The new focus on virtual healthcare in the post-COVID-19 world will bring about an unprecedented industry transformation.
As the COVID-19 crisis has swept our nation and the world, it has held many lessons for healthcare leaders. Perhaps one of the important lessons, with the most enduring effects, has come from the “shelter-in-place” restrictions that have been widespread as our primary strategy to “flatten the curve” of the pandemic.
We have learned that for many healthcare transactions, direct personal contact will no longer be considered as essential, important or even advantageous, opening the door for the virtualization of healthcare.
A new path has opened for virtual healthcare
For a decade or more, U.S. healthcare delivery has been perched on the verge of being virtualized or digitalized. This transformation has been enabled using existing, and in many cases, well-tested technology. Cloud-based data storage and management, consumer applications, mobile devices and wireless connectivity, consumer tracking, virtual meeting technology, telemetry, digital imaging and other capabilities with virtual implications are in use today throughout healthcare delivery.
The nation also has seen many successful initiatives involving virtual healthcare. Yet many barriers have impeded its being widely adopted. These barriers have included restrictive payment rules, state provider licensing, privacy concerns and, most important, resistance from consumers.
In a broad stroke, the crisis has swept away many of these obstacles. As we have been forced to avoid any nonessential in-person meetings, we have come to recognize how much can be accomplished through virtual interaction. These circumstances have forced payers and regulators to acknowledge virtual healthcare as a legitimate and valuable channel for meeting consumer needs. The long-simmering issue of hospitals serving as a source of infection, and hence to be avoided, has burst into the public consciousness. And consumers have grown comfortable with using virtual platforms for a wide range of communications.
This is not to say that direct physician-patient contact will disappear. For consumers who continue to value high-touch interaction, for the very sick and for procedural diagnostics and interventions, we will still need and desire hands-on care. But for routine well-care, uncomplicated sick-care and professional-to-professional consultation, virtual contact will expand as the norm.
How virtual care will be delivered
The realization that much in healthcare can be accomplished efficiently and effectively through virtual interactions will eventually touch every aspect of healthcare delivery. Areas most likely to be affected include the following.
Primary care. For most patients, and for healthy patients in particular, primary care will predominantly comprise digital self-management, virtual care and, only when necessary, visits to urgent care centers or testing stations for lab samples. The days of requiring “routine physician office visits” for mostly well consumers are over.
Care for patients with uncomplicated chronic conditions. Most patients with such conditions (e.g., diabetes, congestive heart failure, asthma) will be managed through a combination of virtual care and remote sensing.
Direct care for patients with multiple chronic conditions. These vulnerable populations will receive team-based care, enhanced with telemedicine and other virtual technologies and a strong component of social support.
Home-based intensive care. Such care will become a reality for many patients, through remote telemetry and home health care.
Behavioral healthcare services. Individual therapy, and in some cases, group therapy and support groups will be conducted through “Zoom-like” virtual meeting technology, which will improve access and decrease costs.
Nonsurgical specialty care. Physician-to-physician consultation in virtually all cognitive disciplines in most non-urban and many urban facilities will be provided remotely, accelerating a trend borne out of regional specialty shortages.
Most of the capabilities needed to facilitate these changes have been developed and are in use today. Other platform technologies are still cutting-edge. As they are refined, they will serve as accelerators for widespread deployment. Remote, wearable and implantable sensing technology will enable providers to monitor patient status both virtually and in real time. The integration of consumer preference, artificial intelligence and the science of behavioral change will improve the effectiveness and efficiency of virtual encounters. Improvements in wireless data technology will improve the stability and capacity of virtual systems.
How increased virtual care will lead to disruption
Changes in the ways that consumers interact with healthcare providers will, in turn, lead to massive disruption in the organization of healthcare services.
Virtual relationships can be maintained on a much larger scale than possible through the traditional physical contact between provider and patients. Many services will no longer be geographically bound. Physicians working from home offices, or from call centers in Chicago or Omaha, can provide consultations, interpret images, evaluate lab results and monitor telemetry for a national service area. Aggregators of virtual services (e.g., medical, sensing, telemetry, mental health) will emerge as key players in the delivery system, creating a new field of competition and investment.
Although the notion that all healthcare is local is unlikely to disappear, consumers will increasingly buy health services, either directly or through portals, from national brands. Larger scale businesses that are not limited by geographies will expand their brands, seeking to build relationships with consumers who no longer feel the need to physically visit a local provider.
Local health systems will continue to play important roles in their communities in providing diagnostic and surgical procedures, treating trauma, and caring for patients with complex medical needs. But they will feel increasingly comfortable outsourcing capabilities to national-scale clinical service organizations. And customer segmentation will become much more distinct, where consumers and patients with different needs will served by completely different and often national delivery models.
The virtualization of healthcare also will likely alleviate long-standing concerns about physician shortages in the context of an aging population. Surgical interventions will still require physical contact, and the need for surgeons will continue to grow with the needs of an aging population. But primary care and cognitive specialties are likely to be organized much differently, and more efficiently, enabling physicians to effectively serve larger numbers of patients.
Implications for health systems
In a decade, we will no longer speak of “telehealth” or “virtual healthcare” or “digital health care”. We will simply have “healthcare,” encompassing all the elements of tele- and virtual and digital that seem so innovative today.
As the COVID-19 crisis eases, health system leaders should be assessing the strategic implications of virtualization. Disruption creates opportunity. And the disruption created by proliferating virtual care will create major new opportunities health systems. The winners will be those that can reposition themselves to succeed in the new world of virtual provider-consumer interactions, which also can include building new national virtual clinical models.
5 key question areas healthcare leaders should consider
As life begins the slow return to normal, health system leaders should address questions around five key areas of consideration.
1. Virtualization scale as additional critical dimension of system strategy. Does our system have sufficient scale to develop competitive virtual clinical service capabilities? In what areas? Are there opportunities to add further scale? Do we have capabilities that could serve regional or national markets?
2. Effect of virtualization on independent physician practices. What is our system’s strategy with respect to independent physicians in our communities? (A key consideration here is whether the practices can survive the loss of business associated with the post-pandemic sheltering-in-place mindset of consumers.)
3. Impact on the health system’s physician enterprise. How will virtualization affect our physician enterprise? Is it the right size and the right composition? How should it be organized? How should compensation models be changed?
4. Impact of virtualization on the health system’s consumer strategy. Does our system have the capacity for effective consumer segmentation and the ability to design consumer solutions based on that segmentation?
5. Design of contracts with health plans. In a post-COVID-19 world, how should our health system’s contracts with health plans be reshaped to ensure appropriate payment for virtual services?