How virtual and in-person care merge for a healthier, sustainable future

Health systems should seize on recent progress to push toward new models that seamlessly integrate virtual, home-based and in-person care.

In brief

• Integrating virtual and in-person care can free up staff and beds, reduce costs, and  improve outcomes as systems treat populations with fewer workers.  
• Integration requires new workforce roles, payment incentives and concepts like digital command centers, care coordination and hospital at home.  
• Health systems should have deep knowledge of patient pools so care pathways can be stratified by consumer preferences, lifestyle factors and health needs.

Built on connected digital platforms that unite data from across the ecosystem, this hybrid care delivery model is proactive, data-driven and user-friendly, allowing for care that keeps patients healthier at home longer and prevents the progression of disease to crisis points. From primary care to post-surgery, care teams can be constructed to help patients set up the wearables and connected devices needed to monitor important biometric data in their home. Those readings can be monitored by clinicians at a digital command center that alerts the care team to act if certain readings warrant a virtual call or a home health visit. Artificial intelligence (AI) can be incorporated to flag changes in readings and surface them to the staff. To access a PDF of this article, click here.

Virtual care and remote monitoring across the care spectrum

Successfully integrating virtual care allows for patients to be routed to the most appropriate care setting. Virtual triage can help health systems connect patients who might otherwise head to higher-priced emergency departments or urgent care to their primary care provider (PCP). To meet the needs of working parents or seniors who lack transportation, systems can offer virtual primary care visits, eliminating drives and waiting room time where they could be exposed to viruses. The burden can be lessened for caregivers, who can be kept informed of the patient’s status, in coordination with care navigators.

Hybrid care models keep patients healthier at home longer

In Alberta, Canada, virtual care has expanded access for a widespread population that may not otherwise have access to care. Neonatal ICU physicians are connected to remote areas via video to consult on newborns in distress, helping determine whether patients should be transported to the NICU. Similar consults can be done virtually with specialists for many needs in remote areas, determining the most appropriate setting for their care.

“We save money, we save time, and we save unnecessary congestion of the EDs in urban centers,” said Dr.  Jonathan Choy, Senior Medical Director of Virtual Care, Access and Navigation for Alberta Health Services, during an EY webcast on virtual care.¹

Virtual care also can help with clinician gaps. In Western Australia, an inpatient telehealth program delivered virtual ward rounds when general practitioners were not available, allowing 87% of patients to be monitored without needing transfer.²

The global evidence for the shift to the home is growing

Research from around the world suggests the business case is building for health systems and payers to move from the hospital to the home when it comes to treating certain conditions. In Italy, a telehealth program for elderly patients with congestive heart failure was able to reduce costs by 65%, while also decreasing emergency department (ED) visits and readmissions within 30 days.³

In the US, a randomized controlled trial of acutely ill adults through Mass General Brigham showed that providing care in the home could reduce the adjusted mean cost of the acute episode by 38%, with home visits, remote monitoring, virtual care, IV medication and at-home testing enabling that care.⁴ 

Integrated virtual care can help improve hospital quality measures while reducing cost and patient suffering

This shift will need to be made as the current methods of delivering care are not sustainable, in terms of workers needed, the care that will be demanded by a larger aging population with increased rates of chronic disease, and in overall costs to governments and consumers.⁵  

Researchers in the Netherlands estimated that between 19% to 32% of care could be moved from the hospital to the home.⁶ They did note that while the wards could reduce nurses needed per shift by moving to remote monitoring, they would have to invest in telehealth nurses and the devices needed to operate virtually. However, once this integrated model could be scaled hospital wide, the system experienced savings.

Too many pilots across the globe hint at the potential for virtual and remote care, but these options must be integrated holistically so it can be truly scaled. 

Hybrid models must consider patient experience to achieve successful consumer engagement. In a patient preferences study at Johns Hopkins, a third of patients surveyed listed qualities  such as physician kindness and “efforts to connect with me as a  human being” as their top concern about the patient-physician relationship, while 80% wanted shared decision making for medications.⁷

The burden to the patient to seek care can also be reduced through virtual, as one US study found that a visit to an in-person urgent care center took on average 10 times longer than the average total time for a virtual urgent care visit.⁸ Ninety percent of survey respondents were satisfied with the virtual visit, and 40% said they would have gone to the ER as an alternative or have delayed care without the virtual option.

“How do we keep people well, but when needed, how do we provide the best care for them in the most frictionless way?” asked Eric Liston, administrator of Connect Services for Intermountain Healthcare, during an EY webcast on virtual care.⁹ He continued, “We’ve built our programs based on data and analytics to make sure that we are giving personalized care.”

They can seamlessly flex between clinic visits versus telehealth versus inpatient care versus a procedure to best meet the patient's needs at that time. When we work with clinical teams to develop that fluency, the telehealth and in-person services are fully integrated and this ensures that we're not duplicating services.”

A whole person approach to knowing your patient population and stratifying patients in clinically appropriate ways

Of course, incentive structures need to evolve for hospitals, as governments and payers will need to construct reimbursement strategies that encourage integrated care pathways to make system more sustainable. Hospital beds are expensive and precious resources that should not be filled with patients who can be treated more efficiently, effectively and comfortably at home. 

Health systems also must confront obstacles in digital literacy and access to broadband, which further underscores the need for health organizations to understand their patient pool and expand their ecosystem partners with pharma, tech companies, retailers, governments and community organizations.  

Five key takeaways for global health organizations