Covid-19 pushed telehealth from one extreme to the other. Pre-Covid, Advisory Board estimates are 1 in 1,000 visits were virtual. But in the height of the crisis, physicians and care teams innovated to provide as much virtual care as possible.

Telehealth visits will naturally recede from this record high but shouldn’t drop back to pre-Covid-19 levels. Virtual care will be necessary for navigating a potential second wave alongside flu season. And telehealth is now a baseline expectation of patients, employers, and payers.

Medical group leaders need to navigate toward the right mix of in-person and virtual care. Groups need to define, for each episode of care, what should be in person, what should be virtual, and what should fluctuate based on patient preference and market conditions.

While it’s tempting to wait for greater clarity about the reimbursement and regulatory environment, groups risk losing momentum from experimentation during the Covid-19 crisis. Traditional competitors and disruptive innovators also accelerated telehealth adoption and are looking to expand their patient base. To navigate during regulatory uncertainty, groups are already increasing the security of interactions to protect patient information. Groups are anticipating that reimbursement for telehealth will fall below rates for in-person visits (except in a few, rare cases) but likely not back to zero.

Treat the early days of Covid-19 as the pilot phase for high-volume virtual care. Identify what worked and what didn’t to create new group-wide standards. This includes both the types of visits but also the telehealth workflow for physicians and the care team.

To win physician buy-in for new telehealth standards:

• Assemble a cross-functional team.
• Limit the time commitment by asking a team to tackle one standard/clinical area and then disband that team and form a new group for the next standard/clinical area.
• Leverage a central team for reviewing exceptions to the standards and making updates along the way

While Covid-19 accelerated physician buy-in for telehealth, acceptance hasn’t been universal. For some physicians, telehealth improved work-life balance. And for physicians with high-risk conditions or those living with people at high-risk, telehealth provided a way to keep practicing. Among the new telehealth champions, groups may designate “virtualists” to help lead telehealth integration with group strategic priorities.

Altering physician compensation is one of the hardest changes for medical groups to make. Moving to a sizeable performance bonus took years and required significant political capital.

Productivity models seemed to balance medical group growth and maintaining autonomy for physicians around their compensation. However, productivity also created inherit tension between group performance and individual performance. Practice changes that were a drag on productivity created a financial disincentive to change.

As groups matured, the tension increased. Strategic priorities like team-based care, telehealth, and chronic care management often asked physicians to put group performance over individual performance.

Covid-19 upended volume assumptions and the control that productivity offered individual physicians. As groups navigate through this pandemic, there is new momentum to design compensation models that reward physician contribution to group success.

Executives have an opportunity to move toward performance-based models— and do so with more physician buy-in. This transformation looks different for independent and hospital-employed physicians.

Both types of groups will be making changes in two key areas:

• Resetting metrics of success to account for strategic priorities around telehealth and group flexibility, in addition to previous metrics like patient experience and access
• Increasing the weight of group performance incentives and decreasing the weight of productivity

See these two recommended Advisory Board resources:

Transforming Independent Physician Compensation

Report from the Frontier of Physician Compensation

Utility players able to flex across site of care or type of care are a coveted resource during the Covid-19 crisis. An advantage of large-scale group practice should be an agile workforce that can quickly pivot to meet changing community needs.

In Covid-19 hot spots, clinician flexibility was critical. Utility players flexed outpatient to inpatient and across critical care areas to help their facilities survive the surge. Even in areas with smaller community spread, flexibility across sties and settings helped rapidly ramp up testing, telehealth, and emergency plans in case of a surge.

Rapidly reshuffling the workforce also exposed how siloed physicians have become. Silos that had to be undone during this crisis ranged from expanding who had privileges at system hospitals to creating workarounds for process and technology differences across sites of care in the same system.

Physician leaders should take steps now to reset the baseline on group flexibility. At a minimum, leaders should recognize clinicians who flexed and celebrate success around patient care and access to the care team. Minor challenges identified in flexing staff—such as privileging—can also be addressed to prevent operational hurdles in anticipation of new surges in Covid-19 cases.

Building on these small steps, leaders should push all clinicians to flex within their specialty, especially to accommodate new patients and acute visits.

Now is also the time to rethink legacy staffing models. Groups should strive for well-rounded care teams. For example, pair providers and nurses with complementary expertise, consider investing in e-consult models to give primary care physicians virtual access to specialist expertise, and leverage APPs.

Cementing these flexibilities as the new normal is a significant change to physician practice. Below, find a list of proven levers to help normalize new flexibilities across the medical group.

Levers to pull to support permanent flexibility

Clinician education:

• Rely on physician “champions” to share their experience
• Train clinicians on new platforms or protocols

Technology investment:

• Integrate technology across sites of care
• Invest in secure vendor solutions

Workflows and protocols:

• Standardize unit or clinic protocols
• Establish guidelines for visit types (such as in-person versus virtual visits)

Recruitment and onboarding:

• Assess new hires for willingness or ability to adopt new care models
• Provide scripting to set practice expectations during hiring conversations
• Revamp onboarding to normalize new flexibilities

Compensation:

• Consider incentives for practicing across sites

APPs can perform many of the same tasks as physicians at less than half the cost. Due to their more generalist training, APPs can also more easily flex across specialties and fill in workforce gaps.

These attributes—combined with relaxation in supervision and scope-of-practice regulations—made APPs an indispensable resource in responding to the Covid-19 crisis. Even if some regulatory flexibility goes away, APPs have an equally pivotal role to play in recovery from the first wave, responding to any future surges, and helping address pent-up patient demand.

Long viewed as “physician extenders,” APPs must be deployed autonomously for organizations to fully capitalize on their value. While they may co-manage a panel with a physician, APPs should see and treat patients independently, acting as a provider in their own right.

Accomplishing this requires medical group leaders to shift away from a pilot mentality, where APPs are deployed ad hoc across the group based on individual physician or clinic preference. Instead, groups deploying APPs autonomously centralize APP hiring, deployment, and oversight aligned to larger strategic priorities. Working with APPs in this way also requires elevating APP leadership roles to recognize the pivotal role APPs play in group performance.

Executives should also continue hiring APPs. Specifically, APP deployment in specialties and markets lagging behind in primary care before Covid-19. For more research and implementation support, download our toolkit Four Keys to Maximizing APP ROI.