The pandemic accelerated the shift of consumers to virtual care and forced many providers to quickly adopt it as the primary means of care delivery. HRI spoke with PwC principals Claudia Douglass, Stacey Empson and Kathryn Burg Plaza about how providers are adapting their business models to incorporate virtual care.
What is the current state of virtual care, roughly nine months into the COVID-19 pandemic?
Virtual care is here to stay. While most providers have had some level of virtual care for some time now, the pandemic caused providers to quickly accelerate virtual care, and they are now determining how it fits into their long-term strategy. Providers are thinking about what percentage of care will be virtual going forward and who will deliver it; whether virtual care will be used for new patient appointments, follow-up care or both; whether remote patient monitoring is here to stay and grow; how it can be used for physician-to-physician consults and specialty triage and so on. Virtual care continues to evolve, and every aspect is under evaluation.
Providers are better prepared now, and they are proactively embracing virtual care and all of its component parts, like technology and workflow. During the last six months, providers reacted to the emergency created by the pandemic. Now, providers are strategically planning for the future
Connecting virtual care to the broader strategy is crucial. Every healthcare market is different. On the West Coast, vertically integrated networks have a longer history of using virtual care, relative to some other markets. Providers should play to their strengths with their virtual care strategy. That could mean focusing on the role of virtual care and remote patient monitoring in their top service lines and measuring their digital presence, ease of scheduling, and patient satisfaction.
HRI: What is the clinician sentiment surrounding virtual care?
Kathryn Burg Plaza: Clinicians understand that there is a role for virtual care in most service lines, but it makes more sense clinically for some than others. Providers are being thoughtful about the types of patients and visits that are amenable to a safe, effective virtual encounter. Most clinicians have bought into virtual care; they recognize the value. What they are looking for is a better process for virtual visits. They are now making virtual visits more like an in-person visit in terms of workflow, recognizing that the effective use of clinicians’ time is key to sustained adoption—for example, prescreening patients for virtual visits to ensure they are appropriate.
Stacey Empson: Clinicians are satisfied with virtual care because patients are satisfied with it. Providers are debating the right mix of in-person and virtual care. Questions remain about how to use or reconfigure real estate—does a clinician need to deliver virtual care from a medical office, should there be stand-alone centers dedicated to virtual care, or can this be done from the clinician’s home?
HRI: Will patients embrace virtual care for the long term?
Claudia Douglass: Some studies suggest that a quarter of all care will be virtual long term. It could be more for certain specialties like behavioral health. Accessing care virtually may become an ingrained behavior for patients, after doing it for months during the pandemic. Smoothing out technical glitches and scheduling virtual visits when they are appropriate, and in-person visits when they are not, will help with patient buy-in long term. Patients may also embrace remote monitoring, which could improve the management of chronic disease at home.
HRI: We have seen that ancillary service revenues are down for providers. How are providers balancing virtual care reimbursement with reimbursement for ancillary services?
Stacey Empson: CMS is currently reimbursing virtual care visits at parity with in-person services. On the commercial insurance side, the decision whether to reimburse virtual care at parity varies by insurer.
Some data are showing there are fewer ancillary services, like labs and other procedures, ordered during a virtual care visit compared to in-person. This is creating economic pressure for providers, specifically hospitals, to get patients back in-person.
In order for virtual care to be effective, we have to find the right reimbursement model going forward. Payers will have to see the long-term value and potential cost savings of virtual care and be willing to invest in it.
Kathryn Burg Plaza: Reimbursement remains top of mind as providers consider their virtual care strategy. Providers have developed some novel ways of providing care virtually during the pandemic. When asked about longevity, the answer is that it depends on whether this will continue to be reimbursed and at what level.
HRI: Any closing thoughts on the current state of virtual care?
Stacey Empson: Virtual care could allow nontraditional players to get involved in direct patient care. That could be through care management or triage of patients. Primary care consults or urgent or emergency services could be siphoned off, and with them, those patients. This could be done by a payer or a new entrant to the health industry. Providers will need to remain aware of this and figure out how to get ahead of it.
Claudia Douglass: This is an exciting time for consumers of healthcare and providers that want to transform. The technology to enable virtual care is here. Relaxed regulatory requirements and payment by CMS and health plans that have followed suit have allowed it to grow and created an environment for innovation. We have seen years of progress compressed into nine months. The greater convenience and access it has provided is going to be demanded by patients and their caregivers where it is appropriate and effective. Providers don’t really have an option to sit on the sidelines. Virtual care is here to stay.