Prescription for Change

How to ramp up virtual care (without alienating your physicians)

by Virginia Hite and Prianca Pai

Before the country's Covid-19 epidemic took hold, most health care organizations only dabbled in telehealth because of low reimbursement and clinician preference for in-person patient interaction. Now, the rapid adoption of telehealth has proven immensely valuable for organizations as they try to maintain as much volume as possible while social distancing.

How Covid-19 is transforming telehealth—now and in the future

Across the past few weeks, Advisory Board facilitated 10 virtual networking discussions with physician executives from across the country. One topic that every executive wanted to ask their peers: How are you thinking about telehealth over the long term?

The widespread consensus is that telehealth is here to stay—and is a must-do to remain competitive. But physician executives face a range of physician reactions to telehealth that they must manage moving forward. While some physicians have said they now prefer virtual care to in-person, others have said they'd retire if telehealth becomes the "new normal." This range presents an immense engagement and leadership challenge.

How executives plan to integrate virtual care into future physician workflow

As physician executives navigate competing perceptions of telehealth among the clinical workforce, here are two approaches they're considering to integrate virtual care into the care delivery model, while still accounting for physician preferences.

  1. Full-time virtual care: The rapid shift to telehealth during Covid-19 allowed many clinicians to see firsthand how effective and convenient virtual care is for their patients. Not to mention, the flexibility and balance it can bring to their own personal and professional lives. While some physicians will want to return to the clinic, physician executives expect a subset of their clinicians will want to "specialize" in virtual care—a group many have dubbed "virtualists." These clinicians will specialize in best practice techniques and technologies to deliver care remotely, potentially focusing on specific patient cohorts, and/or providing non-traditional clinic hours. A challenge with the virtualist model is a lack of diagnostics, so executives who are considering this model are starting to look into upfront investments in digital diagnostics.

  2. Part-time virtual care: Clinical and non-clinical executives alike expect that patients will increasingly prefer telehealth, due to a positive virtual visit and/or continued fear of exposure to Covid-19. However, not all clinicians will want to continue virtual care full time—and not all patients can be adequately treated remotely. To strike the right balance, some physician executives are considering requiring clinicians to dedicate a portion of their schedule to virtual care. Executives discussed two different approaches to part-time virtual care:
    • Offer part-time virtual care from a central location: One strategy medical groups are considering is re-purposing an existing clinic to serve as a virtual care hub. On the days clinicians provide telehealth, they go to the dedicated workspace that's equipped with the technology and security needed for virtual visits. The secondary benefit of this model is the opportunity to cultivate professional relationships. One CMO shared that in her experience, the main opportunity to create relationships with peer clinicians was in the doctors' lounge—a space that has largely fallen by the wayside at many organizations in recent years. A shared space among physicians to deliver virtual care could both increase access options for patients and foster "doctors' lounge" collaboration between ambulatory clinicians.

    • Part-time virtual care in the clinic: Another strategy organizations are considering is dedicating part of their existing clinics and schedules to virtual care—allowing clinicians to easily jump between in-person and virtual visits. As social distancing persists, one clinic plans to use telehealth as a "spacer" to help control in-person volumes. Integrating brief virtual visits into clinician schedules ensures organizations have enough visits per hour to support financial sustainability, while also providing time for infection control measures to keep necessary in-person care safe.

None of these workflow models are one-size fits all. It's likely that organizations will have to mix and match their approaches based on patient demand and clinician preference for virtual care. But one promising theme among all of them is the flexibility to adapt to both patient and physician preferences in care delivery models.

Align virtual care with your strategic priorities

Of course, preferences can't drive telehealth strategy alone. When thinking about where to invest first, consider how virtual care can support your existing organizational priorities. For example, one organization that is prioritizing access expansion is considering implementing a telehealth option to provide 24/7 on-demand care. Another organization that is prioritizing population health found that patients are more likely to fill out psychosocial screens in advance of virtual visits because they're integrated into the patient portal and can be completed alongside other pre-visit work. This has allowed clinicians to leverage video visits to better address patients' clinical and non-clinical needs.  

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