For years, the top minds in healthcare have worked toward more cost-effective, convenient, and accessible delivery models. Now, overnight, a microscopic virus has transformed care delivery in ways the best and brightest minds in healthcare and government could not. In response to the 2020 pandemic, care delivery is rapidly transitioning away from high-cost physical venues like hospitals and clinics to more flexible and affordable virtual settings.
What's more, there's every indication that most of these changes will outlast the coronavirus. Even perennially conservative Medicare has announced its commitment to virtual care. As CMS Administrator Seema Verma told the Wall Street Journal, "I think the genie's out of the bottle on this one."
In this article, I explore how healthcare may evolve over the next three years. My predictions are based on interactions with patients, clinicians, health system leaders, payers, and tech partners. While nothing is certain on the roller coaster ride of 2020, I'm reasonably confident that we'll see the following trends accelerate.
Shortly after the coronavirus burst onto the US healthcare scene, emergency department (ED), urgent care, and medical office visits all plummeted in favor of virtual care. Visits with telehealth providers skyrocketed by 1,000% in some parts of the country. EDs and inpatient departments began embracing virtual solutions to reduce the risk of in-person contact with patients, preserve personal protection equipment, ease workforce shortages, and expand surge capacity.
While this explosive growth in virtual care was unprecedented, it wasn't truly surprising. The benefits of telehealth have long been validated by research. However, stakeholder resistance, bureaucracy, and lack of reimbursement have stalled widespread adoption. These barriers were quickly overcome when federal agencies relaxed their regulations to promote virtual care and streamline billing during the public health emergency.
Thanks to this combination of demand and deregulation, many innovative virtual care programs are gaining traction for the first time. A standout example is the hospital-at-home concept. Despite demonstrated cost and quality benefits, hospital-at-home programs are still considered "experimental" in the United States. However, the need to expand inpatient capacity ahead of potential COVID-19 surges has incentivized hospitals to invest in home hospital infrastructures like remote patient monitoring and mobile nursing teams. As a result, new hospitals-at-home are cropping up across the country.
Rick Newell, MD, MPH
The proliferation of new virtual technologies in almost all areas of healthcare has disrupted longstanding delivery systems and processes. For example, several tech firms have developed solutions that leverage artificial intelligence (AI) and natural language processing to streamline healthcare encounters and boost provider productivity. However, they depend on real-life clinicians and data to properly "train" their algorithms. In response, tech companies are enlisting the assistance of clinicians and patients to ensure they meet stakeholders’ goals and needs. Healthcare-tech partnerships provide fertile ground to pilot and refine AI solutions while simultaneously improving care quality for patients.
I believe that enthusiasm for virtual care will persist long after the pandemic fades. In addition, the patterns of delivery will likely shift over the next few years from episodic, transactional encounters toward more relational, community-based, integrated care delivery coordinated by local medical groups and health systems.
It will take time to create a virtual infrastructure that connects patients to local ED, urgent care, and primary care providers. However, once in place, this will provide a mechanism to easily convert a virtual visit into an in-person one when necessary. Visits will be captured in the local clinic or health system's EHR for improved continuity and care coordination.
Beyond virtual patient visits, I also expect growth in virtual care coordination. Integrated, team-based care benefits complex patients with chronic illness, behavioral health needs, health plan network constraints, and those who need additional help navigating the system.
When appropriate, remote patient monitoring and patient navigation can be used to safely transition patients to lower-acuity community settings while keeping team members informed and engaged. Care coordination will also play a pivotal role in helping skilled nursing and long-term care facilities manage their patients effectively onsite without transitioning them back to acute care.
The shift to virtual care will change the practices of physicians, advanced providers, nurses, and care coordinators. Clinicians will need to learn new tech and virtual customer service skills required for this modality of care, which will demand time, effort, and commitment.
However, experience so far suggests that providers who give virtual care a try are overwhelmingly satisfied with the experience. My colleague Miles Congress, MD, a 31-year veteran of emergency medicine, calls telemedicine "very rewarding and satisfying," and says he's enjoyed it more than anything else he's done in his career. Like many providers, Congress relishes the intellectual challenge of virtual care. Diagnosing a patient via telehealth requires keen clinical judgment because the provider may not have the ability to order labs or imaging studies like they would in the ED. Clinicians liken these visits to "playing detective" and say they actually "have fun" working with the patient to uncover the diagnosis.
Virtual care also means job variety and flexibility. In the future, clinicians may divide their work time between in-person and online visits. I expect to see more opportunities for part-time work and flexible scheduling. And much to provider’s delight, modern telehealth platforms can interface directly with the system's EHR, which significantly streamlines documentation.
Finally, virtual care allows physicians to provide a valuable service that improves the lives of patients. Consumers consistently rate their telehealth experiences highly. In one recent survey, 75% expressed satisfaction with virtual visits. Treating this rewarding and grateful population will no doubt enhance clinician's job satisfaction and career longevity.
As a physician-owned and -led organization dedicated to transforming care delivery, Vituity is stepping forward to meet the challenges of the pandemic and shape the future of healthcare. While COVID-19 has shaken the foundations of our healthcare system, it has also opened amazing doors of opportunity. Vituity is committed to helping our health system partners seize these advantages and thrive in uncertain times. Here are just a few of the innovative solutions we can offer: