How Virtual Care Enables Modernization of Healthcare Service Delivery
Author: Mike Brandofino, President and COO, Caregility
We are at a watershed moment in modern medicine that is fundamentally changing healthcare delivery. The line between bedside care and virtual care has evaporated to the point where it is just healthcare.
What may appear to be a sudden shift towards acceptance of hybrid care models because of the pandemic has been years in the making and can be traced to the early days of tele-ICU pioneered by Philips Healthcare and health systems like Mercy Virtual, which built the nation’s first virtual care hub with six floors of clinical specialists in a building with no patients. Their sole focus was to provide remote care to ICU patients around the country.
What’s transformational about where we are now is the rapid expansion of virtual care beyond specialty units like tele-ICU and tele-stroke to dozens of additional clinical workflows that enable clinical innovation across the entire care continuum, including hospital-at-home initiatives.
A McKinsey and Company report from this past June, “Digital transformation: Health systems’ investment priorities,” describes this shift to a hybrid care delivery model that blends virtual and in-person engagement. Virtual care was cited as the leading investment priority and the second biggest area of potential impact by healthcare executives.
Telehealth and telemedicine have a long legacy as a safety net for hospitals, supporting care delivery during the pandemic and in ICUs before that. It continues to enable synchronous and asynchronous outpatient and behavioral health visits. We’re now seeing virtual care being threaded into processes throughout acute care, creating a secondary layer of remote clinical defense that enhances clinical collaboration to modernize inpatient care.
Telehealth Enters the Hybrid Care Era
Kourtney Matlock, president of Arkansas-based Baptist Health Rehabilitation Institute, sums up the current inflection point in care model innovation nicely, saying “Embracing virtual support as part of our acute care bedside support and quality strategy signifies a pivotal step forward in how we envision the future of healthcare.”
After a tumultuous five years for healthcare organizations, hybrid care models are bringing welcome change. Virtual nursing programs are helping hospitals offset burnout, turnover, and reliance on travel nurses, bringing workforce costs down.
Additionally, virtual sitter programs are helping health systems cost-effectively amplify the reach of patient safety teams. Most importantly, the addition of remote care support in acute hospital settings is helping healthcare organizations better coordinate care, intervene earlier, and improve patient safety and outcomes.
Collaborative Care Teams
Virtual engagement at the hospital bedside is elevating patient and staff satisfaction. In hybrid care models like virtual nursing, bedside and remote caregivers work in tandem to support patient care. That approach enables care teams to redistribute tasks like admissions, discharges, patient education, and more to remote nurses, which poses several interesting benefits.
Patients are building stronger bonds with their care team because of the uninterrupted nature of video-based engagement. One leading Florida-based health system saw a 20 percent improvement in patient HCAHPS scores, thanks to better communication in its virtual nursing pilot program. Enhanced communication and patient education – including the ability to bring family caregivers and interpreters into care planning virtually – supports better patient outcomes.
Collaborative hybrid care models give bedside teams valuable time back through task redistribution. With the average age and experience of bedside nurses dropping, programs like virtual nursing also help expand the reach of experienced nurse resources to support remote coaching and mentoring of less-experienced bedside clinicians. This trend is extending the careers of seasoned nurses and is a model that could help health systems weather future patient surges without having to resort to the expense of traveling nurse models, as they did during the pandemic.
Care teams are finding that an “every bed” approach to remote care enablement not only drives patient and staff satisfaction but also creates an infrastructure that health systems can use as a springboard for field testing new solutions that augment the information available to clinical teams.
Telehealth edge devices make it easy for healthcare organizations to tap into audio and video feeds in the patient room to enhance the clinical insight available to staff. Providers can layer in solutions like augmented observation to help monitor for patient safety threats, contactless monitoring to trend patient vital signs, and ambient listening to support clinical documentation.
The integration of these solutions into Intelligent Hospital Room initiatives amplifies the information available to caregivers, stretching what they can do. In these use cases, virtual care platforms and integrated sensors become additional members of the care team, continuously capturing and analyzing actionable data that caregivers can use to save time, intervene more quickly, and improve patient outcomes.
An Integrated Ecosystem
Artificial intelligence solutions represent just one of many enabling tools in emerging hybrid care models. Pioneering health systems are integrating enterprise telehealth solutions with additional enabling technologies to further future-proof care models in their Hospital Room of the Future strategy.
Peripheral tools that amplify clinical insight. The integration of remote monitoring solutions, clinical decision support tools, and third-party connected devices like digital stethoscopes are helping care teams remotely capture additional insights that drive clinical action.
Smart room design that meets evolving patient expectations. Integration with in-room resources like interactive patient consoles enables health systems to use existing resources to support remote engagement at every bedside. This keeps implementation costs and complexity down while modernizing care rooms to meet evolving expectations.
Service integration that ensures equitable care. Integration with remote, third-party clinical services helps ensure patient access to specialists, regardless of where they’re located, which is essential in rural areas where clinical resources are limited. Integrated interpreter services help health systems further address social determinant of health barriers and meet language access requirements, using two-way video to support communication for the deaf and patients with limited English proficiency.
These are just a few of the ways healthcare organizations are improving care quality for patients and saving time for clinical teams by integrating remote care at the bedside. The industry is pivoting from an “either/or” approach to telehealth to a more holistic era of hybrid care innovation that integrates in-person and virtual engagement throughout the patient journey.
By blending remote support into patient care delivery, hospitals are creating a new care standard that delivers a consistent, technology-enabled experience across the entire ecosystem – from the ambulatory setting through inpatient admissions to the home.
The numbers are sobering: It is estimated that 1 in 5 U.S. adults suffers from a mental health disorder. More than 50 million Americans carry the burden of conditions like depression, anxiety, and more. These mental health issues impact patients from all walks of life:
Young adults aged 18-25 have the highest prevalence of mental health issues (33.7%).
Mental health disorders are more frequently diagnosed among females (27.2%).
Veterans face a 50% higher risk of suicide compared to the general population.
Mental health struggles can be overwhelming and isolating, leading many to suffer in silence rather than get the care they need. Stigma and access barriers compound the suffering.
Virtual behavioral health has become an integrated part of the modern care model. The normalization of virtual options is a game-changer for patients struggling with mental health issues. Privacy, access, and convenience are a few key benefits.
Privacy: Virtual visits offer patients the same privacy and human connection as an in-person therapy session from the comfort and safety of home. Many young adults prefer the digital format for discussing sensitive issues and feel more at ease communicating through screens. Evidence suggests that this format reduces the stigma associated with seeking mental health care.
Access: Virtual mental health visits also break down geographic barriers and allow care teams to align patients with providers who share their cultural or linguistic backgrounds to promote engagement and health equity. In the face of a severe gap between staffing supply and patient demand within behavioral health, tele-psych introduces new ways to connect declining clinician pools to the growing number of patients seeking care.
Convenience: Patient interest in virtual mental health is also a reflection of the times. Familiarity with technology is more common now and a preference for more convenient, digital communication is driving usage. Providers similarly benefit from the convenience of conducting therapy sessions virtually.
Meeting Patients Where They Are
The current rate of sustained tele-psych engagement is a byproduct of smart healthcare organizations meeting their patients where they are. The success of virtual mental health services underscores the effectiveness of hybrid care models that offer patients and care teams multiple ways to engage.
By meeting patients where they are, we can help more people get the support they need without judgment or obstacles.
In a world where so much of life happens online, integrating virtual behavioral health services into care delivery just makes sense. It’s a path to more accessible, inclusive mental health care for all. A healthcare landscape that’s void of digital engagement avenues is already behind.
Learn how the Caregility iConsult application can support your behavioral health program.
Telehealth News Roundup: The EASE Act, H@H Risk, and ViVE
Here is a glimpse into some of the latest headlines grabbing attention in the world of digital health and telehealth news:
The Equal Access to Specialty Care Everywhere Act
On January 30, 2024, the Equal Access to Specialty Care Everywhere (EASE) Act was introduced by a bipartisan group of US House representatives. The proposed legislation advocates for the creation of a virtual specialty network to expand access to specialist care for Medicare and Medicaid beneficiaries, using Center for Medicare and Medicaid Innovation (CMMI) funds earmarked to “test models and innovations that support access to integrated specialty care across the patient journey,” as Anuja Vaidya reports.
Might this be a step towards a national framework for virtual care access that extends beyond state borders, similar to what’s seen in Veterans’ care?
Meanwhile, the clock is winding down on Acute Hospital Care at Home funding, slated to run out at the end of 2024. Designed to free up bed capacity by allowing select Medicare and Medicaid patients to recover at home, Hospital at Home is one of the few levers providers have to offset emergency department overcrowding. Concern about the future of the program is giving providers pause on implementing the solution. NBC reporter Erika Edwards notes that growing interest in the program may garner it a two-year extension or even permanency by the end of this year.
Last but not least, the 2024 ViVE conference is officially a wrap, with recaps from the conference pouring in. Telehealth was a recurring theme in HealthLeaders editor Eric Wicklund’s write-up of five key takeaways from healthcare’s flashiest tradeshow. What do nurses in need of help, the call for more care at home, and health AI enablement all have in common? You guessed it: virtual care.
As 2023 draws to a close, it’s time to take an annual collective pause and plan for what’s in store for healthcare in the coming year. In the spirit of tradition and championing innovation in healthcare, here are a few of our observations on the trends that will shape the digital health landscape in 2024.
1. A Measured Approach to Health AI
Artificial Intelligence (AI) was the topic on everyone’s lips this year, but 2024 is shaping up to see the technology implemented in a more measured approach.
“Interestingly, [AI] funding levels cooled in the back half of the year as pragmatism was ushered in via an increased focus on governance and safety but also an appreciation for the limitations of the current state of technology,” Hospitology editor Blake Madden noted in his 8 Predictions for Healthcare 2024: What the Market is Signaling for the Year Ahead article.
Healthcare organizations are starting to realize that the true value of AI lies not in its novelty but in its clinical and operational impact. With nascent generative AI and other technologies flooding the market, many healthcare organizations are taking a cautious approach to point solution adoption. 2024 should see an increased focus on building a secure infrastructure to introduce audio, video, and other sensor-based AI technology safely while improving large-language and other data models to better leverage AI tools.
2. The Continued Embrace of Hybrid Care Models
Industry-wide workforce challenges that plagued 2023 will persist in 2024. As Sonia Millsom, CEO of Oxeon, put it in the recent Forbes piece Overhyped? Digital Health Executive Anti-Predictions for Healthcare In 2024, “Health systems will remain in crisis. The scarcity of workforce and archaic nature of the workflows is at a crisis point.”
As a result of this trend, hybrid care models have been on the rise, and their popularity is only set to grow in 2024. These models combine the convenience of remote healthcare staff coupled with the personalized touch of in-person care. Virtual Nursing, in particular, has proven effective as an inpatient workforce multiplier for understaffed hospitals, providing real-time reinforcement to overburdened floor staff.
As telehealth and adjacent technologies continue to advance, expect to see hybrid care models integrated into more acute and nonacute healthcare settings. In the coming years, patients will not only appreciate but come to expect the added layer of care, and healthcare providers will benefit from the improved patient experience and reduced reliance on travel staff.
3. Empowering Patients with Wearable Health Tech
Wearable health technology has been steadily evolving, and 2024 will witness a new era of data-driven insights. From smartwatches and fitness trackers to remote patient monitoring devices, wearables are becoming increasingly sophisticated, offering new sources for real-time health data capture in almost any setting.
In 2024, wearable health tech devices will play a more significant role in chronic disease management and early detection of health issues, both in the patient’s home and in hospital settings. With the adoption of AI technology, wearables will provide even more patient-specific health recommendations and alerts, helping to guide care more proactively.
Caregility CEO Ron Gaboury sees these trends coming together to leave an indelible mark on healthcare in 2024. “AI-enhanced hybrid care sets the stage for emerging home-based care delivery models like hospital-at-home, envisioning a future where highly skilled virtual nurses, alongside bedside clinicians, are empowered by intelligent tools to deliver high-quality patient care directly in patients’ homes.”
From a measured approach to health AI to the continued embrace of hybrid care models, digital health trends continue to redefine the way we approach healthcare. As we step into 2024, one thing is certain: the future of healthcare is digital, patient-centric, and teeming with new possibilities.
Funding Telehealth
As telehealth’s entrenchment in healthcare delivery continues, stakeholders are exploring ways to apply the technology in specialized patient care.
Many of those initiatives seek to improve health access and equity for vulnerable populations such as adults with Intellectual and Developmental Disabilities (IDD), aging populations, and other marginalized groups. Interest in condition-specific telehealth programs is also rising as providers aim to improve care for patients navigating treatment for things like cancer, AIDS, mental health conditions, and substance use disorder.
To fund these programs, many resource-strapped, independent, and rural healthcare facilities turn to grant programs. If you fall into this camp, here are several funding opportunities you may wish to consider applying for to support your virtual care initiative.
Federal Telehealth Funding Opportunities
Federal agencies invest millions annually to support better access to quality care for rural and underserved areas.
The Federal Communications Commission (FCC) Rural Health Care Program provides support to eligible healthcare providers for “telecommunications and broadband services necessary for the provision of healthcare.” Supported in collaboration with Universal Service Administrative Company (USAC), a not-for-profit corporation charged with administering federal grant funds, the Rural Health Care Program includes two facets:
The Healthcare Connect Fund Program provides a 65% discount on eligible broadband connectivity expenses for eligible rural health providers.
The Telecommunications Program provides reduced rates to rural health providers for telecommunications and voice services for the use in telehealth.
Additional federal funding opportunities for telehealth and broadband-related programs can be found at Telehealth.HHS.gov. Built by the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), the site aggregates active funding programs from various outlets including but not limited to:
National Institutes of Health (NIH)
National Institute of Mental Health (NIMH)
National Cancer Institute (NCI)
National Institute on Aging (NIA)
National Institute on Minority Health and Health Disparities (NIMHD)
National Institutes on Drug Abuse (NIDA)
Office of Disease Prevention (ODP)
Foundation Grants
Several public and private foundations offer annual grant application opportunities. Examples include:
The Legacy Foundation of Southeast Arizona is a private foundation that funds nonprofit organizations promoting population health in Cochise and eastern Santa Cruz counties.
Additional Telehealth Grant Portal Resources
The National Consortium of Telehealth Resource Centers offers a broader list of current and upcoming funding opportunities available through foundations and within specific regional offerings. Each has either a focus on or a strong potential for telehealth applications.
The Rural Health Information Hub highlights non-Federal funding opportunities for the use of telehealth in rural settings.
HRSA Office for the Advancement of Telehealth also offers numerous grants to expand and enhance healthcare services, including telehealth, particularly for underserved populations.
Grant Application Recommendations
If you are considering applying for a grant, keep in mind that you do not have to look for grants specifically targeted at telehealth. Most grants encourage the use of technology as part of the solution.
Here are a few additional tips:
Register with sites to receive notice of funding opportunity (NOFO) updates.
Carefully review eligibility criteria to ensure your organization qualifies for funds.
Have a specific plan and well-thought-out program roadmap built prior to applying.
Be aware of all submission requirements, including caveats related to fund matching or precursory Letter of Intent steps you may need to take.
Submit your proposal on time or – better still – ahead of the deadline.
Make sure you’re well-versed in post-award requirements your organization will be expected to meet should you be awarded funding.
Ensure you have cash flow available to cover up-front costs for reimbursement-oriented funding programs.
Develop a plan for program sustainability beyond grant funding.
In the event that your organization does not qualify for grant opportunities or fails to secure funding after applying for one, don’t lose hope! Fleet lease options, pay-as-you-go subscription-based pricing models, and pilot programs through your telehealth partner represent just a few of the other avenues available to bring your virtual care program to life.
As patients and providers settle into a hybrid healthcare landscape post-pandemic, these telehealth statistics reveal how adoption and perceptions of virtual care have evolved over the past few years.
In a RAND Corporation longitudinal survey of 1,600 American adults from February 2019 through March 2021:
People who reported having video visits increased to nearly 20% by August 2020 and 45% by March 2021.
Willingness to use video-based telehealth rose to 62% in March 2021, up from 51% in February 2019.
69% reported using telehealth in the past year because it’s more convenient than in-person care, with 53% using telehealth between two and five times in the last year.
78% say telehealth makes it easier to seek out care:
46% used telehealth because they were unable to make an in-person appointment
24% said they wanted to save money
23% used telehealth because their doctor’s office was closed
Women were almost 4x more likely than men to say they used telehealth because they lacked childcare or eldercare services.
90% of physicians believe digital health tools offer significant advantages in patient care.
The digital health tools that garner the most enthusiasm among physicians are tele-visits (57%) followed by remote monitoring devices (53%).
Physicians using virtual visits grew to 80% in 2022, up from 14% in 2016.
Physicians using remote monitoring devices grew to 30% in 2022, up from 12% in 2016.
As virtual and hybrid care models mature, healthcare professionals continue to find new ways to leverage telehealth to drive efficiency and improve patient and clinician experience, particularly in hospital-based settings.
Virtual care is one of the biggest developments to fuel digital transformation in recent healthcare history. What began as a solution to mitigate exposure and maintain ties between providers and patients at home during the pandemic has since spawned a hybrid care movement that seeks to further integrate virtual engagement into the standard of care within inpatient settings.
In 2023, virtual care will continue to carve out its place as a complementary care modality, rather than an add-on or alternative to traditional care. Here are some predictions on what’s in store for virtual care in inpatient settings in the year ahead.
Health Systems will Take a More Strategic Approach to Telehealth
“In 2023, I think we’ll see hospitals and health systems take a more strategic approach to telehealth, in large part to address the staffing crisis, from burnout to the shortage of qualified resources. Inpatient hybrid care models will make virtual engagement available to every patient, giving clinicians and third-party providers remote access to every room. We are rapidly moving to a world where we drop the word telehealth and it just becomes how healthcare is delivered.” – Mike Brandofino, President and COO, Caregility (as quoted in Will We See a Value-Based World in 2023?)
Providers will Consolidate Siloed Telehealth Programs onto Platform-Based Solutions
“Given the tough economic conditions of the past few years, consolidation will be a key driver in health IT initiatives in 2023. Providers will look to centralize siloed telehealth programs onto platform-based solutions that are flexible enough to 1) support use cases across the enterprise, and 2) support integration with innovative connected care devices entering the market. The proper implementation and timely deployment of these resources will play an important role in supporting quality care delivery with a diminished healthcare workforce.” – Ron Gaboury, CEO, Caregility (as quoted in Will Technology Continue to Solve our Healthcare Challenges in 2023?)
Virtual Nursing will Move from Concept to Practical Application
“We’ll see virtual nursing move from concept to practical application as health systems seek to put a dent in workforce shortages in 2023. Hybrid nursing programs introduce virtual support resources and remote work flexibility to nursing teams, which can have a tremendous positive impact on nurse training, clinician experience, and care delivery.” – Wendy Deibert, SVP of Clinical Solutions, Caregility (as quoted in Healthcare Workforce – 2023 Health IT Predictions)
AI and Sensor-Based Tech will Redefine what Care Teams can Accomplish Remotely
“Broader integration of virtual resources into bedside care will create new value for health systems in 2023. Accelerated adoption of virtual workflows in hospitals and home-based care is introducing new use cases for AI and sensor-based technologies that will redefine what care teams can accomplish remotely.” – Pete McLain, Chief Strategy Officer, Caregility
As virtual care and adjacent technologies continue to evolve, they will become vital tools within inpatient care delivery that give health systems new ways to deliver care in a safe, convenient, and cost-effective way.
Virtual Care’s Role in Building Health Equity
In a string of years marred by some of the most challenging times in recent healthcare history, one positive trend is the buzz that has been building around health equity. Recognition of health disparity and the push to reduce it is building.
As providers look to build more accessible and inclusive care models for patients, virtual care has an important role to play. Here are a few examples of how telehealth is helping the cause.
Rural Care Access
Telehealth has long been lauded for its ability to reduce rural health disparity by facilitating virtual access to specialist care for patients in medically underserved areas.
Virtual care encounters also reduce barriers to care for patients who reside far from their local providers. Recent research revealed that patients with longer commute times to care sites were more likely to use telemedicine services, and the likelihood of having a telemedicine appointment grew with increasing commute times. Virtual engagement options similarly improve care access for those who have schedule restrictions and those without reliable transportation, many of whom are also economically disadvantaged.
To mitigate the risk of amplifying health inequity for those without access to broadband or enabling technology, many healthcare organizations are dispensing devices to patients to ensure equitable access to virtual care. Local, community-based outlets are increasingly providing device access, as well.
Engaging with Disabled Patients
One area where virtual care and digital health innovation can play a tremendous role in promoting health equity is within the disabled community. Travel arrangements can be particularly difficult and costly for patients with mobility limitations.
More than 60 million adults in the US have a disability, including more than 4.7 million Veterans with a service-related disability. The CDC reports higher rates of obesity, smoking, heart disease, and diabetes among disabled populations, making it imperative that these patients receive proper care. Virtual-first models ensure the most convenient option is the first line of defense in healthcare delivery.
Virtual engagement is ripe for further innovation in disabled care. As advancements in computer vision and precision eye-tracking enter the market, non-verbal patients are empowered to engage with remote clinicians. The incorporation of eye-tracking into virtual care also introduces new possibilities in the field of remote clinical diagnostics for neurodegenerative conditions such as Alzheimer’s, autism, and Parkinson’s, where problems in the brain can typically be detected in eye function.
Language Interpretation Services
For many patients, healthcare can be out of reach due to communication barriers. This can lead to greater health disparity, particularly within healthcare organizations serving culturally diverse patient populations. Patients with limited English proficiency, or LEP, are at a disadvantage to receive equal access to services due to the language barrier.
By integrating virtual remote interpretation capabilities into telehealth programs, health systems are reducing health inequities for deaf, hard of hearing, and LEP patients. This ensures 24/7 access to high-quality remote interpreters trained to provide culturally competent communication to support patient care. Video-enabled virtual engagement additionally supports ASL-based communication and allows providers to pick up on non-verbal patient cues and body language.
Decentralized Clinical Trial Support
Telehealth is also being used to support greater diversity in clinical trials where minorities have traditionally been underrepresented. Some 50% of FDA trials are conducted in one to two percent of all US zip codes. This limits research into the efficacy of care treatments across diverse populations. Through virtually enabled remote clinical trials, medical researchers can cast a broader geographic net to ensure that the patient sample is more reflective of the population.
Each of these virtual care initiatives plays a part in reducing health disparities and advancing patient care. And we’re just beginning to scratch the surface of what’s possible. As hybrid care and digital health innovation continue to ramp up in the coming years, telehealth will continue to redefine how we think about patient engagement and care.
Providers Weigh in on Digital Health Priorities and Pain Points
Roughly 3,000 healthcare stakeholders recently gathered in Chicago for the 2022 Becker’s Health IT + Digital Health + RCM Annual Meeting. Caregility was on site to join the conversation, which focused on “the future of business and clinical technologies” in healthcare. Here we distill what we learned about the health IT trends that were top of mind among health system executives in attendance.
Managing Connected Health
In an industry where the velocity of digital innovation can be difficult to keep pace with, how do healthcare CIOs and technical teams identify best-fit solutions and prioritize IT initiatives?
Clinical and IT leaders from various health systems shared their approach:
Create criteria to assess the seamlessness of integration during evaluations
Select tools that are scalable over the long term to reduce friction downstream
Consider the level of support that will be needed beyond implementation
Quantify the cost of doing things the old way to understand ROI
Health systems reported having as many as 1,500 healthcare applications in use with well over half of those apps being underutilized. Panelist David Reis, Ph.D., CIO at University of Miami Health System, shared that he works with his team to conduct portfolio rationalization monthly to help determine which apps should be optimized versus sunset. He and his team consider two important factors when making those determinations: 1) Does the app pose a cybersecurity threat? 2) Is there an alternative tool with a broader use case scenario? Risk mitigation and resource consolidation are key influencers.
Migrating to the Cloud
As tech infrastructure gets more complex, health systems are partnering with public cloud hyperscalers like AWS and Microsoft to better support burst capacity, real-time computing, and batch processing. Panelist Andrew Rosenberg, MD, EVP and CIO at Michigan Medicine, noted that as modern methods evolve it can be difficult to find experienced technical staff locally. Hyperscalers have the benefit of offering IT teams dedicated expertise in the areas of resiliency and security.
Many health systems simply “want out of the data center business,” as panelist Neal Patel, MD, CIO at Vanderbilt University Medical Center, put it. He feels his organization is better positioned to manage costs with the cloud. “It’s not cheaper, but cloud metering gives us a better process for allocating where the spend is, which allows us to make more judicious budgeting decisions.”
Integrating Telehealth
Several sessions at the event touched on lessons learned as telehealth becomes further embedded in care delivery. Health systems are leveraging telehealth to provide clinical reinforcement, take tasks off clinicians’ plates, and free up in-person engagement for patients who need it most. This includes a push to build inpatient telehealth into patient rooms to create capacity in acute settings.
“The workforce is shrinking, and we’re saying, ‘do more,’” said panelist Christine Vanzandbergen, VP of Analytics and Research at Penn Medicine. “Where can we use [telehealth] in lieu of one-on-one care? Who are the people and skills we need?”
Panelist Dave McSwain, MD, CMIO at UNC Health, made a call for reimbursement models that incentivize hybrid care that blends in-person and virtual engagement. “We need to avoid silos and stop talking about telehealth versus in-person care,” McSwain explained. “It’s integrated care versus telehealth-only care versus in-person-only care. Which is honestly probably best?”
With the relatively immature telehealth platform market largely still in growing stages, panelists encouraged health systems to:
Identify vendor partners willing to let you influence development
Field proof of concept programs to fine-tune processes and establish baselines prior to broader rollout
Be mindful of legal issues like privacy, patient consent, and clinician licensure
Establish a process for virtual care documentation to flow back into the EMR
When assessing success, at a minimum evaluate call responses, downtime, patient feedback or complaints, and utilization. Some health systems are exploring tech centers to ensure patients are comfortable with home health tools.
Where Does it Hurt?
Of the many challenges healthcare organizations are looking to overcome as part of their health IT strategy, staffing shortages were most often cited. “We have to drive an economic bottom line without burning out our team,” said panelist Anthony Moorman, Director of Solution Marketing at Qventus. This means using technology to automate manual steps wherever possible.
Speakers offered unique perspectives on ways to offset workforce hurdles. “Can we do ‘over the shoulder’ nurse guidance for new hires?” posed panelist Meghan Huffman, AVP of Telehealth Field Operations and Programs at HCA Healthcare. There was also a call for digital program reform to modernize clinical education. And as panelist Mohit Bhasin, MD, Medical Director at Sentara Heart Hospital, observed, our industry “doesn’t just lag in tech – we lag in support resources. The majority of nurses are women, yet no one has onsite daycare. We need to mimic other industries.”
Other pain points cited by panelists included:
Validation and governance of patient-generated data
The emerging need for “explained AI” or transparency in AI algorithms
The need for HIPAA, now more than 25 years old, to be rewritten for connected health to ensure we “balance privacy without stifling innovation”
Panelists also encourage peers not to get bogged down in the idea that they are behind. “Shiny object syndrome” and what is picked up by the media “makes you feel like you’re the only health system without all the stuff,” said speaker Michael Saad, SVP and CIO at University of Tennessee Medical Center. “Innovation is different for each health system. Focus on your personal business drivers.”
What’s Next in Virtual Behavioral Health?
Though the shortage of physicians and staff resources across virtually all specialties challenges healthcare organizations throughout the United States, the gap between supply and demand is particularly severe in behavioral health.
According to an article in JAMA, mental illness, including substance abuse, was the leading cause of disease burden in 2015, surpassing heart disease and cancer. Suicides among young people between the ages of 10 and 24 rose 47% between 2008 and 2019, according to a White House issue brief. The anxiety and social isolation wrought by the pandemic only deepened the problem. An estimated 50% of students reported symptoms of depression during the pandemic, while half of women and one-third of men reported deteriorating mental health, the White House brief notes.
While approximately one in five American adults—52.9 million people—experience some form of mental illness, according to the National Institute for Mental Health, many don’t receive adequate treatment. In fact, half of individuals age 18 and older with serious mental illness report that they did not receive needed care at least once in the previous year, the National Survey on Drug Use and Health shows.
The growing gap for behavioral health services
As healthcare institutions of all sizes and in all geographic locations know well, there simply aren’t enough psychiatrists, psychologists, chemical dependence specialists, and other behavioral health professionals available to treat the plethora of mental health ailments affecting Americans. The gap is substantial and growing. Seventy-seven percent of U.S. counties report a severe shortage of psychiatrists, according to a study by the National Council of Behavioral Health.
With the pandemic’s onset, healthcare organizations scrambled to set up remote medical services in keeping with federal and state safety mandates. Though they’ve learned that virtual visits work better for some types of individuals, conditions, and situations than others, the natural fit between behavioral health and telehealth stood out almost immediately.
Telehealth for behavioral health care, also known as telebehavioral health, telemental health, or telepsych, has quickly become the new normal for many behavioral health professionals and patients. According to a data analysis by consulting firm Mercer, outpatient behavioral health visits conducted via telehealth rose from 1% of encounters before COVID-19 to 50% by the second quarter of 2020 and stayed at that level through the third quarter of 2021.
Recent data shows that although virtual outpatient care has declined since 2020, 36% of patients with mental health and substance use disorders still use telehealth in 2022.
The convenience and privacy of virtual visits
Telebehavioral health continues to show promise as a strategy to narrow the gap between supply and demand now that the worst of the pandemic has passed. The use of virtual care platforms by health systems is helping them address the provider shortage, reduce wait times for care, and reach patients in remote and rural areas who might not otherwise have access to treatment. Virtual care modalities also alleviate the lingering stigma associated with mental illness by allowing patients to receive care in the privacy of their own homes, thus reducing appointment cancellations and supporting improved outcomes.
Behavioral health professionals and patients alike appreciate the convenience and time savings of virtual visits. But beyond these advantages, research reveals that quality is not being sacrificed in favor of ease. Remote services are equally or even more effective than in-person services in the treatment of depression, anxiety, substance abuse, post-traumatic stress, ADHD, and a variety of other disorders, studies are beginning to show.
At the same time, telebehavioral health offers “a pathway for organizations that want to develop more robust behavioral health programs but lack the staff to do so,” allowing them to expand their reach, says healthcare consultant Howard J. Gershon of New Heights Group in an article in Healthcare Executive. “People are learning that telesolutions in mental health services are readily available and work well. This shot in the arm will help us use these options to treat more people,” Gershon contends.
The widespread acceptance of virtual behavioral health
A recent survey by telehealth scheduling company Zocdoc found that both providers and patients see telehealth as a complement to, but not as a replacement for, in-person visits—except for mental health care. The steady increase in virtual visits for behavioral health care (from 74% in 2020 to 85% in 2021 to 87% in 2022, according to the survey) indicates that the option has gained a level of traction in the field that’s likely to last.
With telebehavioral health’s widespread acceptance, organizations that have not yet developed a telebehavioral health service may want to explore the feasibility of incorporating such a service into their virtual offerings. For organizations that already have telebehavioral care in place, now would be a good time to take a step back and revisit the program to optimize it and see how and where it fits in with their system’s larger long-term digital health strategy.
The 2022 Medicare Physician Fee Schedule lists telebehavioral health services that are permanently reimbursable as well as those that are covered only during the COVID-19 public health emergency.
