Virtual care – or remote practitioner-patient interactions – is on the rise. According to a recent article in the Wall Street Journal, virtual care services saw a 20% increase from 2015 to 2016, and experts from the WCH Institute for Health Systems Solutions and Virtual Care (WIHV) agree that by 2025 majority of patient interactions with providers and healthcare systems will occur virtually.[1]

But there are still people who lack access to even basic health care, particularly those living in very remote areas. While geography often dictates the quality of medicine a person has access to, so does one’s financial situation. In the U.S., healthcare is notoriously expensive, and not every citizen or non-citizen can afford it, even basic services like a yearly check-up.

One possible solution to both of these problems could be virtual care.

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Virtual Care: A Short Definition

According to the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), virtual care describes[2]:

any interaction between patients and/or members of their circle of care, occurring remotely, using any forms of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care.

In essence, the term refers to the interaction between a patient and a healthcare provider that is done remotely, with the use of virtual or digital technologies, such as video conferencing software or even mental health apps on smartphones.

According to research done in 2017 by Parks Associates, 60% of broadband households in the United States at least, were interested in remote care either online or by phone.[3]

Virtual Care vs. Telemedicine vs. Telehealth

Virtual care can sometimes be used interchangeably with other terms such as “telemedicine” or “telehealth,” though it’s important to note there is a key distinction between the two.

Telemedicine or telehealth refers to all aspects of the treatment of various medical conditions that are done without having to see the patient in person and often includes virtual care.[4]

Succinctly, virtual care by definition is reserved specifically for patient-practitioner interactions enabled by telecommunication tools, while telehealth, in contrast, extends to electronic health records or electronic medical records (EMRs) and remote patient monitoring.

The fact that these terms are so often confused only underlines the importance of virtual care to practitioners worldwide and both play a valuable role in the blended care practitioner’s toolkit.

What Are the Benefits of Virtual Care?

Healthcare and technology have always gone hand in hand, and there is no doubt that digital technologies will change the way healthcare looks and feels.  Healthcare providers also see great potential in modern technology.

Virtual care significantly improves day-to-day operations for health care providers and their organizations.

Telecommunications allow them to talk to their patients remotely making collaboration more effective. Even if it is for smaller issues like making a virtual check-in with the patient after surgery, the convenience of doing it virtually creates win-win scenarios for everyone involved.

The true benefits of virtual care, however, go far beyond just giving patients easier access to healthcare services. Virtual care significantly improves day-to-day operations for health care providers and their organizations.

Patient Virtual Care

In most published literature concerning virtual care, an overwhelming number of cited benefits have to do with the patient. A few examples include:

  • Enhanced Convenience. Instead of having to travel to a medical check-up, people in remote areas can easily access these services remotely.[5]
  • Improved Accessibility. Having healthcare services so accessible offers the potential promise of encouraging people to attend to their health needs in a more timely manner and more frequently. By addressing health concerns when they first appear and checking in frequently on progress, patients can actively participate in improving treatment outcomes. This makes virtual care a perfect solution for specialists who need to to remotely monitor situations or procedures, while it also makes quick consultations, second opinions, and meetings possible where they might otherwise be cost-prohibitive.
  • Lower Financial Costs. sometimes even as much as half the cost of a traditional in-person appointment.[6] This again can encourage people to address their health issues, particularly when the person cannot afford health insurance or to cover the cost of a traditional health service.

Benefits for the Provider

Let’s consider provider benefits of virtual care – does it offer practitioners similar or comparable advantages?

  1. Reducing healthcare investments. The potential of virtual care services can have a visible impact on healthcare providers, from nurses, doctors, and clinicians to administrators and other medical office staff. On-site visits, for instance, are an important part of patient care, but they consume a lot of time and resources, especially due to missed appointments. Telepsychiatry interventions, as one example, have been shown to reduce some of these costs while delivering comparable results to practice-based treatments.[7]Some of the visits can be easily done with the use of video software, where the nurse or doctor can check in with the patient remotely, answer all their questions, and deliver needed care on the spot.
  2. Potentially limits practitioner burnout. The most significant long-term benefit of virtual care through the time-saving that it offers is the potential prevention of clinician burnout. As Dr. Adam Licruse writes in the Harvard Business Review: “…as we focus our energy on provider burnout, we hope that virtual care will allow for more-flexible provider schedules over time, permitting clinicians to provide some care from outside their practices if they wish“.[8] By making at least some processes more efficient, the levels of stress that providers may face can also be lowered, which in turn may lead to preventing exhaustion.

Benefits for Healthcare Organizations

Although some are concern that virtual care can decrease the number of patients that make appointments and therefore affect the success of a health organization, many experts argue the opposite. Rather, findings suggest:

  • Virtual care services may help institutions be more efficient. Dr. Licruse describes how his organization saw a 50% reduction in the need for referrals to specialists, meaning less spending on the organization’s part for sometimes unnecessary consultations.[8] It is not unreasonable to predict that the advent and popularity of e-clinics may play a role.
  • They may improve – or at least not negatively impact – patient retention. There is no evidence to suggest any health organization will lose real-life patients if they also adopt a more virtual-friendly service. Rather, increasing evidence suggests that internet-based treatments can have valuable patient health engagement benefits, while organizational research is continually focused on how further practitioner adoption can be encouraged.[9][10][11]

Virtual Care vs. In-Person Treatment Quality

Quality assurance is a huge practitioner concern when it comes to any type of healthcare. So while it’s cheaper, and offers easier access to services, virtual care also needs to be safe in order to positively impact the lives of patients and practitioners.

Challenges to Virtual Care Practice

In today’s telemedicine and virtual care fields, quality assurance has posed some practical challenges, and there is not a lot of data pinpointing exactly how safe the market is as a whole.

We do know that virtual care regulations vary from state to state, but a lot of pressure remains on patients and users to practice diligence to ensure they are getting[12][13]:

  • Science-based mobile therapy or mHealth apps
  • Therapeutic treatments from accredited mental health practitioners who are licensed to practice in their particular state[14]. Different regulations may apply when it comes to mental health coaching, which as a field of practice is comparatively less regulated.
  • Private, secure healthcare services with regard to data collection and storage practices[15]

Virtual care and telehealth enthusiasts claim that today’s technology offers the same level of experience and quality of services as the traditional face-to face-meetings with your doctor. Many of these tools and their usage are subject to federal and state laws, and specifically HIPPA regulations.[16]

The American Medical Association, for instance, has developed a set of policies for physicians to ensure quality when using virtual care.[17] These guidelines, however, are more concerned with doctors adopting safe practices than companies who rely only on virtual care services as a business model. This leaves virtual care in larger organizations with many gray areas.

What Do The Studies Show?

There are some studies that provide consumers with some insight into the limitations of virtual care. According to one, there is a variation in the quality of urgent health care provided during commercial virtual visits.[18]

The study, published in JAMA Internal Medicine, utilized individuals trained to act as patients with the following acute illnesses, which have recognized standards of care in outpatient treatment:

  • Ankle pain
  • Strep throat
  • Cold
  • Urinary tract infection
  • Lower back pain

The fake patients performed 599 virtual visits overall with a wide range of vendors. What the findings revealed was the quality of care was variable at best.

Out of the 599 virtual visits, the correct diagnosis was delivered only 458 times. The rate of guideline-adherent care tended to range from 206 visits to 396 visits across eight unique vendors.

These results should be taken with a grain of salt, however, as there is a significant lack of comparison for face-to-face visits.

Doctors do misdiagnose patients on occasion, whether they are virtual visits or traditional visits, and there are also times when a physician may not follow established guidelines.

Another study, published in the Journal of Telemedicine and eHealth, examined access and quality care in direct-to-consumer telemedicine, then compared this to virtual visits from Teledoc.[19]

Researchers also reviewed past insurance claims from the California Public Employees Retirement System, and noted that out of the 233,000 eligible individuals, only 3,000 of them (1.3%) took advantage of a virtual visit.

The research also revealed that the Teledoc doctors performed worse on several indicators when compared to traditional practitioners located in an office. The virtual providers did not order strep tests as often, for one, and they tended to order antibiotics more often for bronchitis when compared to a standard office visit.

Choosing a Virtual Care Provider

So, what does this mean for the patient? It may mean you have to tread lightly. When we look at the accuracy and quality of virtual care services as a whole there are significant variations.

Most of the research into virtual care has been focused on blended care and the added value it can bring when combined with traditional medical services, such as a doctor video-calling their patients a few days after surgery to see how they are doing.[20] But when looked at solely from the perspective of exclusively digital health services, the quality of said services can vary greatly.

Designing Guidelines

One study of commercial virtual care companies showed differences in how often the practitioners’ recommendations were adherent to medical guidelines and even if the diagnosis itself was correct, to begin with.[21] What was surprising to see was that the mode of communication did not seem to make a difference.

The need for stricter regulations regarding virtual health care services has lead to a conversation about what needs to be done to make sure these services are safe. Teladoc, a virtual care company based in the US established the healthcare industry’s first organization that focuses solely on virtual care.

Elsewhere, The Institute for Patient Safety and Quality of Virtual Care has been officially recognized by the Department of Health and Human Services as a Patient Safety Organization (PSO) that focuses on conducting quality and safety activities to improve the safety of virtual care providers.[22]

Competitive Advantages of Virtual Health

There are many competitive advantages to virtual care as well. Virtual healthcare helps increase access, improve the value, and help establish a competitive advantage by operationalizing technology solutions.

Virtual care can either complement or act as a substitute for your usual standard of care. The overall goal of something like virtual care is to improve access to much-needed services while reducing the cost constraints along the way.

With expected physician shortages, the continued growth and expansion of digital clinical solutions and increased patient demand, virtual care makes a lot of sense.

There is a clear competitive advantage as well because virtual care offers an on-demand solution, reaching patients directly in their homes.

There is also an increasing demand for third-party physician networks sponsored by insurance groups to provide services like:

  • Walk-up clinics
  • Online Therapy
  • Virtual consultations
  • Blended care
  • Virtual monitoring
  • Mobile therapy
  • Video Therapy
  • Telemental health services
  • Telepsychiatry

Virtual counseling, or e-counseling, is a great way to help patients who might otherwise hesitate to seek out psychological services. The virtual visit is convenient, private, and secure, making it an attractive option for things like addictions, grief, and loss counseling or even something like an eating disorder.

Areas of Growth

Zooming in even closer, we can pick out some specific virtual care areas that seemingly hold the most promise.

According to a Global Market Study on Virtual Care, revenue generated by the global virtual care market is expected to demonstrate a double-digit compound annual growth rate (CAGR) and reach somewhere along the lines of 13.08 Bn by 2026.[23]

The share of revenue from the virtual care solutions market is expected to expand at a growth rate of 26.9% CAGR during this same forecast period.

Mostly, this is due to the increasing deployment of different solutions in virtual care application areas such as hospitals, pharmacies, and other similar venues.

This segment is further divided into virtual care platform types such as:

  • Video
  • Audio
  • Messaging, and
  • Kiosks

Perhaps due to its many benefits, video is the platform most widely used by virtual healthcare providers.

A Look at the Research

So how do consumers feel about a more advanced type of healthcare?

According to research done by Accenture, a vast majority of consumers are more than ready to receive healthcare services virtually.[24]

  • 77% of consumers surveyed would prefer to track their health status virtually. This includes things like blood pressure, blood glucose, pulse rate, etc.
  • 76% of consumers would prefer to have a follow-up visit virtually.
  • 74% would prefer to get follow-up healthcare at home after being hospitalized.
  • 72% would prefer to get reminders to take medication and get daily support to help manage ongoing health conditions.
  • 70% of consumers surveyed would prefer to have a virtual exam for minor ailments like a sore throat or a sinus condition.
  • 65% of consumers surveyed would be open to attending a class about a specific condition such as diabetes.
  • 54% would be open to participating in a support group.
  • 53% of consumers surveyed would be open to receiving mental health counseling therapy virtually.
  • 50% would be open to participating in mental health group therapy.

These numbers are encouraging and show that people are open to new things and new ways to expand virtual care.

Despite these positive numbers, only 21% of consumers surveyed stated they had received virtual care.

For practitioners, this offers an excellent opportunity to expand virtual care in the marketplace as well as a chance to help people better understand what virtual care is and how it works.

There is a need for more patient education. While 73 % of consumers stated they had some awareness of virtual care, only 5 % of those surveyed said they “know a lot” about virtual health.

A shocking 27% of those surveyed, had “never heard of” virtual healthcare.

What this tells us is that more education is needed to help consumers enhance their knowledge, so they are better aware of what kind of advancements are available in terms of virtual care.

A global market study done on virtual care suggests that the video platform segment is set to grow at a significant rate through 2026.

The Future of Virtual Care

Ongoing innovation in the world of telehealth and virtual care has brought many new and improved technologies to make way for better health care services and can now direct these services to a wider audience.

There is a high chance of more people using it as soon as next year. The Centers for Medicare and Medicaid have already finished policies to bring telehealth benefits to Medicare Advantage plans, which will only lead to an increase in the number of people using virtual care services. With the new benefits, Medicare Advantage enrollees will be able to access virtual services as they would when utilizing a regular healthcare provider.

Some important things to consider when arguing for the bright future of virtual care is better quality care where the care is most desperately needed.

  1. New Technologies, Better Care

The conversation about the safety of virtual care services is far from over. Many believe that rapidly emerging technologies like mobile care, artificial intelligence, virtual reality, and machine learning, could play an important part in shaping the future of telemedicine.[25]

Some signs of this progress are already visible. Mobile devices with internet connectivity have the ability to connect a patient with a doctor from any location, so the patient doesn’t have to be in their own homes for a consultation. This can be incredibly beneficial in the mental health sector, where a patient can get in touch with their therapist at any moment, as needed.

  1. Chronic Care Management

While at the moment most of the virtual care is rather focused on more minor medical needs, we are starting to see these services stepping into chronic care management for people with more complex conditions and illnesses.[26]

Examples include treatments delivered remotely – either entirely or in part – for:

  • Diabetes treatments – such as endocrinology treatments, dietary and symptom tracking behaviors [27][28]
  • Neurogenerative disorder treatments – as seen in treatments for patients with Parkinson’s disease[29]
  • Major Depressive Disorder – through iCBT, video therapy, or behavioral treatments to target symptom severity[30]. With the rapidly expanding field of telehealth, increasingly more specialized treatments, e.g. Applied Behavioral Analysis (ABA), and Acceptance and Commitment Therapy (ACT) are now being made available digitally.

There is a lot of potential here, but not without virtual care needing to make some modifications. For one thing, a virtual care model for chronic illness management will require continuity, which many of these services currently do not offer.

Patients log on to a platform and are then matched with a doctor best suited to help them. But outside of this initial introduction, it is possible that they never interact again. When it comes to patients with chronic conditions, this is not a viable option. Many virtual care providers are working on changing their models in order to overcome these new challenges.

Final Thoughts

Industry providers estimate that around 72% of consumers would prefer a virtual visit with their doctor, rather than a traditional one.[31] There is definitely a great interest in these types of services, from the point of view of the patients, healthcare providers, and institutions.

The future of healthcare most likely will contain a bigger prevalence of virtual care services, and the new technologies that may become more widespread will have a strong say in what it will look like.

For the patient, this means more available options. And if the virtual one gets chosen, this will mean a cheaper option as well.

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References

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