Innovation in Virtual Care: An Executive Panel Discussion

Remote care has a long and storied history. In The Lancet, an article from 1879 describes, “doctor’s appointments through the telephone to avoid unnecessary office visits”. And in the US, acute care in the home has been written about for over 25 years. With the pandemic necessitating change, CMS launched the AHCaH initiative and enabled Medicare-certified hospitals to be reimbursed for inpatient-level care in the home.

During a webinar hosted by Becker's Hospital Review entitled “Virtual Care Across the Care Continuum”, healthcare executives discussed the pandemic-driven expansion of virtual care, patient demand, hospital capacity issues, and shifts in regulations and reimbursement.

Remote Care Expansion

Consumers have increasingly come to expect the speed and convenience of virtual service delivery. "I think consumers of healthcare, similar to other businesses, have seen the ease with which they can set appointments and the way they can seek remote virtual visits," Dr. Ana Tuya  Fulton, Executive Chief of Geriatrics and Palliative Care, at Care New England Health System and Chief Medical Officer of Integra Community Care Network, LLC.

"Before the pandemic, we had around 50 virtual care appointments, per day. And then we went all the way up to over 2,000. We had the technology in place but we didn't have insurance companies who were willing to pay for it," said Dr. Alan Weiss, Chief Medical Information Officer at BayCare Health System. Since the pandemic, many insurers, including Medicare and Medicaid, have expanded coverage for remote care. A recent report from McKinsey noted utilization has remained 38 times higher than before the pandemic.

According to Colleen Hole, Vice President of Clinical Integration at Atrium Health Medical Group, it was COVID-19 surges and capacity restraints that contributed to health systems to adding or expanding their hospital at home programs. Over the past two years, Atrium's hospital at home program has seen nearly 5,000 patients and freed up more than 18,000 bed days.

An important change came in November 2020, when the Centers for Medicare & Medicaid Services announced the Acute Hospital at Home Program, allowing for health systems to get reimbursed for acute ill patients treated at home . Today, across 34 states, 92 health systems comprising of over 200 hospitals have been approved for the waiver.

While increased patient volumes helped drive the expansion of virtual care programs, other factors have also influenced the growth of these initiatives.

"At Brigham and Women's, we've always had a capacity issue, but that was only one of the many reasons we have continued to expand our Home Hospital program. Improved clinical outcomes, reduced costs, as well as the increase in patient and provider satisfaction has shown the benefits of this care model," said Dr. Tahir Haque, a physician and Medical Director at Biofourmis. Dr. Haque also noted the importance of virtual care in improving health equity by making services more accessible and bringing care to the patients’ homes.

Despite regulatory changes, the reimbursement structure for virtual care is still not optimized. For example, Dr. Weiss noted that providers do not receive compensation for the additional time spent on patient communication, necessary for remote care. "Somehow we've got to reimburse our providers for that kind of care," Dr. Weiss said.

Potential barriers

There remain barriers to efficiently delivering quality virtual care. Having an integrated, intuitive, and clinician-designed virtual care platform is critical to reducing logistical impediments; streamlining workflow inefficiencies; and yielding improved outcomes.

According to Dr. Haque, "to prevent more siloed or fragmented care, a solution should integrate with other technology in your hospital, especially the EMR." Ideally, platforms should be compatible with a wide range of wearable devices and utilize AI-based algorithms to analyze data and inform clinical decision-making. "It's important to find the right partner who's willing to configure a solution that works for your hospital’s unique needs and can grow with you over time," Dr. Haque said.

What does research show?

Barriers aside, access to virtual care continues to expand, and clinical outcomes are at the heart of the growth. "We all entered healthcare to do the best we can for our patients, and oftentimes this means high-touch care delivered at home," Dr. Haque said.

Health systems that have implemented a hospital at home program have reported:

  • Improved patient outcomes
  • Higher patient satisfaction
  • Lower cost of care

In a 2021 systematic review and meta-analysis of nine trials in JAMA Network Open, adults with chronic disease, who were randomized to hospital at home care, had a 26% lower risk of readmission, a lower risk for long-term care admission, and lower depression and anxiety scores, when compared to the in-hospital group.

Dr. Haque highlighted some of the findings from a randomized control trial looking at data from Brigham and Women's Home Hospital program. Compared to inpatient care, the program realized a 38% reduction in total cost of care; a 70% reduction in readmissions; and a decreased utilization of diagnostic tests (such as labs and imaging). "Most of all, patients and families are now drivers in their care," Dr. Haque said. The rapid adoption of such programs and the positive response from patients and clinicians has shown that care at home is here to stay.

To view the webinar or learn more about Biofourmis’ remote care solutions in acute, post-acute, and chronic care, visit:


  • B Leff, JR Burton. Acute medical care in the home.J Am Geriatr Soc1996; 44:603-605
  • Becker’s Hospital Review. “Webinar: Virtual Care Across the Care Continuum (Acute, Post-Acute, and Chronic Care).”
  • Office for the Advancement of Telehealth.
  • McKinsey & Company. “Telehealth: A quarter-trillion-dollar post-COVID-19 reality?”
  • Centers for Medicare & Medicaid Services. “Acute Hospital Care at Home Resources.”
  • JAMA Network Open. “Hospital-at-Home Interventions vs In-Hospital Stay for Patients With Chronic Disease Who Present to the Emergency Department: A Systematic Review and Meta-analysis.”
  • Levine DM, Ouchi K, Blanchfield B, Saenz A, Burke K, Paz M, Diamond K, Pu CT, Schnipper JL. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020 Jan 21;172(2):77-85. doi: 10.7326/M19-0600. Epub 2019 Dec 17. PMID: 31842232.


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