“Virtual first”: A new strategy for how people access healthcare

April 1, 2019

By Mark D. Smith, MD, MBA

Just as the definition of “virtual” has evolved—years ago, virtual meant “not quite real,” while now it’s recognized as a service provided by computer over a network—so has the concept of “virtual care.”

No longer is virtual care regarded as “almost-real care” or an adjunct to face-to-face encounters. Increasingly, patients, providers, and health plans recognize that virtual care represents a viable and valuable approach to care delivery.

Healthcare, however, remains one of two industries late to arrive at the “virtual first” party (education is the other), where consumers have needed to be physically present to receive information. Most industries embraced virtual services years, if not decades, ago. Consider travel: When was the last time any of us drove to a travel agency to book a flight or accommodations? Or banking: How long ago did any of us appear at a teller’s window to withdraw cash for the weekend?

Like these other service industries, virtual care is progressing through what some have called the four stages of natural history for a new idea:1 Crazy, Crazy, Crazy, Obvious.

Stage 1: This new idea is simply wacko. Deliver care without seeing the patient? Crazy.

Stage 2: This idea is odd and unproven—and, therefore, probably dangerous.

Stage 3: OK, it’s true there might be potential with this idea—but its value is trivial. We need much more proof before we can seriously consider making a change.

Stage 4: The benefits are obvious! I can’t believe we ever did it any other way!

Virtual care currently falls somewhere between stages 2 and 3. We’ve moved past “wacko,” but haven’t arrived at “obvious” yet.

Among the factors accelerating this transformation is the drive toward value-based payments, a movement with clear momentum. As co-chair of the Health Care Payment Learning and Action Network (HCPLAN), I have watched this model mature and, in recent days, overtake the fee-for-service tradition. Various risk models are now de rigueur—such as bundled or annual payments, payments based on downside risk, or even full capitation—and there is every indication the direction will continue to grow and mature. Ninety percent of payers, in fact, say they expect alternative payment models to only increase. (More information is available in the October 2018 HCPLAN study, “Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage, and Fee-for-Service Medicare Programs.”)

In short, it has become clear the volume-based approach does not serve the industry or patients well. To protect their income, for instance, providers must treat more and more patients in a day—a hamster-wheel model that has led to quality concerns and unprecedented levels of physician burnout. Altering this paradigm clears the path for more efficient, patient-centric care—and fuels adoption of innovations like virtual care.

The “virtual first” approach delivers critical value to address three of the most significant concerns challenging healthcare today:

  1. Access. Rural areas of this country are experiencing a healthcare crisis. (Many urban areas are also woefully underserved.) Too few doctors—especially highly paid specialists—choose to establish their practices outside of urban or suburban areas, leaving many people without the care they need. Virtual care overcomes the barriers of geography, meeting the needs both of individuals who live in remote areas and providers in populated areas.
  2. Quality. Not only does virtual care provide a much-needed channel for care delivery, but it also facilitates the ability for providers and health plans to monitor and improve quality—according to both clinical and service metrics. Platforms like Teledoc Health, which support a virtual-care infrastructure, enable the highly scalable collection, analysis, and reporting of quality data to promote best practices in a myriad of areas such as prescribing patterns around antibiotics and opioids among providers in the network.
  3. Cost. With healthcare representing 20 percent of U.S. GDP, strategies to address spiraling cost concerns are critical. Virtual care offers a solution in ways both obvious and less apparent.
    1. Unit cost. It’s long been established that “seeing” a patient over a virtual network, compared to hospitalization, an emergency visit, or even an office appointment, is less expensive.
    2. Cost to the patient, in terms of their economics, time, and convenience. One estimate noted that, when looking at the investment patients make in a face-to-face encounter (commuting, waiting room, exam room, etc.), only 16 percent of the total time is spent with the provider—an appalling (and disrespectful) lack of efficiency by any standard.

It is clear that current models of care delivery have priced themselves out of reach of families, companies, and even government, and are unable to deliver the value, quality, or convenience healthcare consumers have a right to expect. A “virtual first” approach provides a much-needed alternative to alleviate the pressure on the current healthcare ecosystem and offers value that all constituents—patient, provider, and health plan—can embrace.

Mark D. Smith, MD, MBA, is Professor of Clinical Medicine at the University of California, San Francisco. To learn more about how virtual care drives innovation in healthcare, watch Dr. Smith’s recent presentation to health plan executives, Virtual Care as a Strategic Asset: The Consumer Experience.


1https://kk.org/thetechnium/natural-history/

Posted In: Telehealth