AMC Health Blog

Virtual Care…Are You Ready?

By: Jonathan Leviss, MD FACP

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Is your healthcare organization ready for Real-Time Virtual Care solutions? That depends…

Case 1: The message in my EHR reads: “Does Dr. Leviss want to be called when the patient’s heart rate is greater than 100?” A homecare nurse had called after evaluating a 68-year-old patient at home after her total knee replacement. As the PCP, I’m aware of the recent surgery, but I do not have the discharge plan, I did not authorize the homecare services, and I have not assessed the patient since her surgery. What’s the right response? I message back a request for the patient to come in for an appointment.

Case 2: The patient’s reason for a visit says: “Diabetes follow-up.” I have data to review, including the patient’s home-based glucose readings from the past 90 days, a slightly elevated HbA1c from today in clinic, recent kidney function tests, and a summary of blood pressure readings and medication changes managed by a nurse and clinical pharmacist based on a remote patient monitoring protocol. The vital signs from today and the recent two weeks of home monitoring indicate good blood pressure control, so I confidently work with the patient and focus on improving his glucose control.

Real-time virtual care, including Remote Patient Monitoring and Telehealth, have been proven in multiple studies to help patients feel better, improve clinical outcomes, and reduce utilization (and cost), but not every healthcare organization, or every patient, is ready for this transformative approach. How do we tell the difference? What’s the “readiness check-list” for virtual care?

The Virtual Care Model Readiness Checklist should include:

  • Enabling Technology
  • Engaged Consumers
  • New Models of Care
  • Value-Based Reimbursement Financial Incentives

 

Enabling technology— What data does a care team need to monitor a patient outside of the hospital or provider office? What is needed for the patient and care team to communicate in the simplest manner? What infrastructure is required? The Internet of Things explosion and wireless networks offer a mind-boggling array of data gathering and communication solutions for healthcare. Bluetooth-enabled blood pressure cuffs and weight scales, implantable continuous glucose monitors, and smartphone apps that assess mood, pain control, or medication side effects allow people with hypertension, diabetes, or depression to engage in care safely, effectively, and virtually. Analytic tools help care teams know which patients need attention when and why.

Checklist item #1: The right technology safely and securely captures and communicates the right data between patient and care team and is easy to use, deploy, and maintain.

Engaged Consumers—Patient adherence has long been identified as one of the most essential steps to desired clinical outcomes. Virtual care offers the opportunity to engage people “in the wild,” wherever they are living, not only in the physical setting of a provider organization. Helping patients manage their diabetes while at home, surrounded by their own personal challenges like eating the right foods or finding time to exercise, can powerfully reveal the barriers patients face with diabetes control; however, this only helps if the patients are ready and able to take responsibility for self-management.

Checklist item #2: Virtual care helps patients address problems in self-management, if patients are ready to take on this responsibility.

New Models of Care—Virtual care offers new ways for patients to engage with their care and care teams, revealing opportunities for education, medication titration pathways, and coordination of care. Care teams designed to coordinate patient care effectively, and maximize efficient use of providers, are usually well prepared for the flexibility of different team members interacting with patients virtually. But when physicians must be involved in every step of a patient’s care, including the need to bill for in-person encounters, or care plans are not effectively communicated across the care team, virtual care might not offer improved access for patients or efficiency for care teams. 

Checklist item #3: A model of care must be able to take advantage of interdisciplinary patient interactions and/or occur without the requirement of a face-to-face provider visit.

Value-Based Reimbursement—Virtual care can improve clinical outcomes and reduce utilization and cost of care, but this does not benefit all providers. A person with heart failure who is able to remain healthier and at home, rather than be readmitted to the hospital, feels better, but how does the health system that cares for the patient fund virtual care if reduced readmissions means reduced revenue? The fee-for-service reimbursement model that finances the majority of healthcare in the US remains that greatest barrier to virtual care, as demonstrated by the fact that leaders in virtual care are commonly leaders in value-based reimbursement models.

Checklist item #4: The financial gains of virtual care must return to the organization that supports the program.

Checklist Items #1-4 may seem narrowing, but as an optimist, I am excited that they appear to be contagiously spreading across the US health system. Real-Time Virtual Care will quickly follow, providing value to patients, families, providers and payers.

 

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