Going virtual: Building sustainable virtual visit infrastructure post-COVID-19


Rewind back to March 2020. A new virus was sweeping the world, shutting down cities and infecting people across the world. As health systems faced this threat, they had to not only deal with the influx of patients coming into their doors with COVID-19, but they also had to find ways to provide care to those unable, unwilling, or afraid to come to hospitals or primary care facilities. This demand meant that thousands of health systems had to rapidly implement, deliver, and scale virtual care across the enterprise. 

These virtual care solutions served their purpose during an unprecedented time, and it’s clear the demand for virtual visits shows no signs of slowing. In April 2020, more than 32% of office and outpatient visits occurred through telehealth. While the number seems to have stabilized in 2021 at 13-17% across specialties, it still represents a 38x greater utilization than pre-pandemic levels. 

The demand and potential for improved telemedicine offerings are clear: 69% of patients say easy-to-use technology would make them more likely to choose telemedicine services, and it is estimated that 20% of all Medicare, Medicaid, and Commercial outpatient, office, and home health spend could be virtualized. What’s more, leading health systems are recognizing the need to expand beyond synchronous virtual visits. Many are standing up robust asynchronous care capabilities, which allow providers and patients to connect on their own schedule, providing more convenience and keeping lower acuity  patients out of clinics. One study highlighted that for patients with hypertension, asynchronous virtual visits were equally as effective at maintaining blood pressure as in-person visits, and reduced visits to in-person primary care by 44%. 

Despite the clear demand for sustainable virtual visits solutions, many patients and providers are still facing obstacles when trying to engage in a virtual appointment using technology that was quickly implemented and scaled during COVID-19. In a recent survey, 52% of patients said they encountered at least one barrier that made it difficult to access telehealth, and 35% said they experienced at least one technical issue. Health systems need to take a step back and examine how they can improve their virtual visits offerings to make it more sustainable in the long-term and provide a seamless patient and provider experience.

3 ways to build a sustainable virtual visits offerings post-COVID-19

In order to stay competitive and provide seamless patient and provider experiences, health systems must continue to expand their thinking about the future of virtual visits, including synchronous and asynchronous options. For many health systems, virtual care has become a pillar of their care delivery model, alongside hospitals and clinics. In AVIA’s work with health systems across the country, we’ve identified three main areas for health systems to focus on in order to evolve and scale their virtual care offerings.

Improve your virtual visits workflow

Defining a clear workflow that fits your organization’s unique needs is essential to a robust and sustainable virtual visit capability. This workflow can serve as the foundation for evaluating solutions that address pain points and allow for scalability.  A strong virtual visits workflow should include:

  • Access and scheduling capabilities, which allow patients to schedule an appointment through web, chat, or calling. 
  • Intake capabilities and a virtual waiting room, so patients can upload documents in advance and virtually queue for their appointment. 
  • Robust video quality, that allows for multi-party video that can work across a range of devices. 
  • Billing, orders, and follow-up capabilities, that allow providers to track and manage prescriptions, as well as easily refer patients to specialists within the system. 
  • Technical support, for both patients and providers during their virtual visit. 
  • Flexible staffing, so health systems can appropriately manage scheduling and staffing of providers and third-party organizations providing virtual visits.  

Identify the right care delivery models for your patient population 

There’s one thing that the past few years have made clear – the shift to virtual care has upended traditional care models, and health systems need to evolve the way they operate in order to execute on an ongoing, sustainable focus on virtual care in 2022 and beyond. Health systems should examine a variety of factors to determine the best model for them, including: 

  • What parts of the workflow can you automate, and which people and what services do you need to execute on your automation goals?
  • What care models are we currently using, and which align with our organization’s strategic goals? 
  • Could a virtualist model work for our organization; do we need to bring in third-party staffing to ensure adequate coverage? 

Some care models that are gaining traction across the industry are: 

On-demand specialty care

Health systems that offer an on-demand specialty care model may provide virtual care for a variety of specialties at a lower cost and higher margin by leveraging asynchronous and triage tools, with the ability to escalate to video visits when necessary. The care model allows for decreased referral leakage and increased patient access to commonly understaffed and popular specialties, like women’s health, dermatology, and behavioral health. 

Surgical concierge

With a surgical concierge model, patients can receive virtual care surrounding surgery, including e-consults, virtual pre-op education, video pre-op visits, and discharge with remote patient monitoring. This model can be particularly beneficial to patients who may not be able to travel extensively for all care surrounding surgical procedures, patients within bundled arrangements, and those focused on convenience. Health systems that implement this model could see increased patient satisfaction, as well as reduced surgery cancellations and reschedules.  

Virtual-first health plans

Virtual-first health programs encourage patients to leverage virtual care when medically appropriate, rather than default to in-person care. Healthcare organizations who have seen success with this model are hyper focused on the right level of care for patient acuity in order to make the offering more affordable than other plans. 

Engage providers in virtual care delivery

Health systems acknowledge that provider buy-in is essential to the success of virtual visits long-term. However, hesitancy on the provider side and inconsistent scheduling is a challenge facing many health systems. In a recent AVIA survey, 44% of organizations said that provider buy-in is one of their top operational challenges. With provider burnout at record highs due to COVID-19 – 64% are reporting intensified burnout – designing a thoughtful and effective provider engagement strategy is imperative to the success of virtual visits programs. Providers can best be engaged by:

Partner with providers to define the future 

Increased provider buy-in can often be obtained by making them a part of defining what virtual care looks like at your organization. As on-the-ground users of your virtual care model, they have unique insights into what is needed and pain points that need to be addressed in order to build a sustainable virtual visits program. Conducting focused meetings with providers in each specialty group to discuss where they can see virtual visits expanding or increasing within their specialty is a great way to encourage providers to share their perspective. 

One AVIA health system Member used one-on-one meetings with each specialty group to discuss increasing virtual visits. During these meetings, providers discussed current virtual visit types and volumes and set tailored goals with action plans for how to expand and enhance their virtual visit offerings. As a result of these meetings, the health system saw an increase in the number of virtual visits across all specialities and more engaged partners among the physicians in their system. 

Identify the virtualists

Health systems can give providers the opportunity to volunteer to be virtualists. Virtualists are clinicians with specific training in the best approaches for managing the care of patients using virtual tools and technologies, either episodically or longitudinally, for individuals or across population cohorts. When identifying those providers interested in becoming virtualists, benefits to highlight include the opportunity to work remotely, right-sized attention and time for patients based on acuity, a better understanding of social determinants of health through viewing patients’ homes, and sustained adherence to treatment. 

Manage provider & care team staffing

Appropriate staffing models are key to engaging providers in your synchronous and asynchronous virtual visits program. While there are many methods for managing schedules, three that have shown success for AVIA’s Member health systems are: 

  • Dedicated days: Providers have set days per week where they only deliver virtual care. This solution reduces “switching” time and makes staffing and tech support easier to deploy. 
  • Time blocks: Providers spend a few dedicated hours on virtual visits, either before or after in-person visits. While this solution may complicate scheduling, it can prevent a backlog or in-person visits from bleeding into virtual care time. 
  • Full virtualists: Providers exclusively provide virtual care, working their set hours from either their home or a clinic or hospital. This solution can help streamline scheduling and provide flexibility to providers. 

An AVIA health system Member developed an innovative staffing model to capture specialty referrals in geographically underserved areas. The health system identified that their PCPs in rural areas were referring patients outside of the system because there were no cardiologists nearby. To address this leakage, the system enabled patients to go into their local PCP’s office and meet with a system cardiologist virtually. An MA collects the patient’s vitals and EKG data and shares with the specialist. As a result of this staffing model, they saw a 5% increase in their referral capture rate and a 22% decrease in time to the next available appointment. 

Partner with third-party networks

Another important area to consider is the use of third-party networks. Some health systems are choosing to partner with third-party provider networks, who help provide virtual care on behalf of the health system in order to allow health systems to meet virtual visit demand, offer 24/7 care, and expand their geographic footprint beyond providers only licensed in the states where they deliver in person care. If considering using a third-party network, health systems need to ensure there is a seamless flow between the network’s records and the health system’s EHR, as well as confirm that all referrals will come back into the system to reduce leakage and administrative burden. 

Usher in the new era of virtual visits with AVIA

From improving workflows to identifying care models to engaging providers, building a next-generation virtual visits program can seem like a daunting task. But as disruptors continue to build out their virtual care offerings and patients demand convenient access to care, it is imperative that health systems lean into virtual care. As a trusted partner to over 50 health systems across the US, AVIA can help you transform your virtual visits offerings, driving increased patient and provider engagement, improved margins, and boosted loyalty. If you want to learn more about how AVIA’s Center for Consumerism works with health systems to build virtual visits programs, contact us today