Virtual care after COVID-19: Overcoming five barriers to permanence

In the short term, it certainly looks like this explosion in adoption is set to continue: for example, in our 2021 Future Health Index Report, we revealed 64% of global healthcare leaders are currently investing heavily in virtual care, with the United States (89%), the Netherlands (83%) and Saudi Arabia (81%) leading the charge.

And by the end of Q2 of 2021, global telehealth investment rose for the fourth consecutive quarter [1], with European investment nearly quintupling.

But although all this progress is encouraging, and a positive step towards our vision of “anytime, anywhere” healthcare, it’s also true that much of it was born out of necessity. Which raises the question:

Is virtual care on a path to permanence, or will services diminish once the COVID-19 crisis subsides?

To answer this question, let’s look more closely at five barriers standing in the way of virtual care permanence:

1.    Lack of infrastructure
2.    Uncertainty about ROI
3.    Digital and health literacy inequalities
4.    Absence of regulation
5.    Limited reimbursement pathways

1.   Lack of infrastructure

One of the biggest hurdles to virtual care adoption, particularly in low- and middle-income countries, continues to be establishing a reliable technological foundation, such as high-speed internet, widespread access to mobile devices, and a high-quality electricity supply.  But even in high-income countries, getting the right infrastructure in place to support virtual care is a complex challenge.

Over the last few years, for example, healthcare IT infrastructures have been increasingly bombarded by network demands for large-scale initiatives such as digitizing patients’ health records or automating complex operational processes. The addition of virtual care systems, which typically combine video, audio and data streams, therefore runs the risk of exacerbating already sky-high bandwidth demands.

Then there’s the challenge of how to manage, and what to do with, the continuous influx of patient data that virtual care generates. In fact, in our latest Future Health Index report, healthcare leaders told us that two of the biggest barriers to the adoption of digital health technologies are data related: one being difficulties with data management (44%), and the other being lack of interoperability and data standards across technology platforms (37%).

At Philips, we see interoperability (the ability of multiple technologies to seamlessly connect with each other and share data in real time) as critical to the future of virtual care. For example, interoperability is necessary for tele-ICU – a solution that lets off-site clinicians interact remotely with bedside staff to consult on patient care. Tele-ICU relies on continuous data capture, plus advanced visualization technology and predictive analytics, in order to give intensivists and clinicians the power to weigh up probabilities and take the best courses of action at time-sensitive moments.

Similarly, interoperability is critical for supporting the further decentralization of patient management – for example, medical-grade wearables equipped with secure data integration can help ensure providers stay in-the-know and guide confident decision-making about whether a patient needs to be seen or be hospitalized. This means healthcare providers can help keep patients in a more comfortable, lower-cost setting and better allocate resources according to risk.

All things considered, there are unique infrastructure barriers across almost every region and community, from mobile device accessibility to data management and interoperability. That said, there are a few select markets where the path to permanence looks almost complete. In China for example, virtual care services are prevalent and have been permitted and administered since 2018, supported, catalyzed and scaled up thanks to the rollout of 5G networks.

2.   Uncertainty about ROI

For virtual care to endure in the long term, at scale, healthcare leaders need to be convinced that virtual care can lead to improved clinical outcomes, and that the return on investment is worthwhile.

Fortunately, there’s a wealth of data available about the former that’s increasingly hard to refute. For example, a recent systematic review of telehealth meta-analyses [2] from the last decade across cardiovascular disease, dermatology, endocrinology, neurology, nephrology, obstetrics, ophthalmology, psychiatry and psychology, pulmonary, and multidisciplinary care showed that for all disciplines, virtual care across a range of modalities was as effective, if not more effective, than traditional care.

A recent survey of healthcare executives [3] also revealed that most leaders believe telemedicine has already transformed the standard of care for stroke, and that behavioral health, neurology, primary care, and cardiology are poised to transform next.

When it comes to the financial return on investment, this is harder to quantify, as it’ll be heavily determined by how healthcare payment models evolve and how they differ across markets. At Philips, we’re working to secure alignment and cooperation between all parties in the wider healthcare ecosystem – healthcare professionals, the general population, payers, regulators, and the private sector – so we can collectively seek out and experiment with innovative virtual care payment approaches, sharing the risk together.
 
In tandem, we’re working closely with providers to help them optimize their data collections, so they can clearly demonstrate the value that their virtual care services deliver. For example, using HealthSuite digital platform, we’re helping them measure:
 

• Whether virtual visits are translating into better management of complex chronic conditions
• Whether they’re having a preventive effect, and thereby decreasing unnecessary utilization
• Whether patients and staff are providing good feedback on their virtual care experiences

All of these things will help set them up for success with virtual care under a value-based model.

3.   Digital and health literacy inequalities

In order for virtual care to become permanent, and serve everyone equally, it’s not just the healthcare industry that needs to transform. People also need to be convinced about the value of virtual care and learn the technical skills necessary for getting the most out of virtual care services.

This won’t be an easy feat, for example in patient groups such as the elderly, who on average are less familiar with – and often less trusting of – digital technologies. Then there’s the fact that a great deal of people still don’t have access to the consumer technologies needed to engage remotely with providers, such as smartphones or webcams.

These challenges are significant and will take years to overcome. However, in the meantime, there are actions that virtual care providers can take to try and maximize access to services. For example, providers can choose to keep traditional phone lines open as they transition to offering digital channels for patient engagement, so as not to lose patients in the process, and so they can provide one-to-one guidance to patients on how to familiarize themselves with new systems. Providers can also tailor content ¬– for example, information that lives in patient portals – to suit the digital literacy levels of their patients. This will help ensure remote patients can be just as informed and confident about their care journeys as those being cared for in person.

Community virtual health initiatives can also help bridge the gap between patients and providers in areas where consumer technologies like smartphones and webcams are scarce. For example, at Philips, we recently helped to develop a Virtual Care Station: a pod-based telehealth environment that delivers virtual-care services in convenient neighborhood locations like retail premises and town halls. Once inside, patients sit in a private room and have a virtual chat with their healthcare provider supported by a high-quality camera, lighting, and speakers.

It would be disingenuous to say that these initiatives have or even will remove the barrier of educational and digital literacy inequalities entirely – although they all help, lifting this barrier for good will depend on the activities of not just providers but parties such as governments, educational institutions and regulators who have the resources and powers to drive the degree of change needed across entire populations.

4.   Absence of virtual care regulation

Virtual care regulation has been a grey area for years. In fact, prior to the COVID-19 pandemic, you’d be hard pressed to come across any regulations that apply specifically to virtual care, other than in a few select countries such as France, Ukraine and Colombia [4], where virtual care has been around much longer.

However, the outlook for virtual care regulation isn’t as bleak as it once was. In fact, in many markets, there are already signs of permanence emerging.

For example, on 17 September 2020, the scope of permissible virtual care activities in Hungary [5] was permanently extended. Hungary has since enacted a permanent telemedicine regulatory regime, applicable irrespective of the current COVID-19 pandemic.

On 27 November 2020, the Australian Minister for Health announced that universal, whole-population virtual care services will be made available permanently in Australia [6], and various regulatory and industry bodies across the healthcare profession have released guidance notes on delivering services via virtual care. Whether the current regulatory regime for virtual care services will be made permanent, or a different version of operations will be introduced, remains to be seen, but the signs are encouraging.

And in Singapore [7], although there’s no over-arching legislation governing virtual care, the telemedicine sector will be regulated by the upcoming Healthcare Services Act (HCSA). This HCSA is due to be implemented in three phases, with telemedicine due to be regulated long-term as part of the final phase in the third quarter of 2022.

In all, it’s still early days for virtual care regulation in most markets, but these recent events are extremely encouraging, painting a brighter picture of virtual care regulation going forward.

5.   Limited reimbursement pathways

Like virtual care regulation, the outlook for telehealth reimbursement has traditionally been quite bleak.

However, although it’s early days, there are a few key countries where progress is being made. For example, in the US, the federal Centers for Medicare & Medicaid Services (CMS) have made eight virtual care codes a permanent part of the 2021 physician fee schedule final rule. These codes apply across the care planning, custodial care services, home visits, prolonged and outpatient services, and for group psychotherapy – the first tangible recognition of mental health and virtual care permanence [8].

Australia has also made significant commitments to virtual care since the outbreak of COVID-19, expanding public reimbursement of telehealth services [9] for all Medicare-covered population beyond COVID-related care.

And in Belgium, while there’s no direct reimbursement for virtual care services, the National Institute for Health and Disability Insurance (INAMI) is now developing a framework for the permanent reimbursement of telemedicine and health apps.

To learn more about telehealth reimbursement and how it’s evolving, have a read of the latest blog post by Philips Chief Medical Officer Jan Kimpen, and global Head of Market Access and Reimbursement Bodo Wiegand, Telehealth Reimbursement After COVID-19: The Elephant in the Room.

Is virtual care on a path to permanence?

Considering all five barriers together, there’s still work to be done to set virtual care up for lasting success on a global scale – from establishing basic infrastructure in underserved markets, to increasing digital literacy levels among patient groups such as the elderly as care continues to decentralize.

However, significant strides have also been made within the last few years that paint a very bright picture of what’s to come. For example, reimbursement pathways for virtual care have been established in many markets; solid regulations have been put in place in others; the ROI on virtual care investment looks ever more promising – especially as healthcare breaks away from fee-for-service and towards value-based care, which virtual care is a perfect candidate for.

We also know patient satisfaction with virtual care is high in the wake of COVID-19, with a recent survey [10] revealing 87% of patients who tried telehealth are satisfied with the experience. Another survey conducted in the US revealed that 88% of healthcare consumers are explicitly demanding virtual care [11] once COVID-19 has passed.

Clearly, virtual care is here to stay. The question now is how we can scale it worldwide and ensure every patient in every location can benefit from it equally.

Further reading

Telehealth reimbursement after COVID-19 - Blog | Philips
Virtual care beyond the pandemic: three priorities - Blog | Philips
How digital innovation can bring healthcare to remote regions | Philips

[1] CB Insights, State of Telehealth Q2’21 Report, 2021
[2] Journal of Medicine and Telecare, The clinical effectiveness of telehealth: a systematic review of meta-analyses from 2010 to 2019, 2021
[3] Sage Growth Partners, Defining telemedicine’s role: the view from the c-suite, 2018
[4] DLA Piper, Telehealth around the world: A global guide, 2020
[5] Kinstellar, Current telemedicine trends in CEE and Turkey, 2021
[6] DLA Piper, Telehealth around the world: A global guide, 2020
[7] International Trade Administration, Singapore Licensing of Telemedicine, 2021
[8] JD Supra, CMS permanently expands telehealth as far as congress has allowed, 2020
[9] Ministers Department of Health, Covid-19: whole of population telehealth for patients, general practice, primary care and other medical services, 2020
[10] TigerConnect, 2020 survey report: the state of patient engagement, 2020
[11] Healthcare Finance, Most consumers want to keep telehealth after the COVID-19 pandemic, 2021