Integrating Virtual and In-Person HealthCare will improve Patient Outcomes

By San Banerjee, Head Product Development – Health Services, CVS Health

COVID-19 has accelerated the adoption of telemedicine across healthcare enterprises, creating challenges for clinicians trying to manage diverse health conditions while supporting care across both virtual and physical care locations.  

During the pandemic, many specialties found that their care could be delivered virtually, which was one of the positive outcomes of the pandemic. A lot of that got accelerated by the change in the mandate that physical exam was not necessary for evaluation or treatment. The pandemic also induced an aggressive focus on limiting physical interactions and preserving outpatient and hospital capacity for more sick patients.

As the pandemic stabilized, health care facilities began to reopen for more routine care; in-person volume grew slowly while virtual volume fell. Things may change if there is another pandemic, but virtual care continues to be on an average of 18-20% of overall outpatient care across the industry. 

As we see these shifts, clinicians, providers, and practices have a few common questions – What is the best approach to offering virtual care alongside in-person care, and what is the right mix between these approaches? How will we know whether virtual care is succeeding, and in particular, is it reaching patients as safely and equitably as possible?

Patient Needs 

While we look at this from a provider, practice standpoint from a patient perspective, the introduction of virtual care in the mix, which was needed during the pandemic, has created an additional burden on a patient to choose the right channel to start the care, set the right expectations from the interactions and probably many patients are still trying to learn. To improve patient experience and outcomes, virtual and in-person care needs to be balanced and looked at more holistically.

Beyond technology, it’s also important to create a proper support structure to provide timely support for patients, clinicians and clinical teams before and during any visits.

Best Practices and Outlook

Health enterprises and practices have to develop an integrated process/criteria for triaging and scheduling (integrated scheduling) patients for in-person or virtual visits. These criteria can be condition or symptom-based or a combination of visit types across specialties and patient populations. The scheduling criteria should be set up to help determine whether the visit is appropriate for virtual or in-person instead of putting that burden on the patient. For example, a medication follow-up can be done appropriately on a virtual visit compared to an in-person setting. Building a robust scheduling capability and integrating that into the experience helps patients get answers for the right care venue for the condition they are seeking care. This also helps providers to use virtual care in a more integrated way in creating and following a care plan for patients.

Virtual care platforms and technology also needs to be augmented to support these evolving provider and patient needs like the enhancement of EHR to capture both in-person and video visits, the video offered via SMS messages making it easy for patients to join, and low bandwidth video services for patients having internet bandwidth constraints. The platform should also enable collaboration across the care team, which is a must for any virtual care to be integrated well like any in-person office setup. 

Virtual care platforms need to be augmented by integrating capabilities that compliments the visit like ECGs, blood pressure monitors, wearables, etc. These service integrations should be easily available so that the it can be made available to the patient at the time of care. These capabilities have to planned thoughtfully as its not a one size fit all and needs may depend upon the patient population.

Beyond technology, it’s also important to create a proper support structure to provide timely support for patients, clinicians and clinical teams before and during any visits. 

While many practices may have started on this, clinicians will need to offer a mix of in-person and virtual care from the same clinical space (reimagining clinic space) and have to figure out an effective way to balance between virtual and in-person appointments, maintaining the flexibility in provider/clinician schedule and instituting similar processes for patient intake and follow up. It’s important to document these workflows and practice guidelines and train the clinic staff on them. For this to be successful, sustainable providers and clinicians have to be ready to embrace the change and may have to be supported through the process.

This has to be supported by defining key performance indicators (KPIs) which can capture how effectively virtual care is being delivered along with in-person care with a focus on clinical effectiveness, quality and safety of care. Monitoring these KPIs with carefully selected data and insights like lag times between scheduling visit date, visit length, and parity of payments across both modalities can then be used to identify potential gaps or problem areas and make adjustments to the model and approach.

In the coming days, as many practices and health enterprises take ground on balancing care pathways between virtual and in-person care, more capabilities and practices will evolve like AI-driven scheduling platforms that can determine the scheduling needs of a patient across these care venues. The success of these models will be judged by patient experience, clinical quality and how these visits are provided equitably, specially to patients with social determinants that can limit access to care.