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Beyond TeleHealth: The New Era of Consumer Directed Virtual Care

Glen Tullman

07.14.20

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The coronavirus pandemic will be remembered for many things, the tragic loss of life, the economic devastation, which I believe will be compared to the Great Depression when all is said and done, and the mental and behavioral health impact caused by the destabilization of life as we knew it.

But with hindsight, we may also look back on this challenging time as the moment when healthcare transformed to become more preventive, with a focus on health and care, keeping everyone in the community healthy and doing so more efficiently and cost-effectively. We have already had a taste of the future, and while this accelerated adoption, largely driven by the pandemic, is far from perfect, we’ve learned that much of our care can be delivered virtually. Pairing virtual solutions with more comprehensive at-home diagnostics and lab testing will free up our health and care system to focus more intently on what is most critical.

In a recent interview with Bloomberg Law, Oliver Wyman Partner of Health & Life Sciences, Sam Glick, shared that while more than 70% of people with health insurance had access to telehealth through their plans before the pandemic, fewer than 10% of people actually used those services. The Centers for Medicare & Medicaid Services (CMS) reported that pre-COVID telehealth utilization was 11,000 Medicare members during the week ending March 7th. The week ending April 18th, during the pandemic, utilization skyrocketed to 1.3 million Medicare members using telehealth. The University of Virginia’s Center for Telehealth reported similar increases and that between February and May, their virtual care visits increased by 9,000%.

Almost overnight, we saw our healthcare system flip from more than 90% in-person office, ER, or hospital visits to more than 90% telehealth visits. And the response was overwhelmingly positive from patients, who I like to call health consumers. They found telehealth to be more convenient, more accessible, and a more positive experience overall. Today, the question is not whether telehealth will play a substantial role going forward, but rather how virtual care will reinvent our experience, and the role that health systems and physicians will play in that change.

During the pandemic, we also learned that it’s often healthier, both for the patient and the physician, to keep those who are sick and those who are vulnerable to health complications, at home, rather than coming to the doctor’s office, the ER, or the hospital. Paired with the fact that the single largest reason people do not access care, whether in urban settings or in rural ones, is transportation (which may have its own set of safety concerns), virtual care is the ideal solution.

In its simplest form, telehealth describes a form of clinical communication. However, telehealth alone is substitutive, not transformational. Traditionally, when a person experiences a health need, they schedule an appointment with their doctor, travel to the doctor’s office, sit in the waiting room, and spend a few minutes with their physician, having a drug or test prescribed. Telehealth simply brings this model to a digital format. In fact, the time that people spend with a doctor during an in-person visit is almost identical to a telehealth visit. Both average between 5 and 10 minutes. It remains a one-to-one process that is hard to scale.

We believe that to create a better, more personalized, consumer-first care experience, telehealth is a necessary but not a sufficient ingredient. We must provide additional tools for the physician to better understand an individual’s health profile when she talks with the patient on the phone/web, while putting the health consumer squarely in charge of their health. Most telehealth visits today are missing important clinical background about the individual patient, which would allow for a more accurate diagnosis and care plan. Telehealth happens only after the person realizes something is wrong.

First and foremost, we believe the future is about keeping people healthy at-home and being able to do so at scale. Understanding how people are doing --- meeting them where they are and wherever they are --- and determining who needs care and who is doing fine, and what to do about it is really where the future of health will happen. We call this Consumer Directed Virtual Care, which is enabled by connected devices and advanced data science.

Many people think of this as Remote Patient Monitoring, but that term is wrong for a host of reasons. First, we believe in a model where the health consumer is at the center and she is in charge and empowered to make critical decisions about her health or her family’s health. It’s not about a centralized hospital, ER, or physician’s office. Think of your ability to use Google at-home versus having to go to the library. Second, it’s not about a patient. It’s about keeping a person healthy, allowing them to provide most of the care for themselves, and keeping them from needing time with a physician in the first place because they are healthy. Finally, it’s not about monitoring. We don’t need someone to watch over us, but rather, to provide easily understandable information and guidance to let us make the right decisions about our health. This may include requesting additional care options, perhaps through a seamlessly connected telehealth visit with a physician who already has your most up-to-date health data. This is about self-monitoring --- with prompts and encouragement --- not patient monitoring.

This is far from providing care over the phone or on video, ‘monitoring’ the health status of individuals, or even shifting our current model to a digital format. We must use these new connected digital technologies and the data science (operating magically behind the scenes) in a way that is personalized, effective, and scalable to create better care at a more affordable cost. Most importantly, we must create a new, different, and better experience for people. It’s not just about making it faster (think of the shift from horse and buggy to car), but rather an entirely new way of looking at health and care (which compares to the invention of planes). People want their health and care to be the same quality experience they get every day on the internet from other services they use.

This new Consumer Directed Virtual Care model combines aspects of intelligent connected devices including blood glucose meters, blood pressure cuffs, weight scales, behavioral health therapy tools, and deep machine learning and data science. Where necessary and appropriate, telehealth can be used as a step-up in the care continuum where an office visit is not required. Consumer Directed Virtual Care provides people with 24x7x365 access to the tools and insights they need to stay healthy with instant access to virtual visits with a physician, all from the comfort of their own homes or wherever else they might be in the world. The most important difference of this new model is that we’re empowered and in charge.

A Consumer Directed Virtual Care experience begins with a simple notice that a person’s blood sugar is high or low, that they need to take their medication, that their virtual coaching session is available, or by providing a simple answer to a health or care question. Once again, they are in control.

The answers may come back digitally, through insights provided, through questions asked, or through automatic connection to a professional as requested. People will get care and counsel when they need it, and that includes basic questions (I have a sinus infection) to more complicated questions about multiple chronic conditions, medications, or behavioral health conditions. For the first time, they will get specific guidance when they want it on a very personal level, all in the privacy of their own home or wherever else they may be located.

For example, solutions like NOCD seamlessly connect people with mental health professionals who specialize in Obsessive-Compulsive Disorders, and one of my favorite solutions, Talkspace, matches people with a licensed therapist using their mobile device to deliver care and support exactly when it’s needed. Unlike traditional telehealth providers, solutions like NOCD and Talkspace offer an additional layer of support by enabling real-time chat and messaging features and progress tracking between sessions.

While telehealth and remote monitoring have become increasingly important during the COVID-19 pandemic, we can’t simply stop there. By understanding the new Consumer Directed Virtual Care model and refocusing our efforts to put the consumer at the center of everything we do, we can make a true difference. The coronavirus has provided all of us with the opportunity to create a better health and care experience. Now we must work together to make it happen.

Further reading

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