So, What Now With Virtual Care?

So, What Now With Virtual Care?

source @gapingvoid

In recent years, the concept of how we deliver healthcare has undergone a significant transformation, moving beyond traditional in-person visits to embrace the digital realm. This shift has brought with it the rise of virtual care, a term that has gained increasing importance in the healthcare landscape. But what exactly is virtual care, and how does it differ from hastily implemented pandemic emergency virtual visits? In this blog post, we’ll explore the fundamentals of virtual care, delve into best practices for its implementation and come to understand why it is here to stay!

First:  Virtual care is, simply, care.  Offered virtually.

At its core, virtual care is a simple yet profound concept—it is healthcare services offered through digital means. In a world that is becoming increasingly interconnected and reliant on technology, virtual care leverages this connectivity to provide medical assistance, diagnosis, treatment, and support, all through virtual channels.

source @gapingvoid

Differentiating Between Pandemic Emergency and, Now, Standard Virtual Care

One crucial distinction to make is between virtual care which was quickly rolled out during the COVID-19 pandemic emergency and virtual care as part of a new standard of care. The latter represents a more deliberate and structured approach, emphasizing the importance of sustainable, high-quality healthcare accessible through digital platforms.

Stand-alone Virtual Clinics vs. Patient-Centered Medical Homes

Virtual care is not a one-size-fits-all solution. It’s important to differentiate between virtual care offered through stand-alone walk-in clinics, often for convenience or unattached patients, and virtual care integrated into a Patient-centred Medical Home (PMH). The latter approach places patients at the center of their care and provides a more comprehensive and holistic approach to virtual healthcare than episodic unattached visits.

Different Forms of Virtual Care

Virtual care encompasses various forms, including:

  • Doctor or nurse assessments
  • Remote patient monitoring
  • eConsults
  • Augmented reality homecare
  • Augmented reality emergency/EMS care
  • Sensing technology and shared patient-generated data

Understanding these diverse modalities allows healthcare providers to tailor their virtual care offerings to meet the specific needs of patients.

Paying for Virtual Care

The question of how to offer virtual care to patients who are remote, unattached to a PMH, or in need of urgent assessment outside the PMH or emergency room via a clinic environment is crucial. Possible payment models include private pay, which can be corporate or opportunistic, and public pay as part of a system-sponsored programmatic approach. The choice of payment model can significantly impact accessibility and equity in virtual care.  During the pandemic, every jurisdiction began covering virtual visits as an urgent benefit for patients during lockdowns.  But now most public paymasters have begun to scale back the money attached to virtual visits while coming to terms with the new expectations of patients to be seen quickly and from home.  Payment models are often being linked to comprehensive care fees and bundled payments in a post-Covid world.  This changes both available supply and types of services available to the public and has forced many virtual care companies to revert to private or patient pay models again.

source @gapingvoid

Integrating Virtual Care into Patient-Centered Medical Homes

Integrating virtual visits and services into a patient-centred medical home requires careful consideration:

  • Determine the appropriateness of virtual care for specific patient needs.
  • Position virtual care in the overall visit cycle, including triage, assessment, testing, and follow-up.
  • Match the right provider with the right problem for the right patient at the right time and modality.
  • Consider patient preferences while emphasizing access and patient-centered care.
  • Utilize analytics to assess the types and costs of virtual visits and their impact on patient behaviours, such as double visiting, gaming for access, follow-up care, and emergency room use.

Virtual Care as Program Offerings, Sponsored and Offical

Virtual care programs are emerging worldwide, showcasing the global adoption of this transformative healthcare model. Some notable examples include the relationship between Maple and Nova Scotia Health in Canada, TELUS MyCare in British Columbia, and the Primary Care Virtual Care Pilot with OTN/Novari in Ontario. Internationally, Sweden, the UK, Singapore, Israel, and Kaiser Permanente in the United States have fully integrated virtual services into their healthcare systems.

source @gapingvoid

So What is Needed for Success?

In implementing and providing ongoing virtual care in a clinic or health system, it’s now essential to:

  • Define the specific healthcare needs of citizens in your region.
  • Set appropriate policy, both locally and systemically, to ensure virtual care is used optimately.
  • Consider how virtual care integrates into the broader healthcare ecosystem.
  • Avoid silos of virtual care separate from traditional healthcare services.
  • Explore public/private and partnership models to ensure sustainability.
  • Provide training and education for healthcare providers and patients in the best use of virtual care.
  • Continuously ask the question, “Who are we leaving behind?” to ensure that virtual care remains inclusive and accessible to all segments of the population.

As we move forward in a new health and wellness paradigm post-pandemic in Canada we must remember that virtual care is not just a temporary response to a global crisis but an integral part of the future of healthcare. By understanding its various forms, integrating them into patient-centred models, and following best practices as seen internationally, we can harness the potential of virtual care to provide accessible, high-quality healthcare services to all.  It’s happening anyway.  Let’s just get it right.

6 Replies to “So, What Now With Virtual Care?”

  1. I wonder if the flip side to the last point around equity should be: “who should receive disproportionate access to this service?”

    This alternative approach might be to look at groups with specific health care needs poorly addressed by in-person care and think of a digital-first approach. Services requiring long distance travel, services available in specific languages to underserved cultural communities, and even some health services with relatively little need for physical exams could all be prioritised for virtual care. By funding these services publicly, the province would be able to innovate, show its interest in platforms, and harvest data without hurting their own cause by trying to define when sore throats could possibly be eligible for virtual care.

    1. You raise an excellent point here Andrew! The health system (Ministries of health , Primary Care Networks and Teama and even patient groups) should truly define a series of visit types that can effectively be offered virtually. Then fund them wholly. With that we can even introduce effective triage systems with a digital front door that moves patients to the right visit type for the right problem with the right provider at the right time. This work is somewhat complex, but we can look to countries like Sweden for examples and then do it better !!! Where there is a will there is a way. Now… do we have the collective will???

      Thanks for reading and commenting .

  2. Thanks for compiling this insightful assessment of developing virtual care, Darren. It’s definitely made me think about how we adopt virtual practices into our health care system.

    I particularly found the non-medical and structural influences to be interesting drivers of change; for example your discussion of how payment system usage changed through the pandemic and afterwards. There are so many forces outside of the health care system that influence adoption of sustainable virtual solutions, and I suspect it will be important to identify the drivers of change within the medical ecosystem in order for those changes to be adopted, for example: Incentives (of patients, health care workers, administrators); Project Economics (ROI, implementation lead times, investment availability); Trends (lifestyle, mobility, attitudes & opinions, comfort with tech, demographics); Political Interests (leadership intentions, election cycles, public perception); Technological Capabilities (connectivity, security, rate of change); Legal (safety, legislation, compeition law, patends, employment law); and Partnerships (PPP, market dynamics, bundling).

    It’s mind boggling to consider all the influences external to the health care system itself. I’m definitely going to pay more attention to the major drivers of adoption of virtual health care. It’s going to be a fascinating journey.

Show Buttons
Hide Buttons