In a year not far from this one, a doctor’s appointment could look dramatically different from today’s typical in-office visit.
Your doctor, who may live and work in your town or who may be hundreds of miles away, will meet you in a virtual room. A split-screen shows the notes of your last appointment, the doctor highlighting the areas of emphasis.
In that same moment, you’re uploading 30 days of blood sugar numbers or the results of your last mobile EKG to your virtual health records.
Your doctor sends a prescription to your pharmacy and dispatches a technician to come to your home and take blood for some lab work.
Meanwhile, you’ve never left your office, your home, or better yet, your bed.
The Rise of Virtual Care
The COVID-19 pandemic dramatically shifted the telehealth landscape for many Americans. Prior to the pandemic, about 11 percent of U.S. consumers had used or were using some form of virtual healthcare.
By May 2020, that number had increased to 46 percent.
Today, the number of telehealth appointments has stabilized at a level 38 times greater than pre-COVID numbers (which is down from 78 times higher in April 2020 as compared to February of the same year).
The use of telehealth is decreasing marginally as in-person visits are safer and easier to attend. But the reality is that the sudden dependence on what was once considered a luxury capability has now made telehealth and telemedicine a necessity for many patients and healthcare professionals alike.
In short, telehealth isn’t going anywhere.
Post-pandemic, the service still appeals to patients for several reasons. telehealth can make meeting with a doctor or other medical professional faster and easier. It eliminates the need for travel, whether it’s five miles or several hundred, and it can also lead to a more positive experience once at the office — cutting down on the hassles of taking off work, paying for parking, and waiting, waiting, and waiting some more.
People who have few healthcare resources in their area can maintain regular maintenance visits and follow-up care ...
With lower overhead (smaller offices, smaller staff), the doctor may be able to charge less for the appointment. Meanwhile, you may be able to see specialists who aren’t in your area, without the cost of expensive travel.
In addition, people who have few healthcare resources in their area can maintain regular maintenance visits and follow-up care with the doctor of their choice and build stronger provider-patient relationships, a cornerstone of good health.
However, virtual healthcare has its limitations. In order to access this promising tool, you need electronic devices connected to the internet. That’s still a costly hurdle for some, and many areas are still without broadband connectivity.
To put it another way, the people who might benefit the most from virtual healthcare may be the most unable to access it.
Here, we explore the future of virtual healthcare and the role it can and will play in how patients, doctors, and healthcare teams interact.
In this article, “virtual healthcare” or “telehealth”will refer to healthcare services that are administered using information technology, such as tablets, computers, cellphones, and other connected electronic devices.
Access to Care
During the pandemic in January, 2021, 81% of psychiatrists reported seeing 75% to 100% of their patients via telemedicine.
In the same survey, nearly two thirds of psychiatrists reported that they were seeing patients located in a different state.
That statistic points to a significant benefit of telemedicine: You aren't limited by your location.
Pre-pandemic, many healthcare executives recognized the importance of a shift to virtual healthcare.
In fact, 88 percent of healthcare executives told the American Telemedicine Association in 2017 that they planned to invest in telehealth, with 98 percent of respondents already believing the virtual-hybrid model could be a competitive advantage for their practices.
Early players in the virtual healthcare space began digitizing health records, making them accessible across practices and sometimes even within hospital networks. Today, with the help of smartphones, patients can quickly pull up their records wherever they are. They can also send messages to their doctors or nurses 24/7, improving communication about side effects, recovery, or questions.
Some corners of the healthcare spectrum have been faster to adapt to virtual appointments, like mental health services — and they don’t show signs of turning back. During the pandemic, virtual appointment bookings for psychiatrists and psychologists reached all-time highs, with 81 percent of psychiatrists reporting in January 2021 that they were seeing 75 to 100 percent of their patients via telehealth.
What’s more, in that same survey, nearly two-thirds of psychiatrists reported that they were seeing patients located in a different state. That statistic points to a significant benefit of telemedicine: You aren’t limited by your location.
Redefining rural healthcare
Virtual healthcare may have the largest impact in rural areas, where people are typically medically underserved.
According to the Centers for Disease Control and Prevention (CDC), people living in rural areas of the United States are at increased risk of premature death from all of the five leading causes of death when compared to those living in urban areas. The five leading causes of death are heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.
What are the reasons behind these poor health outcomes? The reasons are as varied as the outcomes, but follow-up care is a critical concern.
Follow-up care can be difficult for people who don’t have immediate access to their doctors and healthcare professionals. That leads to missed diagnoses and worse outcomes.
With a virtual model, you may be able to make an appointment with the specialist in as little as a few days. You may also be able to have a conference call with several medical professionals at once so that your entire care team is on the same page ...
A model of healthcare that embraces a combination of virtual visits and in-person visits may help meet this worsening crisis, as patients can make less frequent trips to their doctor’s office but follow up in nonemergency situations from their own homes.
Furthermore, telemedicine and virtual care can help expand a patient’s circle of healthcare professionals.
Seeing a specialist, even today, often requires referrals and lengthy wait times for appointments. If you’re lucky to live in the same community as the practice or hospital, you may be spared expensive travel costs. But if you must drive or even fly for this care, the cost of the visit can be cumbersome (and it's rarely covered by health insurance).
With a virtual model, you may be able to make an appointment with the specialist in as little as a few days. You may also be able to have a conference call with several medical professionals at once so that your entire care team is on the same page, getting the same information, and working together.
In places like hospitals, this may not only reduce wait times and bed shortages, but it may also be a potential lifesaving advancement.
But as mentioned, many parts of the country remain underserved by broadband or internet connectivity, and none of these advancements is possible in these areas without the necessary infrastructure to make sure everyone has the access they need.
Access for underserved communities
Location isn’t the only factor that can exclude people from getting care. Communities of Color and young people are often underserved or face greater obstacles to care.
A Kaiser Family Foundation poll found that 45 percent of people between the ages of 18 and 29 say that they don't have a primary care provider. The long-term patient-provider relationship has shown a variety of benefits, including better health outcomes, so the loss of this foundational healthcare relationship may have repercussions for years.
However, these same people may find a virtual interaction with a doctor less demanding.
The traditional in-office visit places many barriers in front of people who might wish to seek medical care. Visits require time off from work or out of school. They require travel and potentially long stays in waiting rooms and exam rooms. This, for some people, is too burdensome and keeps them out of the standard healthcare pipeline.
Virtual care, on the other hand, often operates on an appointment schedule where you and your doctor meet at a specified time in a virtual space. You don’t have to travel. You don’t have the long wait for an appointment. It’s more efficient, less costly, and less cumbersome. This could improve participation in healthcare, which would go a long way to serving people who find themselves in great need.
My co-founder, an Asian woman, and I, a Black woman, were tired of not seeing our struggles represented in mainstream wellness.
Inclusive care is important in the virtual mental health and wellness space, too.
Marah Lidey, co-founder of Shine, an inclusive self-care app, echoes this sentiment. "My co-founder, an Asian woman, and I, a Black woman, were tired of not seeing our struggles represented in mainstream wellness.” She and co-founder Naomi Hirabayashi created Shine to provide mental health support by and for diverse users, including people who’ve experienced discrimination or feeling “otherized” because of their skin color, gender identity, sexual orientation, body size, religion, or any other characteristics.
The app offers daily meditations, a gratitude log, a support community, and access to diverse mental health and wellness experts — all of which you can use from anywhere with internet access.
The cost of accessing healthcare remains an obstacle for many people, even those with some level of health insurance coverage.
As the demands of the in-office or in-hospital visit shift to virtual for practitioners and doctors, it's possible that telehealth will also change the price structure of the fee-for-service healthcare model that exists today. That would remove another barrier to care: price.
Flat-rate appointments could help patients understand their financial responsibility up front, which eliminates the confusing, often mysterious, pricing that comes with in-person visits. With current pricing models, virtual care coverage is equally confusing because not all insurance plans even pay for telehealth visits or activities.
Virtual healthcare plans that tailor to virtual-first care could be less expensive and focus on covering the concierge care that telehealth would usher in.
Today, more than two-thirds of U.S. states, plus Washington, D.C., have laws on the book that require health plans to pay for telemedicine visits. Medicare recently extended their temporary COVID-era virtual care coverage, which eliminates geographic requirements and still allows patients to remain in their homes for telemedicine services.
Several U.S. senators have also introduced federal legislation to make these Medicare expansions permanent. They believe that the helpful flexibilities that Medicare introduced at the start of the pandemic will continue to give patients and their healthcare team the best opportunity to properly serve the patient.
A path towards more affordable healthcare?
But virtual care can go beyond insurance coverage to help lower the cost of care from the outset.
For example, a doctor’s office that can reduce their in-person patient load can also reduce their footprint and resource demands. That lowers the office’s overhead, and savings can be passed on to patients.
Doctors offices and even hospitals have begun using e-triage solutions, which allow consumers to be seen quickly and efficiently in a virtual space. The healthcare professional can then escalate the case if they determine the patient does in fact need to be seen in person.
But even then, that need for face-to-face contact doesn’t mean a patient must come to the office or a hospital. In some cases, doctors can send a lab technician to your house. With in-home medical equipment, they can take basic vitals and also draw blood for lab work, conduct physical therapy, or even take imaging tests, like X-rays.
Today’s smart wearable technology can also track vital information like heart rate, sleep, activity, even body temperature. Connecting healthcare professionals to this information may help them monitor a patient’s health or recovery, which could also allow patients to leave the hospital earlier or eliminate costly trips to outpatient facilities.
This “digital front door” approach is a way to leverage digital strategies to allow patients to interact with their healthcare professionals outside of normal hours and outside the traditional doctor’s office setting. And it has the potential to reduce the cost of healthcare interactions and streamline care in a way that also reduces the burden on healthcare settings.
To that end, health insurance plans can negotiate “virtual-first” rates that allow patients to have coverage no matter the place they seek care. If the visits are less expensive, the premiums and deductibles for these virtual-first plans may also be lower.
Home as a
Place of Care
Long hospital stays and recovery times are difficult in many ways. Not only do extra days in a hospital become costly to the patient, but the mental and emotional burden of hospital stays can also be taxing and even slow the pace of recovery.
But with virtual healthcare and with the assistance of smart technology, it may be possible for patients to return home sooner while still receiving all the medical supervision they would get in a hospital setting.
Doctors can use smart monitors attached to the patient to reliably monitor things like falls. E-diaries between patient and medical professional can track symptoms like pain, constipation, or nausea. Even intravenous medicines can be changed remotely through internet-connected devices.
Healthcare professionals can set up active monitoring, which requires patients to complete scheduled tasks at fixed intervals. If the patient doesn’t, the professional is immediately notified and can follow up.
Remote monitoring is only as successful as patients are at setting it up. Difficulties with technology or a lack of digital literacy may prevent patients from successfully using it.
Nurses or paramedics could be dispatched to your home for help with procedures like dialysis, chemotherapy, blood draws, and catheters. An in-home physical or occupational therapist may be able to help you more readily adapt to your own environment.
While the benefits of a hospital-at-home approach would seem to outweigh the negatives, it’s important to realize that a home doesn’t come with staffing. Caregivers would need to be trained to care for their loved one, and patients who live alone may be left out of this possibility without the assistance of third-party professionals.
Remote monitoring is only as successful as patients are at setting it up. Difficulties with technology or a lack of digital literacy may prevent patients from successfully using the sensors and monitors.
Things to Consider
Virtual and hybrid healthcare can dramatically alter the patient-provider relationship and the landscape of healthcare delivery as we know it. But despite all the positive aspects of telehealth or virtual healthcare, it’s not all smooth sailing.
The accelerated redesign of care pathways has brought to the fore several areas of concern that, if not addressed and overcome, could hinder the expansion of virtual and hybrid healthcare.
Rural America already is facing a shortage of healthcare professionals. Pushing toward virtual visits may further disincentivize professionals from offering in-person services to these communities.
Limited access to technology may leave many people behind
Compounding that problem, many rural communities are without reliable internet or broadband. That makes having the bandwidth to maintain an ecosystem of virtual medical care difficult. These patients could fall further away from the care system.
Plus, some people may be unable to afford the elements of virtual healthcare: The devices to connect to the internet (computers, tablets, and phones) are often expensive, and connectivity usually requires a subscription to a cellular or internet company.
Privacy concerns may hinder technology adoption
Privacy concerns remain a concern for patients and medical professionals alike. Technology security is vital to the health of a practice’s technology infrastructure, and patients should expect the highest level of privacy for their virtual meetings.
However, companies offering telemedicine solutions aren’t all compliant with Health Insurance Portability and Accountability Act (HIPAA) standards. That puts practices at jeopardy of violating patients’ rights, so when in doubt, many are choosing not to adopt the technology in order to remain compliant.
Insurance coverage isn't guaranteed
In addition, virtual healthcare visits are not always covered by health insurance companies. While telemedicine has the potential to lower the cost of visits, only 35 states and Washington, D.C., have laws on the books that require health plans to cover the cost of telemedicine appointments.
There remain skeptics of virtual healthcare who believe that patients will suffer from the lack of in-person care. It’s true that there’s no substitute for in-person visits. In person, a practitioner can lay hands on a patient and feel for lumps in breasts, hear heart murmurs, or find masses in abdomens. These in-person visits will remain a vital part of the healthcare experience.
Winning over some physicians and other medical professionals will take time — and it will also take the money of coverage from health insurance plans.
Next Steps You can Take
The American healthcare landscape faced a rapid need to transition to virtual healthcare at the start of the COVID-19 pandemic, but the tide of change had been rolling in this direction for years.
Indeed, strong continued uptake today shows that both patients and medical professionals are comfortable with a future that relies on the virtual-hybrid model of healthcare, even as patients do take advantage of in-office visits.
Virtual care will be a necessary link between doctors and patients, and it holds the promise of both improving patient outcomes and follow-up care, as well as cutting healthcare costs, all barriers to care today.
But you don’t have to wait for the future to begin using virtual or hybrid care today. In fact, many medical offices and hospitals already offer some level of hybrid care. Some may even be fully virtual. Here’s how you can prepare:
Next steps for today
Ask your healthcare team whether they have any telehealth services, such as an app for messaging your doctor, accessing your health records, or requesting follow-up services like prescriptions.
Check with your health insurance provider, if you have one, about what telehealth services they cover. A recent SingleCare survey found that 43 percent of respondents didn’t know whether their plan offered such services. Understanding what’s available to you and what your responsibility of cost will be can help you make decisions about the best location for care.
Next steps for tomorrow
Remote monitoring options are becoming more reliable and affordable by the year.
In fact, your doctor may already use some body-worn sensors or devices to see reports about patient health statistics. Wrist-worn heart monitors, blood pressure cuffs, mobile EKG monitors, blood sugar meters, and other over-the-counter devices may have the option to send your information to an app or website where your doctor can download the reports regularly.
Even if your doctor doesn’t use these reports yet, the devices themselves often provide valuable insight into your own health for you. Having this data saved on your smartphone may help you both care for yourself better and monitor treatments so you have an understanding of how well things are working.
Next year and beyond
As healthcare professionals begin to shift to the virtual-hybrid models, medical insurance plans should begin shifting with them. However, if you find that your plan is unresponsive to this transition, it’s worth considering another plan. In some states, a handful of virtual-only health plans are available, and the number is growing.
As you begin unraveling the ways in which you can use telemedicine and virtual care to improve your follow-up, chronic disease management, or nonemergency care, continue to investigate ways to make your care more virtual-friendly. Seek out practitioners who use virtual medical record storage and hospitals that embrace at-home recovery and monitoring.
Telehealth can make patients more active participants in their care and recovery. It can also empower healthcare professionals to use the data collected by sensors and monitors to tailor counseling and medical plans to a patient’s individual situation and needs.
In short, virtual care has the potential to radically transform the patient-provider relationship. It may improve outcomes, strengthen relationships, and bolster the U.S. healthcare infrastructure with renewed insight into how medicine can and should work for everyone involved.