Health care has been an integral part of workforce strategy for decades. However, COVID-19 revealed the degree to which business continuity depends on sound health care strategy. Employers who proactively forecasted outbreak risk, implemented testing and containment strategies and adjusted workplace policies and procedures were able to reopen faster and withstand additional spikes in the summer and fall. As employers seek to insulate their businesses from further shocks and ensure that their members can stay healthy and productive, virtual care has emerged as a convenient way to deliver high-quality health care.
Prior to 2020, we believed widespread adoption of virtual care was the future, a growth that would follow a gradual glide path. COVID-19 broke every health care process in the country and forced people to use telemedicine at unthinkable rates. In the first months of the pandemic, telemedicine visits spiked drastically, leading the U.S. to experience a 57% increase in the number of people who used telemedicine in 2020.
Despite this promising surge in telemedicine adoption, virtual care has a long way to go and improve in order to maintain patient interest and, perhaps most importantly, realize its full potential. We need to move beyond carbon copies of in-person care that is designed for the system, and lean into a virtual-first system that is designed around the needs of the patient. Here are 5 predictions for how virtual care will evolve to deliver a better experience and usher in the era of virtual-first health care.
1. An estimated 35% to 50% of in-person care will be delivered in a virtual primary care setting
Preliminary estimates suggest up to 35% of office visits and outpatient encounters could be administered virtually. Given rapid advances in technology, as well as the development of digital tools to help patients and providers, 35% is the low-end of the range. Practicing physicians whom we interviewed estimated that over 50% of the care they deliver could be done virtually, with some estimates going as high as 70%.
Significant tailwinds will push patients to try virtual primary care and then the floodgates will open:
- Travel and wait times are too long. Even prior to COVID-19, patients traveled an average of 34 minutes to receive in-person health care services and waited an average of 11 minutes on top of the travel time. An appointment with a primary care physician (PCP) could have a wait time of up to 122 days depending on location. Such scarcity is a significant barrier to care and a contributor to worse health outcomes.
- Remote patient monitoring (RPM) devices. RPM devices enable doctors to conduct video calls with patients and run the same diagnostics they would in an office setting. Blood pressure checks, heart rate, respiratory rate, skin checks, temperature measurement and more are all possible remotely.
- At-home testing. A number of common diagnostic tests are available via at-home kits where a patient collects a sample in the comfort of their home and mails the test to a lab for analysis. Infectious diseases, colon cancer and even the COVID-19 PCR test recently approved by the U.S. Food and Drug Administration are on the at-home test menu.
- Millennial preferences. The millennial generation is the largest living generation in the U.S. and will make up 75% of the workforce within six years. Health and wellness are key aspects of daily life for millennials and they are more likely to adopt new technology than previous generations.
2. Chronic condition management will become majority-virtual
In 2016, chronic condition management accounted for $1.1 trillion in health care costs and was driven by diabetes, hypertension and osteoarthritis. Common treatments for these conditions largely consist of medication management, medication adherence, active monitoring and physical therapy, which can all be delivered through virtual care.
Our data indicate that commercially insured patients turned to telemedicine for chronic care management at significantly higher rates than normal. The proportion of telemedicine claims related to diabetes, hypertension and back pain increased 642%, 441% and 258%, respectively, in 2020. The transition to chronic care management is already happening, but when virtual primary care truly launches, most regular chronic care management will transition to virtual settings.
3. Virtual care will integrate physical and behavioral medicine
Patients with debilitating chronic pain are more susceptible to depression and anxiety. Physical and behavioral conditions are often comorbid and health care for those conditions can cost twice as much. The rates of hospitalizations, emergency department visits and length of stay are all higher for this population. As such, behavioral and physical conditions must be treated concurrently in a coordinated manner to help comorbid patients effectively manage their conditions.
Many PCPs lament the fact that the economics of their practices do not enable them to keep a behavioral specialist on staff. Virtual primary care programs can raise the standard of care by supporting an integrated physical and behavioral health model where PCPs and behavioral specialists collaborate. The convenience of virtual care combined with the effectiveness of integrated medicine could make these patients the first super-users of virtual primary care.
4. Virtual-first health care platforms will need to be a one-stop shops
Americans have grown to appreciate platforms that allow them to find everything they need in one place. Google created a connected ecosystem that blended many of our most important everyday needs into one, seamless experience to serve user needs all within one platform and drive loyalty and engagement: email, photos, storage, maps, home devices, music, TV. The health care industry will need to follow a similar approach to ensure that patients can have the same effortless experience during their virtual care journey.
One of the most impactful features of virtual primary care is a health care navigation platform, as it empowers a truly virtual-first health care experience. Patients can navigate their health needs, find a care advocate, receive care and review billing information in just one place, creating a more efficient and less costly care journey.
Without these resources, patients are left not knowing where to go for care, how much it will cost or how to manage their condition post-appointment. The fragmentation of this experience is a big driver of the 25%+ rate of waste in U.S. health care today.
5. Machine learning algorithms will soon power every aspect of care navigation
Machine learning (ML) is the technological advancement that will most transform our lives. health care lags other industries in adopting this technology, but early results in patient health care navigation show the promise of ML to simplify health care.
Take the doctor selection process, for example. Patients want to find the best care, but this process can be stressful. We were inspired to change that by developing a vast system of ML algorithms to match patients to doctors. By measuring the clinical quality and cost-effectiveness of doctors and matching it with clinical needs of patients, we can connect people to better health care.
ML can also be used for pattern recognition to identify early markers of risk, like social determinants of health, which may indicate a future health event is likely. Providers can engage those patients before they schedule surgery or end up in the ED. While ML-enabled diagnosing is a little further out, rapid progress in other industries indicates that it is only a matter of time before ML can accurately diagnose complex conditions as well.
In order for the industry to fully transition to virtual-first care, providers, employers and payers need to embrace change and the technological advancements that are bound to come with it. COVID-19 certainly accelerated the shift to telemedicine, but now it will be important to sustain this momentum and prioritize usability and the patient experience to permanently improve the delivery of virtual care beyond the pandemic.
Dr. Ami Parekh, Chief Medical Officer at Grand Rounds.