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The future of virtual health and new care models

Driving insights to transform consumer and caregiver experience

Shifting consumer expectations in the new age of virtual health

The speed, adoption and pace of digital transformation is accelerating, and with it, the delivery of healthcare, driven by evolving patient expectations. Bridging the gap between technology and traditional in-person experiences is key to meeting these expectations and the demand for the digitization of healthcare. The pandemic has turbocharged this demand even more, empowering patients to take control of their healthcare experience—before, during and beyond their interactions with a clinician.

With successful strategy and execution, virtual and in-person interactions combine for an enhanced, more accessible and equitable care experience for clinicians, patients and caregivers alike. Together, their shared learnings play a critical, experience-led role in getting virtual health right. From end-to-end, PwC helps deliver the right outcomes, in the right place, at the right time—through hybrid models of care. Our modern healthcare approach is not an exclusively online experience, but a unified one that delivers clients with digital experiences that put people first—not only meeting but exceeding evolving expectations of technology and healthcare.

Together, let’s get virtual health right.

Opportunities and challenges for the health ecosystem

New care models and virtual health present multiple opportunities and challenges across healthcare industry stakeholders. The challenges faced by each are interrelated and at times complex.

The pandemic showed the power of embracing the change to new care models and virtual health as a collective across healthcare payors, providers and patients. We must now look beyond this foundational level of virtual health services to leading and innovative care models that can deliver health improvements through working together.

How can health organizations collaborate and continue to apply digital technology and analytics to enhance and expand care beyond the traditional care settings?

Consider the following key questions:

Providers

Strategy

  • How can your organization build upon and scale new care models and virtual health capabilities that worked well during the COVID-19 pandemic?
  • Which of your strategic partners can help you to be disruptive rather than disrupted?
  • Given the range of ways (e.g., build, buy and partner) in which to develop capabilities to meet the emerging virtual care needs, how is your organization thinking about these options?
  • What is the next investment that you see your organization making to drive the continued evolution of care toward virtual?
  • How can your organization expand Provider Sponsored Health Plans to capture the premium dollar and not be as susceptible to payment risk?

Models of care

  • Are there established coding and documentation processes and training for virtual health services to ensure proper reimbursement?
  • What healthcare services can be delivered through a virtual channel? Are there clear workflows defined to support virtual rendering of these services?
  • How can you implement virtual health technologies without sacrificing the quality of care?
  • Which governance structures will help your organization integrate new care models and virtual health capabilities and manage operations as you scale?
  • What are the professional, regulatory and accreditation standards that must be adhered to?

Evaluation

  • Is there a monitoring and evaluation framework to evaluate effectiveness, access, equity and efficiency of new care models and virtual health?
  • What is the patient profile that organizations are using for virtual health vs. home health? Are there patients that organizations are still trying to reach (given disparities in tech, access, etc.)?

Technology

  • What technology do you need to use to deliver care virtually?
  • What are the interoperability considerations with current systems and key care stakeholders?
  • What are the standards for identification, capturing consent, data and privacy concerns?

Workforce

  • How can your organization enable and empower healthcare providers to deliver care virtually?
  • How does your organization resource a virtual care model?
  • What are the medicolegal considerations for virtual health in your organization?
  • How are you considering addressing the potential for clinician burnout?

Patients

  • How can your organization ensure that everyone has access to virtual and home health capabilities so more disparities are not created?
  • How do you ensure virtual health is designed to meet patient needs? 
  • What education and training do people require to be empowered virtual health patients?
  • To maintain and further accelerate the shifts in care moving forward, what is the biggest patient challenge that needs to be overcome?

Cybersecurity

  • Have you assessed how cyber threats can impact your virtual care journey?
  • How do you plan to embed cybersecurity and privacy requirements as part of your virtual care model?
  • Do you understand the cyber skills required by your staff as part of your virtual care journey?

Payors

Payment model design

  • How can the US payment model be updated to support the adoption of new care models and virtual health in primary, community and acute care settings?
  • How can this be designed to improve care continuity?
  • How can data and analytics ensure appropriate use of virtual health billing and coding?
  • How can you start or enhance your own virtual health programs, in which you are providing the care in addition to paying for the care?

Measuring outcomes

  • What outcome measures should be used to evaluate effectiveness, access, equity and efficiency of new care models and virtual health?
  • What is the most appropriate way to incentivize outcomes and value (versus activity) in virtual health?

Consumers: Patients and their caregivers

  • What are US expectations around virtual health?
  • How do you ensure that new care models and virtual health are designed to meet patient needs?
  • What education and training do people require to be empowered virtual health patients?

Transforming care delivery with new care models and virtual health

Increased adoption of new care models and virtual health requires focus across all areas of care delivery. PwC’s suite of virtual health services and solutions supports you to develop and embed sustainable models of care to help keep people healthy and ensure they receive the right care, at the right time and place.

Explore our suite of services to enable you to successfully deliver your new care model and virtual health vision:

The role of home-hospital care models

Home care is increasingly expanding along the care acuity spectrum, with an explosion of interest in the sector since 2020. Home-hospital care is one aspect of your virtual health journey to consider to enable continuity of patient experience, alleviate inpatient capacity bottlenecks and develop the capabilities that will support the larger transition to virtual care delivery.

To launch and sustain a successful home-hospital care program, relevant strategic and infrastructure considerations should be evaluated upfront. Key considerations include scale, target offerings, timing, technology solutions, infrastructure readiness, privacy, security and compliance.

PwC alliance relationships help drive innovation and speed to value

We've established relationships with selected companies to help better serve your needs. In the healthcare space, we collaborate with our alliance partners to help deliver virtual health solutions for you.

Explore our global alliance relationships

Contact us

Thom Bales

Thom Bales

Health Services Consulting Solutions leader, PwC US

Claudia Douglass

Claudia Douglass

Principal, Health Services Provider, PwC US

Alena Taylor

Alena Taylor

Principal, PwC US

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