Sustaining Virtual and Digital Health Beyond the COVID Pandemic: Strategic Questions for Health Care Leaders

by Heather Ramirez, MS-HSM, Vizient Ventures Director

Brianna Motley, MBA, Principal, Sg2

As hospitals grapple with how virtual and digital health will change the health care landscape, it’s hard to ignore its continued influence and disruption since the COVID-19 pandemic began nearly two years ago. Care models were operationalized in virtual environments at an exponential pace, and this dramatic shift has forced a reimagination of how to better meet patients’ needs. Vizient and its subsidiary Sg2 explored the rate of adoption nationwide, and how virtual and digital health was stood-up or expanded in response to COVID.

A survey of 55 member organizations in the fall of 2020 assessed organizations’ response to, and changes implemented to understand strategic and operational priorities to support short-term goals and longer-term growth initiatives. The survey found that ambulatory visits occurring virtually represented only 0.3% of visits before March 2020 but grew some 200% as of April 2020. Though virtual volumes leveled off between 19–25% through January 2021, the degree of impact will continue to transform the health care ecosystem.

The results provide important considerations as hospitals work to sustain virtual and digital health beyond the pandemic. Here are four questions that leaders can ask to help set or revise their virtual health programs and digital health strategies.

What priorities and business cases are driving investment opportunities and technology adoptions to improve patient loyalty and patient acquisition?

• The survey found that the top strategic priorities driving investment opportunities are expanding access to support lowering the cost of care, developing new revenue streams from downstream utilization and assessing value propositions. To secure market positioning, organizations are focused on enhancing the patient experience, leveraging innovative solutions and balancing financial considerations.
• Many hospitals reported having the capabilities in place to deliver virtual care through virtual visits and remote patient monitoring before the pandemic, yet these capabilities were largely not deployed at scale across the enterprise due to competing strategic priorities.
• In addition, nearly half reported looking to advance future capabilities in artificial intelligence, at-home testing kits, and integrating data and predictive analytics to improve patient management and outcomes across care settings. These efforts have been supported by the Centers for Medicare & Medicaid Services’ (CMS) Hospital Without Walls Initiative and Acute Hospital at Home program during 2020.

What are the key levers to determine optimal leadership and staffing models to expand virtual and digital health capabilities?

• To expand virtual capabilities adopted in response to COVID-19, over half of respondents reported having a strategy dedicated to virtual and digital health in place to secure widespread buy-in and align to enterprise goals, values and strategic initiatives.
• In addition, most hospitals reported having aligned reporting structures to executive-level leadership to support cohesive program implementation, yet there are opportunities to centralize clinical and administrative leadership roles within virtual and digital health governance beyond distinct functional areas. Nearly half reported using a dyad leadership model, ensuring clinical and administrative functions and services supporting virtual care delivery are centralized and scaled in line with programmatic growth.
• To extend capabilities beyond the enterprise, hospitals plan to prioritize aligning virtual and digital health strategy to enterprise-wide initiatives, such as value-based care, population health and patient satisfaction. It will be important to centralize appropriate staffing teams and optimize staffing levels to integrate workflows across the enterprise. These services establish optimal shifts in delivering care virtually and in-person, at scale.

What current virtual health visits, workflows and experiences should be sustained to scale capabilities across specialties?

• At the peak of virtual visits in April of 2020, some elements of virtual care (i.e., screening, video and audio visits) were implemented across most ambulatory specialties to manage and treat patients. Today, organizations are seeing higher sustained virtual visit utilization across the psychiatry/behavioral health, endocrine, primary care and neurosciences specialties.
• Remote patient monitoring emerged consistently in the study for managing chronic health conditions and improving access to medical care for a wide range of services, including cardiology, pulmonology and endocrinology. Solutions ranged from wearable monitoring devices to portable mobile devices with predictive algorithms to support chronic care patients.
• Nearly all respondents indicated that moving forward they will focus on standardizing clinical workflows and defining optimal in-person to virtual shifts across clinical pathways to improve the patient experience and ease provider adoption. Technology will need to be integrated with virtual workflows to streamline administrative demands to innovate the patient experience.

How are key barriers such as emerging payment, access and usability being addressed?

• Respondents indicated that before the pandemic, regulations were a significant barrier to virtual health adoption. The relaxation of regulations because of the public health emergency enabled the widespread adoption observed over the past 18 months. Looking forward, reimbursement/payment acceptance and access to broadband infrastructure/reliable internet bandwidth remain the biggest challenges to adoption.
• While most platforms that hospitals reported using are HIPAA compliant, there is a significant opportunity to streamline technology platforms to ensure seamless integration and system-wide interoperability (with the electronic medical record, other clinical and operational platforms) while prioritizing privacy and security protection.
• To address top operational challenges in scaling digital health-patient/provider experience, technical support and disparate workflows, most organizations are prioritizing developing robust data and analytic infrastructures to support data capture, data integration and interoperability across settings and technologies. Patient outcomes and satisfaction should drive workflow improvements to streamline the care experience, care coordination and support trends in consumer health.    

As the legislative landscape continues to evolve, organizations that want to be at the forefront of health care innovation are not going to wait for reimbursement to be resolved. Organizations need to understand their current virtual and digital health capabilities, market landscape and the range of virtual health services they need to offer to support different patient populations. Hospitals should continue to identify shifts and care delivery model changes across care settings and develop a digital health road map to prioritize investment in digital tools to create a vision that will offer a differentiated patient experience and optimize clinical efficiencies. Remote patient monitoring and other emerging technologies will prove more important as patient convenience, social determinants of health and capacity management move to the forefront of health care organizations’ strategic priorities.