The pandemic has resulted in a huge increase in the use of virtual health care. But his place in the post-pandemic world is up in the air. To help policy makers, payers, and providers evaluate the various ways in which virtual nursing programs could have positive effects on patients, clinicians, payers, and society in the future, the American Medical Association and Manatt Health have developed a framework. It can be used by health care providers to develop and evaluate new digitally assisted care models, by payers to make coverage and payment decisions, and by policy makers to regulate.
The Covid-19 pandemic has resulted in a dramatic increase in virtual health care in the United States. The surge was driven by the need for social distancing and made possible by a wide range of policy flexibilities implemented by lawmakers, regulators, and payers at the federal and state levels. However, many of these allowances are temporary. As the pandemic subsides, policy makers and payers are deciding whether and how much to pay for virtual care services in the future, leaving clinicians unsure of whether they can afford to continue their virtual care programs. But the parties often make these decisions based on outdated or limited measures of success that do not holistically reflect the reality of value creation.
To meet this need, the American Medical Association (AMA) and Manatt Health, a legal and advisory firm, have developed a framework for assessing the value of digitally assisted care. It takes into account the various ways virtual nursing programs can increase the overall return on health by creating benefits for patients, clinicians, payers, and society in the future. The framework can be used by care providers to develop and evaluate new digitally-assisted care models, by payers to make coverage and payment decisions, and by policy makers to set regulations that will guide the future of virtual care.
Prior to the Covid-19 pandemic, virtual care adoption was slow, accounting for less than 1% of total health care volume. In most cases, virtual care existed outside the traditional health care system and was often not coordinated with personal care. One patient developed a fever over the weekend and went to a virtual emergency service, who in most cases was not his family doctor. Some innovative health systems or technology-enabled health care companies such as One Medical and Cityblock Health had implemented integrated virtual care tools, but for the most part the virtual care ecosystem existed in parallel and separate from the personal health care ecosystem.
Accelerated by the pandemic, we are entering an era where personal and virtual-enabled care are seamlessly integrated, and the nature of care based on clinical appropriateness (i.e. when telemedicine should and when not) and factors such as convenience and cost. When patients were given the option of telemedicine during the pandemic, they saw their existing doctors largely for their needs versus a new provider. Digitally supported care models are being developed for the entire spectrum of the severity of the disease and for all clinical conditions. The integration of new digital health solutions such as video visits, remote monitoring, asynchronous telemedicine, continuous and passive sensors and AI into digitally supported care models offers the potential to access high quality care and positive patient and doctor experiences at lower costs.
Although much progress has been made, the existing evidence for telemedicine is tightly focused on short-term measurements of the financial value of virtual health. There are now many opportunities to glean details on broader benefits such as improvements in access to care, clinical outcomes, impact on patient and clinical experience, potential for operational efficiency, and impact on equity in healthcare. These benefits also vary based on a variety of factors that affect value and outcomes, such as payment models, virtual care modalities (e.g., audiovisual visits, asynchronous), or clinical use case. Because of this, we have developed a comprehensive framework to help stakeholders measure the different ways that virtual nursing programs can create value based on their specific needs.
Measure the value of virtual care
To this end, we examined the existing literature on the effects of telemedicine and consulted national experts on virtual care, funding, technology and research. We also consulted with current and past executives from Ochsner Health System, Virginia Commonwealth University Health, Cityblock Health, the Healthcare Financial Management Association, Harvard Medical School, the Medical Group Management Association, private practices, and others.
The framework describes several environment variables that affect different value streams that collectively attempt to capture the total value derived from a particular digitally assisted model. Environment variables include practice type, payment arrangement, patient population, clinical use case, and virtual care modality. The framework is flexible as it recognizes that different provider organizations have different clinical or business reasons for pursuing different models based on their environmental and strategic context. For example, a small rural primary care practice with a largely paid Medicare population will experience the value of digitally assisted care very differently than a large vertically integrated regional health system.
Next, the framework includes six value streams: clinical outcomes, quality, and safety; Access to care; Patient and family experience; clinical experience; financial and operational impact; and health equity. The impact of a digitally supported care model should be measured on all of these value streams – a balanced scorecard approach, if you will, to measure and realize the full potential of virtual care.
Some leading health systems are starting to measure values holistically. One is VCU Health, a Virginia health system that, in response to the pandemic, increased virtual visits from less than 1% of outpatient psychiatric visits to more than 90% last year. It has started assessing the impact of its new virtual model on the various value streams in the framework and has identified some new insights. For example, the no-show rate (an element of financial and operational impact) has decreased from 11% before the pandemic to 6% during the pandemic, and VCU Health is now considering how to use virtual care to reduce wasted time slots to improve its operational performance and improve access (another value stream). VCU Health also measures the impact of virtual care on equity in healthcare as there is a concern that older people may not be as digitally savvy as younger ones. It found that there were no differences in access to care by age group when delivery was shifted from almost all face-to-face visits to almost all virtual visits. This report provides additional case studies from organizations such as Ochsner Health and Massachusetts General Health, as well as resources such as upcoming meetings and virtual discussions for the industry to share their own experiences.
Virtual mentoring is there to stay, but many stakeholders across the industry are in the process of deciding how best to invest in their programs and measure their success. This framework of values can help.
The authors would like to thank Jacqueline Marks and Michelle Savuto of Manatt Health and numerous AMA colleagues for their valuable contributions to this article.
source https://dailyhealthynews.ca/how-to-measure-the-value-of-virtual-health-care/
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