Embracing Virtual Health During COVID-19

The COVID-19 outbreak has become a forcing function for health systems to embrace virtual health rapidly, at scale. Virtual health (defined as enabling or delivering care without physical presence) is gathering momentum faster than ever before because of COVID-19:

• One virtual visit company saw a 1,700% increase in virtual visits in the first two weeks of the crisis
• One AVIA Member shifted a multi-state volume of 10,000 in-person visits a week to handling 90% of them via phone visits

As we look beyond the current crisis, the question for health systems is whether they will embrace the shift to virtual health that’s become an imperative during the COVID-19 crisis, or risk being disrupted by competitors eroding existing market share.

An increasing number of health systems are committing to an enterprise virtual health strategy in recognition of the market forces in play. In the last 18 months alone, corporate giants like Google, Amazon, Optum, and CVS have been building, buying, or partnering to enable virtual assistant, remote monitoring, and virtual visit capabilities. Meanwhile, virtual care disrupters have caught the attention of the market and are setting fundraising records, most recently exemplified by Babylon, the global chatbot and primary care provider, which raised a record $550M in August of 2019.¹

At the same time, private and public payers are embracing virtual health at a rapid clip. Not only has nearly every health plan in the country and most large employers offered coverage for telehealth visits, but also the majority of states have approved parity payments for virtual services, including, most recently, California. CMS is reimbursing more virtual services than ever before, and regulatory bodies, such as CMS and others*, have relaxed regulatory constraints even further due to the COVID-19 crisis.²

These macro trends indicate both a focus on lowering care costs and an emphasis on aligning with consumer desires and perceptions. Today, the majority of consumers search for health information online, and three-quarters of consumers state access is more important than human interaction. And, on a converging path, nearly one in four consumers uses a wearable device that continuously monitors their health every day.

Common barriers slow widespread adoption of virtual health

Many of the common barriers to virtual health adoption are being overcome or eliminated as health systems and governments strive to reduce the spread and impact of COVID-19. In a pre-COVID-19 world, there were many reasons health system adoption of virtual health lagged. Common barriers include reimbursement, provider education, new workflows, lack of stakeholder alignment, gaps in healthcare consumer awareness, and overall resistance to change. Such barriers have not stalled innovation in virtual health, but they have slowed its widespread use by many health systems.

While many systems have piloted or scaled virtual health for specific use cases such as low-acuity video-based patient visits or telestroke, the number of proven consumer-directed and provider-directed use cases across service lines is large and growing. These use cases, for both new and existing patients, are providing tangible business value under both fee-for-service and fee-for-value scenarios across the care continuum and care settings. They are enabling health systems to better address consumer expectations, alleviate supply and demand variation, and improve outcomes.

In addition, some of these use cases are rapidly being scaled or accelerated to address the surge of patients with COVID-19. Health systems have invested in automated triage solutions (chatbots/symptom checkers), virtual visit, and remote monitoring solutions to reduce the spread of the disease and overcrowding in emergency and acute settings.

Solutions that used to take six to 12 months to implement have been implemented in a matter of weeks, with COVID-19 acting as a forcing function. These efforts have by no means been easy, with teams working overtime to stand up solutions across the enterprise. But what’s been proven is that it can be done, quickly, at scale. Digital transformation will look fundamentally different after this crisis. Enterprise-wide virtual health capabilities will be the new normal.

Rapid responses to COVID-19 may address immediate needs, but may also create challenges like unsustainable workflows, limited interoperability, and manual hand-offs, where solutions may be temporary, unsustainable, or do not align well with longer-term strategies or operational efficiency. For example, manually scheduling phone visits or video visits using Skype or Facetime requires significant manual effort and is challenging at scale.

Enterprise-wide approach has been limited to innovators, risk takers, or rural systems

Depth and breadth in virtual health capabilities have historically been largely limited to health systems that are strong innovators, carry a high level of risk, or rural systems driven by necessity. For most, scaling pilots and enabling use cases broadly within the enterprise to create more engaged providers and improved consumer experience is a different and more difficult proposition altogether.  However, the COVID19 crisis has reduced or eliminated these traditional barriers and health systems are scrambling to enable immediate solutions, even if they are temporary in nature.

Many health systems struggle to define a cohesive virtual health approach that aligns with their organizational and operational priorities. Such efforts require 4 key ingredients:

• A compelling enterprise strategy
• Prioritized use cases
• A key performance indicator (KPI)-aligned business model
• Strong executive support

Success Story: MemorialCare implements virtual health at scale

One health system that tackled this challenge head on is MemorialCare, a large nonprofit integrated healthcare delivery system with 1,300+ beds and 500,000+ annual visits located in Southern California. Operating in a large competitive market, MemorialCare wanted to keep pace with its rapidly innovating competitors, many of whom were venturing into virtual health. MemorialCare leaders knew they had to move quickly, but they were challenged by the breadth of solutions, varying levels of stakeholder understanding, and competing operational needs. They realized they needed a partner with the expertise to help them develop and quickly execute an enterprise-wide strategy.

MemorialCare engaged AVIA to develop a virtual health strategy and roadmap that aligned with operational needs, garnered broad support from executives and stakeholders alike, and provided an actionable multi-year plan with the funding, governance, and resources to fully enable a broad set of differentiating virtual capabilities.

– Kevin Davidson, Vice President of Strategy, MemorialCare

Roadmap enables enhanced funding, new positions, and governance model

MemorialCare has made significant progress since program execution began less than a year ago, including:

• An aligned funding approach that included shifting capital from a purely brick-and-mortar growth strategy to one balanced with virtual investments. The new approach focused on:
  • Accelerating the pace to address patient access and growth needs
  • Creating an enhanced digital consumer experience
  • Better managing advanced practitioner utilization and PCP growth
  • Scaling behavioral health support to vulnerable seniors at a lower cost
  • Speeding specialist referrals and reducing delayed treatment or out-of-network leakage
• To help support MemorialCare’s new business model, leadership and technical positions were defined and filled in strategy and IT.
• In addition, strong stakeholder governance was enabled with defined processes and accountable leaders whose responsibilities span IT, marketing, medical groups, and finance.

Focused and empowered workgroups have, to date:

• Selected and implemented a digital treatment solution for behavioral health
• Evaluated and selected solutions in broad set of capability areas including digital assistants, virtual visits, and asynchronous provider consults – each in a different phase of planning and enablement

The future in virtual health looks bright for MemorialCare. MemorialCare leaders have identified and will be tracking KPIs for each solution and use case rolled out over the coming years.

– Adam Solomon, MD, MMM, FACP Chief Medical Officer

The MemorialCare response to COVID-19 has been accelerated by its strategic roadmap and solution selections. The video visits project accelerated its consumer  implementation and experienced 1,000 visits in the first week. In addition, the chatbot symptom checker with COVID-19 triage pathways was also quickly implemented.

Sea change creates urgency to move quickly in virtual health

Embracing virtual health for the long-term is a critical necessity for health systems that don’t want to lose market share or risk being disrupted. The accelerated awareness and adoption of virtual visits and triage spurred on by COVID-19 is here to stay. The fact is, most systems are still behind the curve — behind what consumers want and behind what digital giants, healthcare disrupters, employers, and payers are developing and delivering, with speed and scale.

Health systems must consider not if to embrace virtual health, but when and how to build long-term value-creating models. Making the shift from pockets of virtual expertise to efficient enterprise-enabled workflows and tools is challenging and time-consuming. No doubt, some health systems will defer taking action until the impact to existing business models and markets is clearer. However, for those watching what is happening with virtual solutions and the COVID-19 crisis, there is recognition that the sea change is in progress and accelerating. Regulatory, provider, and consumer barriers have dropped, rapid adoption is in progress, and awareness is growing. There is no going back, virtual care is becoming  mainstream and the imperative to act has become a critical necessity for future success.

1: https://www.forbes.com/sites/monicamelton/2019/08/02/babylon-health-gets-2-billion-valuation-with-new-funding-that-will-help-it-expand-in-us/#62b4be87a1a6
2: https://www.cchpca.org/resources/covid-19-telehealth-coverage-policie

Kevin Davidson is Vice President of Business Development & Strategic Services for MemorialCare, where he leads business development and innovation initiatives for the medical group division of the MemorialCare, including the expansion of key ambulatory operations and the organization’s digital health roadmap. MemorialCare is a nonprofit, integrated health system delivering value-based care in over 200 ambulatory sites and four hospitals in Southern California.

Oliver Lignell is Vice President of Virtual Health at AVIA. AVIA is the leading partner for digital health insights, strategic guidance, and consulting services. Members of the AVIA Network solve pressing challenges with digital solutions that deliver outsized financial and clinical results. AVIA provides strategic focus, unique market intelligence, and proven resources that accelerate digital transformation throughout healthcare. Learn more at aviahealthinnovation.com. Follow us on LinkedIn and Twitter.