Virtual Care Adoption | Infancy Stage

I was wrong. Way off. Not even close. As one imperfect marker of virtual care adoption, I predicted ambulatory visits would stabilize post-pandemic around 20% of total encounters. Collectively, we are well below 10% and decreasing. Will we go back to pre-pandemic levels of 1% or hover somewhere around 5%? I think it is safe to say we won’t go back to where we started. The toothpaste is out of the tube and not going back in nicely. In fact, ever the optimist, I feel we have nearly bottomed out and will start to see year over year modest increases. I see us hitting 10% by the end of the decade. I have been wrong already, but 10% seems doable.

I postulated consumers would demand virtual alternatives. Providers would differentiate via virtual offerings. Human centered design would close the gap between technology and experience.

What happened?

First Impressions. You only make a first impression once. Most providers treated virtual care much like a traditional visit, but via camera. A terrible experience. So when patients are given a choice, many are coming back in person. You can’t blame them.

Payment & Credentialing Uncertainty. No doubt, providers have taken a conservative approach, not rushing to transform into a virtual care operation. Faced with annual mandates that today allow for billing parity and interstate credentialing, these can expire without much notice. It is hard to build a foundation on shaky sand.

Virtual Care Acclimation. Even where welcomed, the virtual option is a pretty radical departure from long sustained practices. It is one thing to use your phone to schedule an appointment instead of a phone call or leverage WhatsApp video to see your cousins in India…But this is your health! Many insist to be there in person and ensure their provider knows the pours on their skin or the color of their freckles.

Tradition. Providers are much like Tevye from Fiddler on the Roof. We believe tradition helps maintain balance and that it is unwise to bring in change when everything seems to work pretty well. We do procedures or host a patient visit, and we get paid and everything runs smoothly. Until economic pressures force a change, tradition! Tradition! Tradition!

How to Encourage Sustainable Adoption

I sat down in a room full of eVisit customers and prospects recently trying to better understand what does work. Participants varied from large academic medical centers to federally qualified health centers to safety net hospitals. They were outliers, making virtual work and reaping the benefits for both patients and providers. Here is what I learned from those making virtual care work.

Sophisticated ROI. There is clear ROI in virtual but you have to seek it out and show the business case. Tradition being the dominant culture, you have to combat resistance with data and be a tenacious advocate. Look at the financial impact of throughput challenges and poor experience scores. Leverage your vendor partners to help you uncover hidden opportunities given their vast experience with other providers.

Clinician Champions. We know this and still ignore this. We expect the “digital” or “virtual” or “chief” information officer drive interest and adoption while clinicians fold their arms. Been there. You need to find respected clinician partners to be out in front while the more administrative teams provide support. If you are not a clinician yet are holding the mic for virtual care, it is time to let go. Side by side, arm in arm is a healthy approach.

Change Management. Not only do you need clinician engagement, but bold and visible leadership from the Board on down. The CEO and team must be active participants reenforcing the messaging and show no fear from threats. Board members should be active and visible. There can be no sacred cows or carve outs. I have yet to see any threats be actualized such a mass clinical staff defection. 

High-Leverage Workflows. It is never the technology that disrupts opportunity but useability. It is all about the workflow. If you improve workflow and hence the experience for patients and clinicians alike, adoption will happen organically. The few remaining naysayers will dissipate.

Real estate is location location location. Virtual care is workflow, workflow workflow.

Differentiation. With many providers in retreat, a gap has opened and the wise seek to fill it. Clearly we know we should offer our patients and communities options. As you get the leadership, workflow and change management aspects right, you can offer differentiated alternatives. Consider this a strategic move that not only enables improved experiences, but improved revenues and some would argue, clinical quality.

What Now?

Doubling back down on virtual care is not an option. It is survival of the digitalist. Heads in the sand make for short lives. The steps are doable and outlined above. The final step is seek a virtual care vendor who will partner with you. A partner whose platform is interoperable and modular in design, allowing for growth and innovation. A partner with engaged executives whose hearts are aligned with yours.

We will revisit this prediction yearly and track virtual care adoption. I know my family won't return to the old ways of healthcare whenever avoidable.