By Danna Chung, MD
If you look up the term “virtual care” today, just about every major pharmacy/retailer, health plan, and local medical group appears in the results. The virtual care boom of the pandemic-era has resulted in an explosion of virtual care solutions. This has, in turn, changed care-seeking behaviors. According to research from McKinsey, virtual care utilization rates are already more than 38 times what they were before the pandemic, ushering in a complementary change in consumer and provider attitudes. And with that, we can’t overlook the role that VC funding has played in all of this, either. Total 2021 funding among U.S.-based digital health startups amounted to $29.1B across 729 business deals, with an average deal size of $39.9M. That’s nearly a doubling of the overall investment of 2020, which is reported at a $14.9B former record haul, according to research published by Rock Health.
Despite an abundance of funding, the availability of new and improved technology, and strong utilization stats, questions still linger regarding whether virtual care can be more than “a cheap digital knockoff of in-person care,” as Harvard Business Review coined in “The Telehealth Era Is Just Beginning.”
Beyond Triage and Virtual Urgent Care
Ironically, one of virtual care’s benefits has turned out to be one of its hindrances. Virtual care’s popularity as an urgent care solution persists from its telemedicine predecessor. Particularly this time of year, the usual suspects of cold and flu diagnoses come to mind as ripe for virtual care. Addressing acute needs serves an immediate purpose but doesn’t address the patient as a whole. Meanwhile, this visit encounter may be the only time a provider has with a patient to screen for potential underlying depression, vulnerabilities around social determinants of health, or unresolved care gaps with screenings. We know that patients benefit from a care experience that’s less transactional and more ongoing, according to the recently published Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care (2021). The opportunity is clear for virtual care to be applied in more comprehensive and longitudinal healthcare settings, particularly relating to the prevention and management of chronic disease.
Virtual Care as Part of Chronic Disease Management
The traditional approach to managing chronic disease includes intermittent and transactional care episodes. Typically, once a diagnosis is made, a series of routine, in-person follow-up office visits are scheduled for every four to six months. This one-size-fits all approach is failing people with chronic diseases, as some patients with well-controlled conditions might not need to see their doctor for a year, while others would benefit from monthly evaluations.
We can’t afford the mismanagement of chronic illness any longer. According to the CDC, chronic diseases have significant health and economic costs. Ninety percent of the nation’s $4.1. trillion in annual healthcare expenditures goes toward treatment of people with chronic conditions. Heart disease is still the leading cause of death in the U.S., costing our healthcare system $219 billion annually. Preventing chronic diseases, or managing symptoms when prevention is not possible, can reduce these costs and improve outcomes for patients.
Virtual care has an ability to offer more touchpoints for patients to communicate with their care team and vice versa. This can be greatly helpful in terms of disease prevention and/or management. The ongoing support virtual care enables throughout the patient journey is optimal for achieving wellbeing vs. combating sickness. For anyone living with a chronic health issue, there are so many components of effective disease management that take place outside the four walls of a doctor’s office, including more real time medication and symptom management, as well as the keeping track of integral lifestyle activities like exercise, relaxation, and healthy eating.
Closing Care Gaps and Building Trust Through Multiple Touchpoints
One of virtual care’s biggest strengths is improved access through multiple synchronous (video/phone) and asynchronous (messaging) touchpoints in between in-person visits. For people living with chronic diseases, opportunities to connect synchronously via a live video visit or phone call for routine virtual follow-ups can be hugely beneficial for effective disease management and adhering to treatment recommendations. For example, according to original data from Crossover Health, people with diabetes who sought virtual care appointments as supplementary to necessary in-person visits were 30% more likely to achieve glucose control than those who received in-person care alone. With more frequent visits, such as those available through a truly hybrid offering, patients can also increase their health literacy and have additional opportunities to discuss their progress in maintaining positive lifestyle changes. More frequent virtual check-ins also help providers catch complications earlier and more frequently, which can lead to fewer hospitalizations and emergency room visits.
Additionally, virtual care enables patients to communicate asynchronously with their providers to share important information without having to set up an appointment. This includes patients exchanging a text, email, portal message, or picture with a clinician, or filling out a form to gauge symptom progression or improvement. Between visits, the provider can track the patient’s progress through remote monitoring devices to track blood pressure or glucose levels. Further, the ability to communicate asynchronously with patients saves time and resources, and facilitates more frequent interaction for stronger relationships. The combination of asynchronous messaging and synchronous video care provides quick access and multiple touchpoints with less attrition, which helps close care gaps across specialties for a coordinated patient journey.
Creating a Coordinated Care Experience
To achieve optimal outcomes for people living with chronic diseases, organizations must work toward offering virtual care as part of an integrated, coordinated, member-focused team. Care for patients with chronic disease is often disconnected and fragmented across multiple providers and specialties, resulting in a challenging scenario where patients must self-manage care tasks. But when virtual care is integrated and team-based, and part of a true hybrid care model, outcomes and patient satisfaction improve. Recently, I saw a member who was newly diagnosed with Type 1 diabetes. In our 30-minute office visit, it became clear that his concerns were not just about his sugar levels and medication doses. Helping him navigate his diagnosis and provide thorough education would require frequent virtual touchpoints and support from an interdisciplinary care team. Together, members of the care team and I were able to provide him mental health support to cope with his diagnosis, health coaching to guide dietary choices in his workplace cafeteria, and physical medicine support for a tailored exercise program. The member was grateful for team-based virtual care during this vulnerable and pivotal time in his health.
As we look ahead to the future, healthcare delivery organizations and providers will model such approaches to care that focus on prevention and wellbeing rather than transactional medical interventions. They’ll do so by expanding virtual care applications to ensure interdisciplinary, longitudinal collaboration, which will improve the chronic disease lifecycle. By directing people with chronic diseases to various modalities, including mental health, physical medicine, and health coaching, optimal health outcomes are achievable. Via a coordinated care experience and multi-model interdisciplinary approach that includes virtual care as part of a hybrid offering, the patient truly is at the center of their healthcare journey. This is Health As It Should Be.
About the Author
Danna Chung, MD, is the Virtual Medical Director at Crossover Health. She is board certified in internal medicine, allergy/immunology, and integrative/holistic medicine. She joined Crossover in 2019 with prior experience working for a number of telemedicine companies and at the US Department of Health and Human Services.