As patients are becoming increasingly mobile and comfortable with video interfaces, the market for virtual care is growing.
Virtual care allows brick-and-mortar organizations to remain competitive, encompassing everything from on-demand urgent-care consults to weekly video-based sessions with mental health professionals. Implementing virtual care programs can reduce the burden to emergency departments, while potentially bringing new patients into the primary-care setting where they belong.
Yet for some healthcare organizations, expanding into virtual care still feels overwhelming, a far cry from delivering care in person, in exam rooms, homes and hospital beds. Most physicians are comfortable engaging in limited telehealth applications such as a phone conversation with a patient or remotely reviewing imaging results, even if they don’t recognize it as telehealth. However, the idea of implementing a targeted, intentional telemedicine program can be far more daunting. Therefore, to move forward and capitalize on opportunities in this market, it’s important to have a clear understanding of your organizational goals, the characteristics of your individual marketplace and an understanding of new technology platforms.
Setting Goals
The first consideration when opening a virtual clinic is how it fits into your larger growth strategy. Do you want to offer virtual urgent care to acquire new patients and retain existing patients to your health system? Or, do you envision something more specific to improve access and efficiency of a specialty service, such as virtual care that serves a niche of patients who need ongoing behavioral health services or a condition-specific chronic disease program? Do you hope to establish a virtual clinic as part of a larger system-wide population health telehealth strategy?
For many organizations, improving access is the most important goal. In fact, that was the number one reason cited by 70 percent of organizations using telehealth who participated in a survey for Avizia’s 2017 Closing the Telehealth Gap Report.
It was also among the reasons cited by one New York hospital we work with, as they implemented their system-wide telehealth platform. The organization saw a need to improve emergency department (ED) operations while meeting a growing market demand for virtual urgent care. Its telehealth platform needed to support its plans to expand healthcare access to existing patients, but also support new patients, many of whom didn’t have a primary-care physician.
Another hospital we worked with based in Illinois shared these goals, hoping to expand access for patients in rural areas to high-quality clinicians in its emergency centers and primary-care settings. To execute on this vision, the organization required a system-wide telehealth platform that would host virtual consultations and enable better coordination between multiple specialists across various locations. The organization today uses data derived from its telehealth platform’s analytics application to measure its efficiencies (e.g, the use of telehealth for minor consultations, which are less expensive than practice-based/in-person visits and therefore save the health system money).
In addition to setting large organizational goals like these, it’s also important to keep up with telehealth reimbursement trends. As noted in a 2017 report published by the Center for Connected Health Policy, while many states are beginning to expand telehealth reimbursement, others continue to restrict and place limitations on telehealth services. For example, while nearly every state offers some type of live video reimbursement in their Medicaid program, what and how it is reimbursed varies widely. For example, the Medicaid program in a state like New Jersey will only reimburse for telepsychiatry services, while California reimburses for live video telehealth across a wide variety of medical specialties.
Clinicians and Technology: The Who and What of Virtual Care
Choosing the appropriate virtual care platform and right clinical team for virtual consultations is as important as setting organizational goals.
At a minimum, your telehealth technology platform should be interoperable with all major EHRs, to ensure a seamless experience as providers coordinate care. It should also be flexible, allowing for virtual consultations across multiple form factors, and scalable — able to accommodate increased usage as your organization grows. Finally, it should be backed by a vendor with a proven track record, who meets with your organization on a regular basis to troubleshoot problems or make adjustments as needed.
If you’re leveraging a system-wide telehealth platform for other programs, such as telestroke or tele-behavioral health, moving into virtual DTC urgent care is easier because you’ve already leveraged a platform that can scale and interoperate with your EHR.
The importance of employing high-quality clinicians to deliver the care cannot be minimized. Whether you decide to use in-house providers for virtual consultations or outsource specialists such as behavioral health professionals through a third party, a solid vetting process is necessary to ensure they can deliver consistently high-quality care. Remember that not all doctors are YouTube stars, and some may require more training to be comfortable with conducting remote video consultations. To be successful with that training you need providers who are engaged in an emerging mode of care delivery and willing to accept and respond to the subtle differences of seeing patients remotely. They don’t need to be the “futurists” or your most advanced IT clinicians, but they do need to be receptive to learning new technologies and adjusting their patient care to fit into the capabilities of the technology on hand and recognize when the technology is not adequate and an in-person mode of care may be needed.
Opening your virtual care practice is an exciting endeavor that can help you extend your value to new and existing patients, improve access to care and boost your bottom line. Setting measurable goals, in addition to pursuing vendor and physician partnerships that will support and strengthen those goals, is key to moving forward.
Dr. Bernstein is a family physician based in Washington State, and the vice president of clinical affairs for Avizia, which acquired Carena in 2017.
