered with the ClearHealth Quality Institute to develop and offer training and accreditation options in telemedicine.
Moving care delivery forward through expanding virtual care is going to be increasingly critical for patients and providers. Drs. Nochomovitz and Sharma are clearly committed to forwarding the cause of virtual care. Their ideas for training and the core competencies that clinicians will need to effectively use virtual care to care for patients are well-thought out and comprehensive. However, for the reasons outlined above, I believe a medical specialty would be more of a distraction than a benefit to the healthcare landscape.
About the Author
Rebecca Hafner-Fogarty, MD, MBA, FAAFP
In addition to being a primary care physician and serving as Vice President of Policy and Strategy at Zipnosis, Dr. Hafner-Fogarty has extensive experience in medical regulation, having served on the MN Board of Medical Practice from 1998-2003, 2004-2010, and 2012-2016. She was board president in 2009 and has also been involved in medical regulatory activities at the national level.
Working closely with our customers, I hear over and over that patient access is a key strategy and reason for launching virtual care. Taking a cue from our health system customers, we talk a lot about virtual care’s ability to expand and facilitate access to care. But what does that really mean? Who benefits from the expanded access that virtual care provides?
One of the things I find really refreshing about working at Zipnosis is that we don’t stop at thinking about what our health system customers need. What I mean here is we’re also thinking about their patients. Who is using their virtual care platform? Why are they using it? What can we do to improve the experience for them?
We actually have well-realized personas covering several known users. The flagship persona is someone we call “Kate.” Kate is in her mid-30s, married with two kids who she chauffeurs around in a late-model SUV. Kate works full-time and has insurance through her employer. She’s also the persona who drives our standard product demo – if you’ve ever seen the Zipnosis platform in action, it’s probably through the lens of Kate.
Recently, I began to think about Kate because access for her means something different than it does for a lot of the population. It’s really about convenience more than need. Kate could take time away from work, she could drive to see her primary care doctor for care, it’s just inconvenient to do so. But what it we took away Kate’s SUV, her employer-sponsored insurance, even her full-time job?
Katie looks a lot like Kate on the outside. She’s also in her mid-30s with two kids, but instead of Kate’s SUV, Katie relies on public transportation. Instead of Kate’s employer-sponsored insurance, Katie has a high-deductible health plan that means she pays for most healthcare costs out-of-pocket. Instead of Kate’s full-time job, Katie works two part-time jobs and doesn’t have paid time off. What does healthcare access mean to Katie?
To answer that question, I gave myself an exercise: Put myself in Katie’s shoes and understand the decisions she needs to make when looking at where—and whether—to seek care for a common condition like a UTI. Here’s what I learned:
In-Person Care Options
I looked at 4 in-person care delivery options: A primary care clinic, an urgent care center, a retail clinic, and the emergency room.
Working two part-time jobs without PTO, Katie needs to find time to go to the doctor. That may mean determining if she can afford to take time off of work, coordinating shift coverage with co-workers, or finding an option that’s open when she’s free. That means the hours of operation and when an appointment would be available are major factors in decision making.
Primary care: 8 am – 6 pm; appointment availability “tomorrow”
Urgent care: 7 am – 7 pm most weekdays
Retail clinic (average): Weekdays, 9 am – 7:30 pm; weekends, 9 am – 4 pm*
Emergency room: 24 hours daily
*Lunch hours: Practitioners take a daily, required lunch break each day. Please note that lunch time are approximate and may vary.
Part of managing schedules is figuring out the impact of public transportation. Katie needs to factor in schedules and routes. Then, she needs to determine how much time she’ll need to spend in transit. Using my house as a starting point, I determined that transportation would take anywhere between 15 and 45 minutes each way, most of which required walking about ½ mile in addition to the bus.
If Katie needs to seek care outside of her typical working hours or when the kids are not in school, she needs to consider what to do with her children. Does she haul them along to the doctor’s office? Does she get a last-minute babysitter – and is that practical from a financial standpoint?
Finally, with her high-deductible health plan transitioning the full cost of care to Katie, how much will she have to pay out-of-pocket for each of her options? The data shows costs varying widely for services, but the following are pulled from a Blue Cross Blue Shield (MA) fact sheet on typical costs for common services and Consumer Reports:
- Primary care: $130 – $180
- Urgent Care: $120
- Retail Clinic: $55 – $75
- Emergency Room: $400 – $700
Access with Virtual Care
Imagine the impact a virtual care offering could have on Katie. Access to a virtual care service effectively eliminates the need to balance her competing priorities.
Work Schedules – With virtual visits available via any internet-connected device, Katie doesn’t have to worry about missing work.
Transportation – Katie can access virtual care anywhere, so transportation ceases to be a concern.
Child care – Katie can complete a virtual visit while her kids do their homework at the kitchen table, or while they’re playing at the park.
Cost – Unlike the more costly in-person options, most of our health system customers charge between $20 and $40 for a virtual visit, making it far and away the most affordable option.
With virtual care, Katie can quickly, easily, and affordably receive care for her UTI – without the stress and worry. Virtual care may well be working to bring convenience to the Kates of the world – and that’s no small thing – but our greater impact is in the benefit we bring to the Katies.
Do you remember the healthcare world pre-EMR? Healthcare organizations from large IDNs to individual practices were swamped by stacks of paper. There were rooms filled with files, cabinets bursting with the medical histories of every patient that sought care at a given clinic.
Then came computers and along with them, electronic medical record systems (aka, the EMR). And everything changed. Digitized patient records didn’t take up any space. Health systems, physician groups, and clinics were freed from the morass of paper they’d been buried in for years. And over time, the EMR evolved to be more than just a digital record storage solution. From patient portals to revenue cycle support and scheduling, EMR vendors expanded their offerings to support a wide variety of health system needs.
It’s no wonder then, that when health systems begin looking at a virtual care solution, the telemedicine module/functionality in their EMRs is often the first place they look. Many EMRs automatically include this online care delivery with the software. In fact, the main argument in favor of health systems using their EMR’s virtual care solution is that they’re already paying for the technology, so adding virtual care would essentially be free. But is it really?
Imagine this: Your health system is moving forward with launching virtual care. After reviewing your options, your team decided to build within your EMR. Like most health systems, you want to maximize your EMR investment – plus the promise of “free” virtual care technology is too good to pass up. Then you get started…
What Does “Free” Cost?
Turning on the telemedicine module in your EMR to offer virtual care is much more complicated than just flipping a switch. You will need to dedicate time and personnel to creating your virtual care service: developing the user experience and interface, creating and mapping the appropriate fields in your EMR, and ensuring the necessary integrations with scheduling, billing, etc. are in place and working properly. This means either diverting resources from other projects, adding to your technology team’s workload, or hiring – on contract or full-time.
- Simply adding development to your technology team’s workload is the most cost-effective option, but it does cost the organization. Pushing off other projects incurs costs, and adding to the workload can stress employees causing an increase in absenteeism and even turnover.
- Contracting with a certified consultant can run to hundreds per hour, and you may still need to dedicate person-hours toward development.
- Hiring – whether contract or full-time – incurs costs in recruitment, training, and compensation.
The technology side is just the first cost hurdle. Your virtual care service also needs high-quality clinical content, including patient-facing questions, algorithms, and clinical decision support – none of which is included in the EMR’s technology. Same as the technology, you have three choices for creating your clinical content: dedicate internal resources, purchase the clinical content, or hire a clinical informatics specialist – either on contract or full-time.
- Even if you have a clinician with a background in informatics, finding internal resources means diverting clinical expertise away from patients. The cost of inexperience in this area could be even higher, with poorly-constructed algorithms producing the potential for quality concerns.
- Purchasing content will, of course, incur the cost of the content, but it may also require additional time and energy from your technology and clinical team to customize it to your unique needs.
- Hiring, again, means recruitment, training, and compensation costs.
Building internally through your EMR means an ongoing resource commitment. You will need to regularly allocate resources for:
- Technical support
- Managing software updates
- Clinical content management and updates
- Service and technology enhancements (e.g., additional conditions, specialties, and services)
Right now, health systems across the country – and likely in your market – are launching virtual care. According to a recent KaufmanHall study, 56% of health systems stated that developing virtual access points is a high priority, and 23% have a virtual care solution in place today. On top of which, telemedicine companies are growing their service capabilities and becoming more like complete online health systems than one-off urgent care centers. While you’re finding an EMR vendor-certified consultant, hiring IT and clinical staff to support virtual care, and actually building out all the individual, customized components of your service, these competitors are already marketing to and perhaps serving your patients.
Protecting patient relationships and retaining patients isn’t the only consideration. On the flip side, with virtual care proven to add patients to health systems, the time spent in building virtual care internally means the potential for losing new revenue. A recent white paper by Kurt Waltenbaugh, CEO of Carrot Health (and yours truly) found that approximately 25% of new patients from virtual care went on to have in-person care appointments within a health system. With the average annual revenue per new patient close to $3,000, this can add up to significant lost opportunity.
Finally, building your virtual care service within your EMR makes it much more difficult to change EMR vendors. You may not want to consider it right now, but if something occurs that causes you to change EMRs and you’ve built your virtual care, you lose your virtual care service, and all the time and money invested in building it.
Adding it all up
Back to our imaginary scenario: You’ve gone through your technology build, and you begin adding up all the costs associated with creating your virtual care service. All told, your free virtual care technology ended up taking more than a year and costing several hundred thousand dollars to build. During that time, your two biggest competitors launched online care services, and now have contracts with the major health plans and employers in your area. What’s more, your urgent care centers and clinics have seen a decrease in patients, as those services siphon visits away from your health system.
Having spent the past decade supporting health systems, I understand the temptation of the word “free.” Healthcare organizations are consistently asked to do more with fewer resources, and budgets are under heightened scrutiny. But look closely at any option billed as “free” – it may end up costing you more in the long run.
Last week marked our 3rd annual Zipnosis Customer Summit. More than 20 representatives from 11
health systems joined us in Minneapolis to network, learn, and celebrate the accomplishments from the past year. This was my first Customer Summit, and I was thrilled by the spirit of partnership and excitement our customers brought to the event.
Over the course of the day, we covered a wide range of topics, all geared towards helping our customers optimize virtual care within their organizations. Presentations covered the evolution of Zipnosis as a company, customer successes, and a look into the future. So, with that in mind, here are a few of my favorite moments from the Customer Summit:
Peer Insights Win the Day
We were fortunate to have three customers join us as presenters. As Vice President of Customer Success and Operations, my goal is in my job title – success for each and every one of our customers. It’s gratifying for me to hear about the positive results customers are achieving. But more than that, the Customer Summit gave everyone in attendance an opportunity to learn from the experience of their peers.
Understanding Healthcare Today
We were lucky to have Brian Kalis from Accenture Consulting join us for a terrific keynote on the changing nature of healthcare. His insights on healthcare consumerism, shifts in the competitive landscape, and technology adoption were eye-opening.
What Tomorrow Holds
In addition to presentations about what is happening right now with Zipnosis and the healthcare landscape, customers were treated to a preview of upcoming products as a part of the Zipnosis product roadmap session. I, of course, can’t share this top-secret information but we have some big things coming soon.
Networking at its Finest
The Customer Summit was packed with insights and information, and I felt fortunate to be able to to connect with so many of our customer attendees. We heard immediately how valuable it was for our customers to connect and network with one another. All in all, it was a fantastic event! My goal (and strong belief) is that having face-to-face time accelerates our customer’s understanding of their Zipnosis platform capabilities as well as opportunities they may not have thought of before. I hope to see many more health system leaders at next year’s summit.
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.
As the healthcare industry evolves, health systems are increasingly using online care delivery to help meet the changing needs of healthcare consumers. But choosing a virtual care partner can be challenging. How do you know you’re making the right choice for your health system?
While there’s no silver bullet, our experience partnering with health systems has uncovered 13 areas every health system should look at when selecting a virtual care partner. Check out our virtual care baker’s dozen:
1. Who Are Your Stakeholders?
It’s easy to identify key executives who need to be involved in selection of a virtual care solution and partner, but making the right choice involves more than just top levels. Understanding the impact virtual care has on stakeholders throughout the organization can help you choose the solution that best aligns with your health system’s needs. This is particularly important for those who will be expected to interact with the virtual care solution on a day-to-day basis. Involving front-line stakeholders – particularly clinicians – early in the process can help foster buy-in, create a smoother transition when it comes time to launch, and ultimately support program success.
2. Your Health System’s Goals
Before you can effectively evaluate potential partners, it’s vital to understand why you are launching virtual care and how this initiative intersects with larger organizational objectives.
- Are you looking to expand patient access?
- Do you have capacity concerns?
- Are you seeking ways to manage a challenging competitive environment?
- Are you looking for new revenue channels?
- Is saving on your employee health insurance costs a focus?
- Do you want to support your brand and be viewed as a technology leader?
The answers to these questions will help form your virtual care strategy, which should be at the center of your partner selection process.
3. Internal Processes
It’s also important to fully understand internal processes and clinical workflows. A best practice is to perform an evaluation of current processes looking at elements like patient experience, clinician workflow, billing and claims, etc. prior to selecting a virtual care partner. This can be a good time to revise processes and workflows that are no longer working well for your health system. Whether you choose to make process improvements or not, a comprehensive grasp of current processes will help you select a virtual care partner and solution that complements – rather than hinders – clinical operations.
4. Virtual Care Program Requirements
Your virtual care strategy and understanding of processes and workflows will provide a guide to building out your list of requirements. Health systems often start out with a long wish-list and idealized version of how the virtual care program will run. Prior to beginning your search for a virtual care partner, it’s important to evaluate and prioritize program requirements and understand where and if you’re willing to compromise. For example, you may have to balance factors like staffing levels and budgets with choice of modality, or organizational objectives with regulatory constraints. Get your team on board with a list of must-haves, nice-to-haves, and things to avoid at all costs.
5. Leadership & Team
Virtual care is most often a “software-as-a-service” (or SaaS) solution, meaning that you’re purchasing the right to use the software, but the result you get is more service-based. That means the people you’ll be working with matter. During the evaluation process, try to interact with both company leadership and people directly responsible for day-to-day operations. Most importantly, be sure to get to know the person or team that will be supporting your account – they will be critical to your success.
6. Financial & Organizational Stability
With the proliferation of virtual care and telemedicine companies flooding the market, it’s important to make sure your virtual care partner is experienced and stable. Ask potential partners about:
- Current and anticipated funding – Make sure your potential partner has a solid financial foundation
- Industry tenure – While length of time providing services shouldn’t be the number one determining factor, make sure you’re not choosing an untested, untried solution
- Board membership – This ties in with company leadership, but a stable, well-functioning board is indicative of a stable, well-functioning company
- Company growth – Look for an organization that demonstrates steady growth, but not one that is growing so quickly they may not be able to effectively serve current clients
7. Business Model
Understanding a potential partner’s business model is an important part of the selection process. Many companies serving health systems also have a direct-to-consumer offering, which may or may not present a conflict of interest or otherwise impact the success of your partnership. When evaluating partners, ask yourself:
- Do they market and sell telemedicine or virtual care services directly to patients, health plans, and employer groups?
- How deep do their services go in serving patients directly? Might patients who use the service go directly to them for other care down the line?
- And, most importantly, does their business model present a conflict for your organization?
Solution and Relationship
8. Technology & Product Roadmap
Finding the right technology for your health system and your patients is a critical part of selecting a virtual care provider. You need to understand the differences between different modalities – phone, video, and store-and-forward. Each has a place and a use, so the technology solution you choose needs to align with your goals and strategy. You also want to look at how different solutions work within your current technology ecosystem – you don’t want to sign a contract only to find that the virtual care software is incompatible with your EMR, billing, and scheduling tools.
When choosing a partner, it’s also important to take a long view. Telemedicine and virtual care today looks different than it did 10 years ago, and as technology and the healthcare industry evolves, your virtual care solution needs to evolve with it.
9. Service & Support
When purchasing a software solution or a service, it’s vital to understand what type of service and support is included in your purchase. Determine what services are important to you and make sure you have a full understanding of what each solution brings to the table.
Services to look for:
- Implementation plan and support
- Initial and ongoing training for administrators and clinicians
- Reporting availability and metrics tracked
- Technical support for all users – providers, administrators, and patients
- Account management services and relationship support
- Branding and white-labeling
- Ongoing product roadmap and service scaling
10. Clinical Quality
Evaluating the clinical quality of potential virtual care solutions is a critical element of partner selection. Clinicians need to be comfortable with the quality of care provided, patients need to feel they are receiving the best possible care, and regulators need to see that the standard of care is upheld across care delivery channels. Potential partners should be willing to:
- Share quality reporting data – guideline adherence, antibiotic stewardship, etc.
- Provide information on clinical protocol development
- Demonstrate the features and functionality that ensure quality care
- Outline the steps they are taking to support clinical quality across all customers
11. Clinician & Patient Experience
As you’re evaluating solutions, consider how your patients and your staff will interact with the virtual care software. If you’re outsourcing clinical functions, where will the intersections be and who will need to manage them? If you’re staffing internally, understand how this will look, and how it will impact your clinical operations. More importantly, how will it impact your clinicians? A positive clinician experience can make or break a virtual care service.
Patient experience is equally important. Developing a fundamental understanding of who your patients are and what their lives look like is critical to selecting a virtual care partner and solution that will work for them. Things to look for include:
- Ease of use
- Accessible language
- Process transparency
- Expectation management
12. Partnership Approach
Virtual care is a critical, strategic initiative, and to realize the greatest benefit you need more than just a vendor – you need a true partner. As you evaluate technologies, services, and solutions, keep your eyes peeled for clues indicating which companies are truly committed to your success.
- Ask for stories about how potential partners have helped their customers overcome specific challenges, or ways they’ve met an unexpected customer need.
- Look at how their technology and service structure is set up – is it geared around bringing value to health systems and their patients?
- What opportunities are available for customers to network, learn, and grow?
This may be obvious, but your potential virtual care partners should be willing and able to provide information on the results their customers are seeing. These need to be transparent, understandable, and provable. Check out case studies, webinars, and independent research (if any are available) to see what type of results health systems are seeing with each potential partner. While formal reference checks can be useful, also ask around to your health system peers. Virtual care providers will most likely only give you access to satisfied customers, which is why reading the buzz in the industry is just as important asreference calls.
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”.
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.
What’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.
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.
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
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.
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, 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.
You may have heard the latest news coming out of Texas – A major piece of telemedicine legislation has just been signed into law that will change the game for health systems looking to deploy virtual care. This bill abolishes the requirement that patient-physician relationships be established with an in-person visit before telemedicine or virtual care can be used. For health systems, that means they can now offer virtual care to the broader marketplace, rather than just to current patients. With virtual care proven to add patients to health systems, this presents an opportunity to employ virtual care as part of a patient acquisition strategy. Game-changing.
In Texas (and elsewhere), health systems new to telemedicine and virtual care are now looking at launching their own services to support patient acquisition. But without a foundation in virtual care, health systems moving quickly to take advantage of the new environment may be making decisions that have potential long-term implications for their organizations and patients. More good news for Texas health systems: By avoiding these 5 common virtual care mistakes, success is within reach.
1. Lack of organizational support
Often, health systems will decide there’s a need for virtual care, and begin with the best of intentions, delegating a department or individual to work on finding and implementing a solution. But without a clear plan, regular communication, and stakeholder engagement, the virtual care project does not get the proper attention and true buy-in needed to create a successful, long-standing virtual care offering.
Think of virtual care as a large, strategic technology investment – something that can support organization-wide objectives and strategies while adding value to your patients’ experience and your providers’ work. Make sure you have a clear plan around launching, and assemble a steering committee of leaders throughout the organization to guide the implementation and growth of your virtual care service.
After launch, maintain a communication plan to help keep virtual care front-of-mind throughout the organization. From clinical operations through marketing, your team should understand why virtual care is an important part of your strategy and how they can help make it a success.
2. Unclear reporting structure
Traditionally, telemedicine and virtual care service lines have been subject to a surprising lack of oversight. Health systems that don’t set up a clear reporting structure or determine which metrics to track will never be sure whether their virtual care service is meeting its objectives, and won’t have the insight needed to improve or grow the service.
This is an easy mistake to avoid – just make developing a cadence of accountability part of the implementation process. Understand what data your partner can capture and report on and what data you have access to. Decide on a reporting schedule—and identify who will be responsible for assembling and who will be responsible for reviewing reports.
If you need help identifying metrics or developing a reporting structure, our eBook, Measuring Success in Virtual Care, has the information you need to get off on the right foot.
3. Lack of marketing support
“If you build it, they will come” only works in baseball fantasy movies. But some health systems think that just having the service is enough. The truth is that patients won’t use your virtual care service if they don’t know it exists. And, in the digital age, marketing techniques need to be updated to match your audience.
It’s not enough to buy billboard space. When launching a virtual care service, you need a multi-channel, long-term marketing plan to drive virtual care adoption. This may include elements like a press release and local media strategy, prominent website placement, social media strategy, direct mail, email marketing, and in-clinic marketing. Likewise, an initial introductory push will only do so much for the service. If you want to see long-term success with virtual care, create a continuous cadence of communication, including seasonal marketing pushes around things like cold and flu or seasonal allergies.
Internal communications are also key. Providing training and information to nurse line and front desk staff to help them direct patients to the virtual care service can do a great deal toward driving adoption. Additionally, getting physicians, physician assistants, and nursing staff on board with talking about and recommending virtual care can make a tremendous difference in virtual care adoption.
4. Not understanding big-picture value
People are people, and people get locked into old ways of thinking. This is particularly true when looking at payment and revenue. Health system finance departments sometimes view the return on a virtual care investment by subtracting revenue from cost – but that’s not how virtual care adds value. The true value of virtual care lies in downstream revenues and cost savings as evident in a recent study.
Virtual care’s organizational impact can appear in any combination of the following:
- Increased patient acquisition
- Reduced patient leakage
- Lower cost of delivering care – or cost shift
If you want more information about the potential revenue impacts of virtual care on your health system, our revenue calculators can give you a starting point:
5. Choosing the wrong partner
Not all telemedicine and virtual care companies are created equal – the technologies, business models, support, and product roadmaps can vary widely. For example, many telemedicine companies have a direct-to-consumer model, meaning that they have the potential to create a relationship with your patients that could lead to those patients circumventing your system altogether in the future.
Many health systems rush their decision due to pressure from increasing competition or fail to perform their due diligence in the belief that telemedicine and virtual care companies are all the same. Often, healthcare organizations will find that their partner isn’t providing what they need six months to a year into a multi-year contract. Concerns can be as simple as workflow alerts, to low utilization, to lack of flexibility and scalability in the technology. And then they’re stuck. Fortunately, with planning and care, it’s possible to select the partner best suited to your health system’s needs.
First, talk to your stakeholders – understand patient and provider needs so you can choose the partner that is best suited to meet those needs. Don’t assume. Next, take a look at your organizational strategy and understand how virtual care fits into your overarching goals. Finally, develop your criteria for selecting a virtual care partner, including technology, support, staffing, and integration, to name a few.
The partner you choose should offer technologies that meet your patients’ needs, while fitting seamlessly into their lives. They should also offer solutions that fit into provider workflows to maximize clinical efficiency and support a positive provider experience. Your virtual care partner should also be able to demonstrate support for providing the highest levels of care quality that your patients expect from your health system. Finally, find a partner that will be just that – a partner. Find a company that will work alongside you to help create a successful virtual care service line – from launch through growth, scaling, and innovating.
Get Set for Virtual Care Success
Virtual care holds the potential to bring health systems a lot of value. Keep your eyes peeled, put in some effort in planning on the front end, and avoid these five virtual care mistakes, and you’ll be in a great position to win – whether you’re a Texas health system taking advantage of the new regulatory environment or just ready to take the next step in launching an online care delivery service.
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.
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 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|
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.
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.
The 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|
About the Author
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.
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.
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
Zipnosis Chief Clinical Officer Kevin Smith’s most recent article for Health IT Outcomes discusses how virtual care can make an impact on care quality. Responding to a study published in JAMA Ophthalmology, he notes that virtual care can help more effectively capture patient-reported symptom information and ensure EHR records are accurate. Read more.
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.
No one will be shocked to hear that technology is driving the future of care delivery or that staying current with healthcare technology is increasingly vital to organizational success. But you may be surprised at the role virtual care can play in your digital health strategy.
The Digital Health Ecosystem
Being successful in this brave, new, technology-fueled world means building a digital health ecosystem. Like an ecosystem in the natural world, all components should come together to create a seamless whole. Your digital ecosystem needs to support the overall goals of your healthcare organization, including enhanced patient access, continuity of care through EMR integration, simplifying billing and claims processes, easy patient visit scheduling, and superior patient experience through portal integration.
Having a clear digital health strategy that outlines the technologies you will employ and how they will work in concert to support the continuum of care is critical. It’s easy for health systems to become so focused the individual technology solutions, they can’t see the (digital) forest for the (virtual) trees. Without that strategy, they may not realize there’s a virtual care-shaped hole in their digital health ecosystem.
Virtual Care: The Missing Puzzle Piece
It seems myopic from today’s perspective, but virtual care was traditionally viewed as a siloed point on the care continuum. In the digital age, virtual care is a delivery channel that supports a large breadth of services – from low-acuity conditions to more complex services such as chronic care management, and from primary to specialty care.
Even better, virtual care complements other elements of the digital health ecosystem, making it stronger and more unified. Paired with ePrescribing, virtual care fosters convenient, complete treatment of a variety conditions. It can be used alongside traditional telemedicine video visits to reach more of your patient base. And, virtual care gets both patients and providers comfortable with online care, making it easier to accept digital health technology in higher-acuity situations.
Your Digital Health Strategy
Health systems need to keep pace with changing consumer needs and the shifting demands of the dynamic healthcare industry. According to research firm Gartner, 40% of primary care visits will be virtual by 2018. With direct-to-consumer telemedicine companies vying for patients and growing numbers of health systems launching virtual care solutions to meet growing patient demand, virtual care is a vital piece to your health system’s success and your overall digital health strategy. Are you ready?
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.
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.
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.
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:
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.
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.
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.
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!
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 HealthAffaris.org, 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!
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.
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
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
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.
In growing numbers, patients are expecting convenient, accessible care from health systems. At Zipnosis, we hear this all the time. This need is compounded in areas where patients may need to drive hours to reach a physical clinic. Seeing these market forces play out in their community, Bryan Telemedicine, the virtual care arm of Bryan Health—a leading health system based in Lincoln, NE—decided to meet this challenge head-on by offering virtual care.
The Search Begins
Like many health systems, Bryan Telemedicine began looking for a virtual care solution to meet the demand for accessible, convenient care. They had a wish list that included being able to leverage current staffing and internal clinical expertise, support continuity of care for their patients, and achieve high levels of clinical guideline adherence. Initially, it seemed they might have to settle for a traditional video only (synchronous) telemedicine solution – then they found a unique approach by Zipnosis that better addresses their requirements.
The Start of a Beautiful Partnership
Bryan Telemedicine was attracted to Zipnosis’ evidence-based protocols and proven clinical quality they deliver. Bryan Telemedicine was also excited by how Zipnosis leverages marginal clinical capacity – a feature that allows them to provide 24/7 virtual care without adding staff. But what about those patients that can’t be treated online? The Zipnosis platform routes these patients to the most appropriate level of care within the Bryan Health system. You see, we’re all about delivering the right care at the right time – whether online or in person.
One Year Later…
Bryan Telemedicine launched their virtual care service, Bryan Health eVisits, in late summer 2015. Since then, they’ve been pleased to see how virtual care fits seamlessly into their overall continuum of care. They have also seen an increase in new patient acquisition and a reduction in patient leakage to other virtual care solutions and health systems.
Recently, Bryan Telemedicine has expanded their virtual care service through a partnership with Memorial Health Care Systems (MHCS) in Seward, Nebraska. The arrangement takes advantage of the virtual care expertise of Bryan Telemedicine and their Nebraska board certified physicians. Bryan Telemedicine physicians will staff the new service, reviewing patient information and making an appropriate on-line diagnosis.
The Zipnosis team is continually impressed by Bryan Telemedicine’s innovative approach to care delivery. Check out our joint case study to learn more about Bryan Telemedicine’s journey and the results they’re seeing as a Zipnosis partner.
Want more information on virtual care? Check out our guide to best practices!
Cold and flu season is just around the corner and as health systems across the country prepare to meet the challenge of full waiting rooms and sniffly noses, there’s one solution that can help: virtual care. Having a virtual care service in place during cold and flu season can help mitigate the sick visit surge and strain that many health systems face as fall turns to winter.
Cold and Flu Season Puts Health Systems Under Pressure
Upper respiratory illnesses, in particular influenza-like illness (ILI), account for a major portion of annual visit volume in settings such as retail clinics, urgent cares and emergency rooms. Throughout the US, cold and flu visits account for 27.4% of all retail clinic visits, 9.7% of all primary care visits and 5% of all emergency department visits each year, according to research published on healthaffairs.org.
According to a study published in Academic Emergency Medicine, the greatest number of urgent care visits occur during the winter, with the highest number of daily visits recorded from November through February. At Zipnosis we see this each year, with visit volume increasing during the fall and winter months (see Figure 1). Information from Google Trends, which aggregates web search data, follows a similar curve with more searches on cold and flu occurring during the winter (see Figure 2).
How Can Virtual Care Help ?
Implementing a virtual care solution can help health systems mitigate some of the challenges that come with cold and flu season.
Take the strain off of brick and mortar care locations
Regardless of how visit volume from cold and flu is distributed across your health system—urgent care, retail clinic, primary care or emergency department—it’s likely that locations are operating at or beyond maximum capacity during cold and flu season. Moving visits to a virtual care service takes some of the strain off your clinicians and support staff, and can free up visit slots for higher value, more complex conditions.
Virtual care has the potential to significantly reduce the burden of clinics during cold and flu season (Tweet this). For example, a large midwestern health system with a well-established virtual care service through Zipnosis saw nearly 6% of cold and flu visits shifted from in-person to virtual care, opening up appointment slots for more complex patient needs and relieving pressure on providers and staff.*
Keep your waiting rooms safe
Keeping patients healthy is important, and one element of this is minimizing exposure to illness. In a recent study, researchers from the University of Iowa noted that well-child visits for children younger than six years old increased the probability of a flu-like illness in these children or their families during the subsequent two weeks by 3.2 percentage points. This seemingly incremental risk translates to more than 700,000 preventable illnesses annually with a price tag of nearly $500 million. By moving office visits for highly contagious conditions like influenza to a virtual visit, risk of healthy patients becoming sick decreases (Tweet this).
Support patient retention and continuity of care
During the high volume times associated with cold and flu season—particularly when health systems are at capacity—it’s increasingly likely patients will seek care elsewhere. Whether they choose a retail clinic, competing urgent care or direct-to-consumer telemedicine service, visits outside your health system open the door to potential patient leakage. Moreover, seeking episodic care means that if patients return to their primary care provider, their record may not be reflective of the care they received elsewhere. Offering your own virtual care service can help capture these patients who might otherwise seek care elsewhere, while supporting continuity of care and maintaining accurate patient records.
There’s Still Time to Act
Many health systems are already beginning to see patients for cold and flu visits, but with peak influenza activity predicted for mid February to mid March 2017 according to the Epidemic Prediction Initiative, there is still time to launch and market a virtual care service. With Zipnosis’ 60-day guaranteed implementation, you can have your virtual care service up and running to handle cold and flu season – and help provide safer care for your patients.
*Assuming 9.7% of visits are for cold and flu (per the healthaffairs.org study referenced).
Patient engagement is becoming increasingly important, and virtual care offers health systems a solution to meet patient needs while fitting healthcare into their lives. Kevin Smith, Zipnosis’ Chief Clinical Officer and innovative healthcare pioneer, discusses how virtual care can help health systems better engage with patients to boos patient retention and minimize patient leakage.
Over the past decade or so, the U.S. healthcare system has transitioned from paper-based documentation of patient records to the use of electronic health records (EHRs). One might assume that computerized health records and systems would result in dramatically improving the efficiency and quality of care. The outcome isn’t so cut and dry.
While some efficiencies have been achieved with EHRs, a recent survey showed that fewer physicians believe that use of an EHR has facilitated improved treatment decisions (46 percent in 2015 vs. 62 percent in 2012). What about improvements in the quality of care? We know that overuse of antibiotics is a problem of global proportions, resulting in increased antibiotic-resistant organisms making it more difficult to treat certain infections. Another study demonstrated that patients with viral upper respiratory infections (the common cold) receive inappropriate antibiotic prescriptions 65% of the time. And a third study found antibiotic guideline adherence rates for treating sinus infections were just 43%. This is in spite of the many tools in EHRs that are supposed to assist with improving the quality of care. So how can we improve?
That’s where effective clinical decision support – and the Zipnosis platform – come in.
Clinical Decision Support Boosts Care Quality
There are many ways to improve the quality of care. One approach is akin to a pre-flight checklist. When we fly in an airplane, we trust that the pilot is using a checklist to make sure everything on the plane is working properly before take-off. “Engines, check. Wings attached, check.” We would be less comfortable if our pilot relied only on their experience and intuition and skipped the checklist.
In healthcare, the equivalent of a pre-flight checklist is used less often than you would expect, with busy clinicians sometimes relying solely on their experience and intuition, which is often very good. However, a clinical checklist approach includes tools which clearly spell out best practice guidelines based on the current scientific literature. Health professionals do their best to keep up on the latest studies, but no single human can manage to wade through the estimated 2.5 million scientific articles published each year – in the English language alone. However, one form of clinical decision support includes summarizing relevant clinical guidelines and providing the best practices to clinicians at the time they are making treatment decisions.
To ensure that the clinical decision support (CDS) is effective, it is necessary to be able to measure the rates of clinician guideline adherence to determine if care provided followed the established best-practice standards. Studies have shown that when specific CDS features were used, clinical guideline adherence was significantly improved. Overall, internal analysis of visits through the Zipnosis platform, where CDS is incorporated into the diagnosis and treatment process, have shown a guideline adherence rate of 94%. In my doctoral research, implementing clinical decision support, along with other educational interventions, resulted in an increase in guideline adherence of 3.3% for treatment of sinusitis, from 95.2% to 98.4%.
Clinical Decision Support Meets Virtual Care
At Zipnosis, we help providers improve the quality of care they deliver. Our proprietary protocols are grounded in national best practices, and offer built-in CDS.
The process starts with an adaptive patient interview that systematically captures the appropriate patient symptom history by asking the same questions that would be asked in a face-to-face visit – except the software never forgets a question.
This history is then summarized and presented to the clinician, along with curated diagnosis pathways and treatment options enhanced by CDS in the form of clearly summarized guidelines and best practices. This reduces the variability in diagnosis and treatment, which in turn, results in higher rates of guideline adherent diagnosis and treatment.
Health systems can effectively track guideline adherence through the Zipnosis platform, too. Both the patient history and the diagnosis and treatment plan are stored as structured data, allowing for efficient and accurate quality reporting. At any point, our Statnosis™ real-time analytics platform allows clients to easily report on how well clinical providers adhere to the best practice guidelines.
Achieving Adherence with Zipnosis
Let’s look at a real-world example. Remember the not-so-impressive statistic above – inappropriate antibiotic prescriptions for the common cold 65% of the time? In an analysis of over 1,700 virtual care patient visits for upper respiratory infection symptoms from two large health systems, adherence to best practice guidelines was achieved in over 95% of the cases. At Zipnosis, we take the issue of appropriate antibiotic use very seriously. We saw the need to do better, and we did.
High quality care that is safe, effective and adheres to best practice guidelines can and is being be achieved in the virtual care setting. And the outcomes exceed the quality of care the more traditional face-to-face setting represented in the study above.
Providing quality care is vital – as healthcare practitioners, it’s our job. Ideally, there should be no differentiation in quality standards based on the setting (virtual care versus in-person care). The quality of care is good or it is not and Zipnosis helps health systems meet the highest standards of healthcare today. Quality care – check!
About the Author
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Like a tangled ball of string, telemedicine can endlessly fascinate. It can improve care access – anyone from anywhere can see a physician. It can reduce care costs – how expensive can it be to Skype your doctor? It can be used to diagnose and treat your health problems – everything from your sinus infection to your Type I diabetes. It can even be used to talk doc-to-doc – care coordination solved. What can’t telemedicine do!?
The boundless enthusiasm reminds me of the great Monty Python skit about an advertiser brainstorming a marketing campaign to sell 122,000 miles of string in three-inch pieces. It’s waterproof! Rust proof! Low calorie! It can tie up very small parcels! It kills 99 percent of known household pests! It’s got a million uses!!!
The Quest for the Holy Grail
In reality, the implementation of a successful telemedicine strategy is a lot more tangled than that – think string theory in Quantum Physics not ball of string and cuddly kitten. What we perceive as promising answers to critical healthcare problems actually lead to other universes with new challenges to contemplate. It’s easy to get lost in the complexity, as practical applications with solid ROI remain elusive.
Telemedicine has been a tantalizing goal for about 60 years, ever since scientists in the space program first debated ways to diagnose and treat astronauts. Since then, not much has changed in the thinking behind the idea, so why the excitement now? Information technology, of course, is the new space program. Picture quality and bandwidth have advanced light years. We can FaceTime with Grandma whenever we want so why can’t we televisit with the family pediatrician? If Netflix can predict what we want to watch and how, why can’t a hospital help us avoid the ER when we know our child has strep?
Marketing claims made within the industry are propagating those easy parallels without being straightforward about the complexities or actual benefits. It’s got a million uses!!! Lacking a practical business model, video-only telemedicine services don’t come close to meeting the everyday needs of patients and the efficiency and financial challenges of clinicians and providers. Pushing video as a stand-alone solution is like selling three-inch pieces of string and promising the world.
What’s missing is a clear understanding of value.
And Now For Something Completely Different
Telemedicine, like any other healthcare service, is not a cure-all but a commodity. It has its uses but it’s a tool to be leveraged not an answer in and of itself.
Patients don’t care about access; they value convenience and ease. How convenient would it be to shop on Amazon by video conference?
Clinicians don’t want to spend time engaging patients on-screen the same way they do in person. They want quick, digitized interactions that focus on care and decrease hassle, data entry, and time wastage.
Provider organizations don’t want an IT strategy that drives up user numbers without bolstering revenue. They want channels to new customers, a more competitive value proposition for current patients and clinicians, and meaningful gains in cost reduction and workflow efficiency.
So why let video-only rule?
Adaptive online interviews allow patients to make health queries and enter information when it’s convenient for them, not for providers or clinicians – think in-between meetings or in the minivan, not in the waiting room.
Evidence-based algorithms can determine when it’s necessary for a patient to see a clinician in person, or when an e-scrip or video consultation are better options.
Text alerts and EMR messages can let busy clinicians know when a patient is ready for a video visit and give them all the patient information they need exactly when they need it.
Video, in other words, should just be one part of a larger platform of solutions that creates actual value for patients and clinicians while driving solid ROI for providers.
The next time yet another telemedicine startup describes its video solutions, ask about the whole ball of yarn, not just the three-inch piece.
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!
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.
Like jetpacks and flying cars, telemedicine has been part of our collective vision of the future for a long time. Has that future finally arrived?
I haven’t seen any cars flying by lately, but I did gaze heavenward in July when Teladoc achieved a dreamy billion dollar IPO. While that kind of market validation is reassuring for those of us working to transform healthcare delivery, I can’t help but wonder whether investors and the media are buying into a vision of the future that won’t quite match reality.
Why am I skeptical? Because when it comes to telemedicine – unlike flying cars and jetpacks – it’s not technology holding us back. The barriers are economic. Can telemedicine make it easier for patients to get treatment and also provide a sustainable economic benefit to providers?
Telemedicine has been available since the early days of the space program. 60 years ago NASA could diagnose and treat astronauts on space flights via video consultation. Today, video is available on any smartphone or computer, people are starting to record their personal biometric data obsessively, and connectivity is ubiquitous, so it would seem that any remaining barriers to telemedicine have finally been eliminated. Then why are we not using video en masse for diagnosis and treatment?
The simple answer is that it’s still not convenient for patients or economical for providers. Unfortunately, few of those heralding the next great advance in healthcare delivery take the time to really pencil out the ROI and the value add. We’re so infatuated with sexy video screens and the novelty of telemedicine, we gloss over the cold, hard facts.
Where’s the Volume?
So let’s run the numbers.
The going price for a video consultation with a clinician runs about $40 to $50. From the consumer’s or payer’s perspective, this price is outstanding since emergency visits cost about $500 and a trip to urgent care runs about $250. Most of those visits are for minor ailments treatable by any primary care doctor or nurse practitioner. That’s why, if telemedicine was widely adopted, estimates of system-wide cost savings run as much as $25 billion.
Cost containment, however, does not a healthy market make. There’s a flip side to any exchange. Is it financially worthwhile for clinicians to perform primary care visits via video, and does the revenue model work for telemedicine businesses?
The short answer is no. Currently, most clinicians doing video visits handle about 100 to 500 a year, and the overall volume in the market is insufficient to keep clinicians working at their capacity, let alone earning the pay they would otherwise make through in-person consultations.
That reality is reflected in Teladoc’s IPO filing. A billion dollars in market capitalization notwithstanding, Teladoc’s expected revenues for the year are only around $74 million while costs are rising faster than revenue and the projected volume of customers will not make up the difference.
Although expectations around margins and profitability are generally different for emerging technology businesses, healthcare is in the throes of wrenching change to its business model. It’s unlikely that clinicians will embrace an approach that earns them even less money than they make now. It’s also hard to imagine outsourced telemedicine services like Teladoc, MDLive, American Well or Doctor-on-Demand driving growth that way, or investors continuing to back such ventures given the immense investments in marketing and infrastructure.
The Social Side of Telemedicine
Economics aside, there’s also an engagement factor to consider. Will consumers and clinicians find reasons to be drawn to telemedicine?
There’s no doubt that patients are more willing to engage with clinicians by video than they were a few years ago. Every busy parent I know likes the idea of avoiding the doctor for simple care. However, actually using video during the course of a normal hectic day is a barrier. Imagine trying to do a video call while juggling sick kids or sitting in your car. Now compare that to the ease with which you can order an Uber car or buy something on Amazon. In other industries, no thriving mobile service relies on video to conduct transactions.
And what about clinicians? Personally, I can’t imagine one 15 minute visit every four days or so providing enough activity to keep even an easy-going semi-retired healthcare professional content.
In my experience, physicians and nurse practitioners want to actively practice medicine and help patients. Their job satisfaction already wanes from struggling with crushing paperwork and cumbersome EMR data entry. Sitting in front of a row of video screens waiting for one or two visits a week would only exacerbate their dissatisfaction. Clinician satisfaction and engagement is key to any successful delivery model. Unhappy, under-paid clinicians are an anathema for change in healthcare.
The Search for a Better Answer
Instead of gazing heavenward, waiting for flying cars, let’s ground ourselves in solid economics and an understanding of what healthcare consumers and providers need to make telemedicine work.
In the next few blog posts, I want to show you how a new model for telemedicine, rooted in evidence-based care, is proving its ROI with health systems across the country. In the vision I’m going to lay out, patients get access to cost-effective, quality care in the right setting, providers are fully engaged within their workflow, and health systems get a boost to their bottom line and their market share. In the process, telemedicine starts to look a lot less like science fiction and more like another valuable convenience in our connected world.