The tiny town of Cicely, Alaska, has a health care access problem similar to other communities in remote, sparsely populated locations—it lacks a physician to treat the residents, and the nearest hospital is a 200-mile plane ride away. One day, recently graduated New York City physician Joel Fleischman, M.D.—who intends to practice medicine at a large Anchorage hospital to repay the state for underwriting his education—is assigned to be Cicely’s new general practitioner. Local residents are thrilled, Fleishman, not so much. The resulting clash of cultures and expectations drove comedic situations on the award-winning 1990s TV show Northern Exposure.1
In real life, access to physicians and other health care resources can be a top priority to Alaska’s geographically isolated residents.2 There are a number of federally funded and/or operated agencies that can provide care to these sparsely populated areas. They include Indian Health Service (IHS), which is responsible for providing federal health services to American Indians and Alaska Natives; Federally Qualified Health Centers (FQHCs), community-based and patient-directed primary care centers that exist to serve those who have limited access to care; Military Health System (MHS) members and dependents on and off US military bases; and the Department of Veterans Administration (VA) medical centers.
Access issues are not confined to the public sector. Patients of rural commercial heath systems might have to travel many miles for everything from basic check-ups to chemotherapy. Such situations heighten the urgency for widespread adoption of virtual health—a method of enabling continuous, connected care via digital and telecommunication technologies. Virtual health goes beyond simple video visits and has the capability to complement to in-person care.
Common applications of virtual health include:3
- Synchronous care to improve patients’ ease of access to providers
- Physician-to-physician communication to improve patient care through information sharing
- Chronic disease management to improve monitoring and alerts for chronic disease patients
- Virtual social work to improve communication and care for underserved populations
- Telehealth to improve patient monitoring (e.g., eICU, telepsychology, telestroke)
- Remote patient monitoring to improve providers’ understanding of patients’ health and medical data
- Care management process to improve patients’ understanding of and engagement with their treatment plans
- Patient adherence to improve medication adherence, health tracking, and patient accountability
- Care coordination to improve relationships between health plans and health care providers
The game changer: Internet access
Several key factors are elevating stakeholder interest in implementing virtual health programs. These include expected physician shortages, continued growth in advanced technologies, increased patient demand, and the changing policy landscape, as reported in our Deloitte Transforming care delivery through virtual health article. One big game-changer: Almost 90 percent of US adults surveyed by Pew Research use the Internet,4 giving doctors the capability and flexibility to communicate via web to answer non-urgent medical concerns.
The Deloitte 2018 Surveys of US Health Care Consumers and Physicians have found that both stakeholder groups agree on the benefits of virtual care. Consumers point to convenience and access (64 percent) as important benefits. Physicians agree that virtual care supports the goals of patient-centricity. The top three benefits from physicians’ perspective are improved patient access to care (66 percent); improved patient satisfaction (52 percent); and staying connected with patients and their caregivers (45 percent).
Importantly, virtual health has the ability to expand access to care for patients in rural and underserved areas. Already, there have been 3,000 rural sites connected to 200 telemedicine networks for specialty consultations, continuing medical education (CME), and other services.5 Increasing numbers of health systems and government agencies are instituting virtual health programs to better serve their patients. Here are a few noteworthy examples:
- Intermountain Healthcare’s Connect Care service, launched two years ago, has 35 telehealth programs that provide specialized care throughout Utah. This virtual health service connects a provider with a patient who is looking for basic urgent care–such as with a cold or a rash–through a video chat on the patient’s phone, tablet, or computer. The provider can diagnose and create a treatment plan for patients, including ordering prescriptions if necessary. The same technology that powers Connect Care is also used in Intermountain hospitals to connect providers to other providers, creating a support network that improves patient care. The technology can help a patient, no matter where they live, get the highly-specialized care they need and, whenever possible, avoid being transferred to a bigger hospital.6
- Sanford Health patients in Minnesota, North Dakota, or South Dakota can request a physician e-visit through My Sanford Chart. Patients fill out a questionnaire about their symptoms and a provider responds via the chart. The responding provider may recommend a course of treatment, order a prescription or request to see the patient in person if the condition is more severe. E-visits are available 24 hours a day, 7 days a week, and patients are guaranteed a response within four hours.7 For current patients in North Dakota, Iowa, and Nebraska, and both current and new patients in South Dakota and Minnesota, Sanford also offers video visits. Using a tablet, smart phone, or home computer equipped with internet access and a web camera, a patient can meet face-to-face with the medical team for any acute, non-emergent primary care need including coughs, colds, rashes, aches and pains. Finally, Sanford Cancer Center gives patients receiving chemotherapy the ability to stay closer to the comforts of their home with its virtual infusion project. The project, which is supported by a grant from the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS), is available at infusion center in three Sanford hospitals. Each center is staffed with oncology-trained nurses who have immediate access to an expert oncology provider through telehealth technology.8
- Phoenix-based nonprofit Banner Health, which operates hospitals and other related health entities and services in seven states, has a telehealth program.9 Its specialized services include Banner iCare™, an in-home care delivery model to treat Banner Health Network members with complex, chronic illnesses. Through the use of a tablet-like device, patients interact directly with their health team – primary care physician, pharmacist, nurse, and health coach – to track and address any medical concerns. Banner iCare aims to decrease emergency department visits and hospitalization, and increase medication compliance while providing care in the comfort of the patient’s home.10
- The Federal Communications Commission intends to run a $100 million pilot program that aims to provide telehealth services for low-income US citizens. The FCC’s Connected Care Pilot Program will focus on providing health care for veterans and Americans residing in rural areas.11
Public- and private-sector providers that embrace virtual health might see improved clinical outcomes, increased patient engagement, expanded access to care, and reduced costs. An MHS use case illustrates its potential:
Musculoskeletal conditions and injuries account for over one million medical encounters and roughly 10 million days of limited duty. These affect about 50 percent of US service members each year,12 and may require orthopedic surgical procedures such as partial or total knee replacement. By combining virtual video visits, health monitoring and engagement, and care coordination through a single, highly configurable virtual pathway—a digital workflow—MHS can enable its care teams to provide timely convenient, efficient care.
In this scenario, the service member is guided through two phases. In the pre-operative phase, the soldier is prescribed video-based education and asked to self-report various outcome measures. Additionally, the service member is directed to input their pain, while the system would persistently track and monitor activity (via connected device). In the post-operative phase, the virtual pathway assigns virtual video visits (both asynchronous and synchronous). The asynchronous video visits are used for ongoing check-ins (e.g., incision reviews and range-of-motion checks), while the synchronous video visits are used for high-risk complications (e.g., the service member reports pain, fever, or some other problem with the surgical site). Throughout both phases, the care team is coordinated and prompted to proactively engage the service member at the right time, using various methods—video visits, recorded video messages, assessments, and video-based range-of-motion reviews.
Efficiencies gained through virtual health applications could improve care and drive down costs for MHS and other providers across the care continuum. It is estimated that virtual visits could save an average of $126 per visit,13 and about $7 billion worth of primary care physicians’ time could be saved annually if yearly visits shifted to virtual visits.14 Indeed, the virtual health space has potential to transform care delivery. A 2016 report estimated that the US virtual health market will reach $3.5 billion in revenue by 2022.15 While outcomes from early adopters have been mixed, there is a clear trend demonstrating the effectiveness of clinical solutions such as telehealth and remote monitoring. For example, recent US telehealth efforts have generated savings in chronic disease management, which takes up 85 percent of the country’s direct health care spending.16
Northern Exposure reboot
Fast forward two decades to 2018. If Northern Exposure were still on the air, the conditions would be quite different from Dr. Fleischman’s first years in Cicely, Alaska. His practice would now have Internet access and he could consult with specialists at hospitals in faraway Anchorage—or even New York City. Many of his patients would be digitally connected, either at home or a community center. Those patients might substitute an e-mail exchange or video visit for a 4+ hour trip to the doctor’s brick-and-mortar office. Distance is no longer an assumed requirement or barrier to care. Local residents and Dr. Fleischman might be happier and healthier—even though Alaska’s winters seem to last forever.
For more on Deloitte’s virtual care perspectives and insights, visit our Deloitte.com page here.
3 Deloitte virtual health iPad application, https://marvelapp.com/81ce021/screen/39109287
4 “Internet now used by 87 percent of American adults, says poll,” CNET, February 27, 2014, https://www.cnet.com/news/internet-now-used-by-87-of-american-adults-says-poll/
11 “FCC Seeks to Run $100M Telehealth Pilot Program; Brendan Carr Comments,” Executivegov.com, July 12, 2018, http://www.executivegov.com/2018/07/fcc-seeks-to-run-100m-telehealth-pilot-program-brendan-carr-comments/
12 2016 Health of the Force: Create a healthier force for tomorrow, US Army Public Health
15 Verify Markets. “High Growth Potential for the United States Virtual Healthcare Market”. March 23, 2016, http://www. polycom.com/content/dam/polycom/common/documents/ success-stories/saint-vincent-health-system-cs-enus.pdf
16 “FCC Seeks to Run $100M Telehealth Pilot Program; Brendan Carr Comments,” Executivegov.com, July 12, 2018, http://www.executivegov.com/2018/07/fcc-seeks-to-run-100m-telehealth-pilot-program-brendan-carr-comments/