The global industries were unraveled when the pandemic struck. However, healthcare industries emerged as a steadfast marketplace with virtual Care leading its path. The technology that supported virtual health has been within one's grasp for the last 10-15 years, and more often than not, it was labeled a global disruptor. However, the adoption rates amongst the masses were not significant. Therefore, COVID-19 pushed the case for virtual Care at a broader level with investments from venture capitalists and other global medical companies. At the same time, the government made structural changes to their medical reimbursement systems to accommodate any end-user financial impact. Hence, the industry worked on the three key propellers- providers, payers, and consumers to maximize engagement. The adoption rates under consideration were 2019 First Quarter vs 2020 First Quarter might show inflated growth. However- vital sustenance has been observed in the marketplace after opening up lockdowns and vaccination drives.
The population has been growing old, at a pace which is significantly higher than technological upgradation or service facility maximization. Hence, the virtual care module has come out as a supposed alternative which the industry participants can successfully utilize. The healthcare facilities have grown, and as a result, the resilience toward virtual Care is rising as people continue to live longer than what they were expected years back. For the U.S., aging population is projected to gain a 45% increase OR growth of 23 million seniors projected from 2017 to 2030.
A) Canada, France, Germany, Italy, Japan, Greece, Portugal, United States, and United Kingdom are growing significantly faster than the OECD average for old-governing that these regions could be a potential market for new market participants.
B) China and India are amongst the key economies which have a substantial low influence of geriatric population-however huge population makes the relative percentages hike. Further, the following regions can be readily exploited owing to low literacy and robust access of internet and services.
Key Virtual Care Challenges being faced by the geriatric population on a whole-and their supposed responses:
A) Elderly population might not have access to internet and technology, like the rest of demographics, further they have chronic conditions which makes their Care through virtual challenges tricky. However, in our research it was found that market operators are rapidly advancing their reach by providing solutions beyond normal. For example, Iora Health and Oak Street Health started delivering custom formatted tablets to its highest risk patients, while their health coach remotely instructed patients on technology use. Additionally, Iora Health and Oak Street Health provide on-site help. For example, Oak Street Health's van drivers, deliver a cellular-enabled tablet to the patient and log the patient into the video visit so he or she can start right away. Later, drivers pick up the tablets, clean them and deliver them to other patients.
B) Elderly population have potential health conditions such as hearing impairment, vision impairment, or dementia. Hence, virtual Care can be plausible challenge leading to complications. However, as a response strategy one of the renowned service provider, Landmark Health engaged non-clinician caregiver (more often family members) in telehealth visits to ease communication between patient and doctor. One of the key examples revealed on how a nurse practitioner coached the spouse of a patient suffering from a lung disease to use a nebulizer.
C) Technology availability often doesn't translate into digital literacy. As governed by various testimonials around 50% of the patients with appropriate available technology failed to use the facility of "video visits". However, practice visits can be conducted by administrative staff of healthcare organization prior to the actual consultation. Results have shown substantial improvement post practice.
Higher availability and ability to service wider locations
Patients are distributed in diverse geography and the accessibility to the treatment depends upon the location. Rural areas had a greater frequency of chronic disease and accompanying mortality, according to the National Centre for Health Statistics Research. However, many rural hospitals have closed in the previous ten years, threatening access to Care. Nearly 60 million Americans live in rural areas and depend on the local available hospitals for Care. However, around 20 such hospitals were shut in 2020 owing to budgetary constraints and low profitability margins. Moreover, according to Cecil G. Sheps Center for Health Services Research, around 136 rural hospitals have been shut since 2010 in U.S. Hence, a greater allocation of virtual care services resources can increase the overall market share.
Hospital Beds by Country in 2020 (Per 1000 People):
Virtual Care continues to expand the range of behavioural health services offered, potentially alleviating provider shortages in many parts of the country. In the United States, for example, 56 percent of counties lack a psychiatrist, 64 percent of counties lack mental health practitioners, and 70 percent of counties lack a child psychiatrist. This type of access could also be a way to strengthen community, payer, and provider relationships.
Increasing specialised care capacity, particularly in rural locations where numerous specialties may be unavailable. Even if you don't live in a rural region, provider-to-provider virtual health can improve your experience and the quality of your Care by allowing you to quickly access specialists. As an alternative to lower-acuity emergency department (ED)
visits, urgent care visits, and after-hours consultations, on-demand virtual urgent Care is available. The most popular telehealth use cases among payers today are these care needs. This allows a customer to consult with an unknown clinician remotely on demand to treat immediate concerns (such as severe sinusitis) and avoid going to the emergency room or an urgent care centre. This type of use could be expanded to treat a larger part of the low-acuity visits that have traditionally been found in Eds.
Notably, projects such as N50 or Next 50 are growing denser across geographies, which are helping the overall global need to satiate healthcare. The listed project aims to accelerate global digital inclusion and deliver virtual healthcare solutions for those in need. The project aims to allow the next 3.9 billion people to participate in the digital world, thereby facilitating healthcare as a foundational stone.
Some of the common strategies being implemented to serve a wider population:
- A regional health system which would help in providing virtual specialist visits and tele-ICU coverage by enabling partnerships with local rural health bodies or hospitals. Thereby, a volume and patient boost can be accessed by the rural hospitals. OR
- A regional health system which would supplement a third-party provider-thereby enabling a virtual primary care to extend medical capacities and bring linkages to the medical infrastructure.
Broader channels are coming into play to recover lost volumes
Virtual Care has the capacity to endure both threats and opportunities for the providers, specifically in the local markets where new entrants possess capacity to offer additional virtual access to patients in concern. Furthermore, providers are now looking to quickly resume their care facilities and services to where it was before the pandemic started. To fuel clinical and financial strategies broader market channels are now being incorporated, which have the potential to fulfill the create the demand-supply gap. Virtual care facilities, if adopted on a larger scale can broader the revenue channels as it would attract patients across conditions and demographics. Effective service demarcation can set the entire experience on the right track. Leaders across the industries are now making strategic investments to widen their revenue channels, moreover, certain service providers plan to expediate their services across geographies. When enabling for such cross—geographical facilities, consumers can access lower-cost setting of Care and acquire equivalent quality.
As per a recent pilot program from Brigham and Women's Hospital, 97% of the patients achieved satisfactory result post a virtual visit, with 74% stating that virtual interaction allowed to improve their relationship with medical practitioner. Additionally, as per a testimonial of a Medical Director for Telehealth in Women's hospital, around 87% of patients said that they would have felt the need to come into the office to gauge the provider's face if it weren't for the virtual visit.
Recently, digital health company, Vira Health secured an investment of $12 million to add new services such as telehealth and prescriptions to its existing menopause mobile application. Moreover, their service module depicts that around 1 billion women would experience menopause by 2025-thereby with virtual care services-market reach could be expanded without hindering with the pre-existing subscription price.
Some of the other form of strategic moves include:
- To allow for setting up an Academic Medical Center or AMC, which would help in providing virtual specialty care-wherein consumers can gain access from different geographies with only a limited patients/ consumers choosing to travel. OR
- To allow for regional health system to provide primary and specialty care through an option of physical or virtual application. Moreover, partnerships with an AMC can allow to access the virtual sub-specialty store.
Bridging the gaps between physician and capital productivity
From our analysis, it can be gauged that institutional investments are being made towards lower cost- alternative settings such as Ambulatory Surgery Centers, further, these investments are expected to continue owing to rapid cash flow and higher turnover. Furthermore, capital is now being allotted towards area which can deliver more convenience at a subsidized costs for the so-growing geriatric population. Health systems are also re-aligning their capital productivity goals on whole, as per a secondary source-more than 60 health system executives, around 22 executives indicated their inclination to decrease their investment focus from "capital infrastructural investments" owing to the recent development of virtual care platforms. Hence, the following capital can be used to address acuity needs-which are a much-needed fulfilment metrics for stretched out health systems.
Virtual care models are now being actively used in acute Care. For example, the HaH or Hospital at Home model has been growing at an incredible pace-and the virtual disruption have eased its case for roll-out in elderly patients who are vulnerable to healthcare-associated infections and other complications of inpatient care. Government supported programs are rapidly adjusted according to need or are forced through the legislative by the leading associations. As per Commonwealth Fund, HaH setting has been extremely prevalent in the likes of countries such as U.K., Canada, and Israel. Moreover, Pacific countries such as Australia provides around 6% of the total hospital days in HaH setting, additionally, around 60% of the patients suffering from deep vein thrombosis were treated at home. It is critical to understand that the following practices are deem to success only if the payment structures allow for incentivizing lower-cost settings of Care.
Physician productivity gets enhanced while adopting virtual Care as the patient service model. Moreover, virtual options allow physicians and their groups to manage their provider time optimally. The knowledge of physicians can be multiplied while adopting for the likes of tele-ICU models, as economies of scale can be achieved by covering a larger fragment of society at optimal costs.
Outlining the virtual care paradigm forward
A critical aspect for outlining the virtual care health system is optimally managing the expectations from top-management to align the broader consumer interest. Healthcare systems who rolled out their virtual care model fueled by the COVID-19 pandemic had three crucial responses ->
Organizations tend to forget the responses which made their virtual care model successful in time, as they start to become a commoditized parts of the healthcare continuum. The efficient leaders of the industry would make the responses a new norm than the new entrants where profitability plays a key role.
Some critical plans to help prepare for the tipping point:
A) The organizational strategy and rebuilding plans:
Healthcare organizations need to resist the urge to start their products out, thereby, planning with a strategy back view which aligns and pushes the virtual care continuum priorities. It is vital to understand the competitive threats and opportunities which can highlight unique patient demands and needs, provider who can be the first to capture such move can gain market edge. Offensive play has to be adopted while virtual Care is under consideration as service areas for most hospitals and health systems are tightly knitted to physical care locations. By incorporating virtual Care, one creates new opportunity which helps in leveraging brand and service lines care strengths, which could allow for extending reach and market share. Lastly, organizations should seek to influence regulatory changes and extend the easing of restrictions around billing, licensing, and credentialing that accompanied the crisis.
B) Understanding financial and non-financial value testing:
A value model governing financial and non-financial implication should be made before hand, which explicitly defines current and future effect that virtual care initiative would bring forth. Further, it is quintessential to define for the inputs/assumptions and measure ROI, break even points, and lastly, a cumulative value over the period of 3-5 years. Lastly, define virtual hospital value levers such as patient acuity, ICU utilization, labour cost scaling, and provider attrition to clearly define both financial and non-financial value for key stakeholders involved.
C) Closing on technology partner(s):
Comprehensive and inclusive technology development have been made in the recent past, especially owing to the pandemic emergence. Med-tech companies are making significant capital contribution to develop platform-centric virtual care solutions. Providers would continue to discover a vast array of technology to help in positioning their organization. Critical aspects to withhold for interested companies is to carefully consider install timeframes-expect speed for installation which translates into partner capability to connect across enterprise strategies. Balanced initial investments should be a potential factor to consider, and scrutinizing ROI for the partner chosen-as it must align with the company's broader strategic and financial priorities.
D) Integrated operational model:
It is a key notion to operationalize thinking patterns in horizontal and vertical alignment. Further, establishment of such models ensure that senior executive team and project managers are in line with making, directing, and representing accountabilities. Further, an inclined consideration should be made to position one for flexible growth. Core team needs should include directly involved caregivers and the leadership model should allow ease of expansion to future service areas from original priorities and tightly connect physical and virtual care models.
E) A spontaneous performance metrics:
It is critical to define and measure key value measures which are in line to ensure financial and non-financial value priorities, further, these values should be met and in case they are not, strong re-alignment forces should correct courses. Further, mechanisms should be developed which can help in monitoring employee adoption and streamlining workflows. Lastly, rapid enhancement cycles must be implemented to achieve desired financial and operational goals.
Recent Innovations and Developments in the Virtual Care World:
Innovations and developments within the field of virtual Care has been a steadfast mechanism driving the imperial growth of the market. Some of the recent happenings are as follows:
A) Microsoft expanded its healthcare cloud strategy by enabling new solutions and capabilities across data, AI, and clinicians experiences. It would further deliver industry's first generally available solution which can ingest-manage-and transform combinations of clinical, imaging, and Med-tech data. Further, company revealed the general availability of Azure Health Data Services which is purpose-built for PIH (Protected Health Information). The improvements are designed to transform the healthcare journey, using AI to give full visibility into data, reduce provider administrative burden, boost productivity for care teams on the frontline, increase workflow automation that can improve quality of Care, reduce clinician burnout, and deliver better Care faster and at a lower cost.
B) XR-Health a company operating a state-of-art virtual therapeutic care rooms using FDA and CE registered medical extended reality technology raised $10 million in funding to expand its foray into virtual healthcare within the metaverse. The round was backed by the liked of HTC, the Bridges Israel impact investment fund, AARP, and crowdfunding on StartEngine.com.
C) Samsung Electronics America launched its new 4K QLED Smart Healthcare TVs with partnership from Share-Safe. The smart healthcare TV would transform in-room displays in easily-managed-all in one communication. Further, hubs can be personalized for hospital patients and senior care residents-thereby would improve collaboration, patient engagement, and workflow efficiency. The following comes as a broader market move to enter the virtual health market.
D) Mantra Health, a digital mental health start-up has been roped in as the official digital health provider for the National Association of Intercollegiate Athletics (NAIA). The 252-member association would gauge excess to the digital-mental health service, beyond the already available on-campus help.
E) Firefly Health, a virtual healthcare company partnered with Oshi Health- a virtual specialty gastrointestinal health company to deliver half-prices and twice-as good clinical outcomes to the patients. The former company has been on a spree to partner with specialized partners to elongate its journey.
F) Main Line Health has collaborated with Yext and Stericycle Communication Solutions, the former is a health care system in the Greater Philadelphia region, and the latter is an AI search company, while Stericycle is a specialist in patient engagement. Patients will use an AI search engine with natural language processing (NLP) to find doctors, specialties, conditions and more, and then directly in the search results be able to book an appointment through Stericycle's digital scheduling platform.
G) Woebot Health announced that BAYER's investment arm-Leaps made a strategic investment of $9.5 million to help in accelerating further development of its AI-powered behavioral health platform and products.
H) Andor Health and Microsoft Partner have partnered to extend the virtual Care to include hospitals at home. Microsoft's latest capabilities in ThinkAndor®. An innovative enterprise platform, ThinkAndor's unified approach to virtual health, combined with Microsoft Azure and Microsoft Teams with healthcare templates, enables health systems to establish a comprehensive approach to virtual health.
I) TELADOC Health launched Amazon Alliance to advance virtual Care. Amazon and telemedicine provider Teladoc Health is starting a voice-activated virtual care program that lets customers get medical help without picking up their phones. Further, services for health issues which aren't emergencies-would be available around the clock with the help of Amazon's Echo device. Additionally, value meets consumer has been a mantra which the CEO of the former company deciphers to be driving this industry.
J) Department of Health and Human Services (HHS) awarded nearly $55 million to increase the presence of virtual healthcare access and ensure top quality through community health centers. The funding would be provided to the 29 HRSA-funded health centers who would be responsible for increasing health care access and quality of underserved populations via methods such as telehealth, remote patient monitoring, digital patient tools, and health information technology.
K) Blue-stream health, a platform as a service which makes it easy to implement and scale on-demand virtual Care announced its partnership with the N50 project, which would thereby help in providing virtual Care and telehealth services to marginalized communities around the globe. The N50 Project includes partners like Blue-stream Health that have a passionate drive to close the global digital divide. The organization includes Fortune 500 companies, Non-Governmental Organizations, Academic Institutions, and entrepreneurial ventures.
Conclusion: (Future Perspective of Virtual Care)
The virtual care industry is taking leaps and bounds, that too at a significant pace owing to tremendous demand from geographies and demographics. Market leaders and entrants are leveraging support from each-other to create higher consumer value at an affordable price.
The offensive play must be adopted while virtual care is under consideration as service areas for most hospitals and health systems are tightly knitted to physical care locations. Critical aspects to withhold for interested companies is to carefully consider install timeframes-expect speed for installation which translates into partner capability to connect across enterprise strategies. Core team needs should include directly involved caregivers and the leadership model should allow ease of expansion to future service areas from original priorities and tightly connect physical and virtual care models.