Click-and-Mortar Healthcare: The Best of Both Worlds

The Evolution of Healthcare Delivery: From In-Person to Hybrid Models

Prior to the emergence of COVID-19, healthcare delivery was largely bifurcated – either entirely in-person or exclusively virtual. Individuals were often required to select one approach or another. Some opted for a combination, utilizing traditional in-person healthcare systems for the majority of their needs, while supplementing with services like Livongo for diabetes management or Hinge Health for musculoskeletal issues.

Challenges with Traditional Approaches

A purely in-person model can prove inconvenient and time-consuming, particularly when a clinician’s assessment involves only a visual examination or review of laboratory findings. Conversely, a completely virtual approach may be insufficient when uncertainty exists or a physical examination is necessary.

The COVID-19 pandemic, despite its devastating impact, inadvertently accelerated the adoption of virtual care. Both healthcare providers and patients widely experienced its benefits, leading to a belief that hybrid models – termed “click-and-mortar” – will become prevalent. These models aim to integrate the strengths of both in-person and virtual care, resulting in more reliable and efficient outcomes.

Rapid Growth of Virtual Care

The expansion of virtual care in 2020 was remarkable. A significant 97% of primary care physicians incorporated some form of telehealth into their practice. Furthermore, telemedicine accounted for nearly 44% of primary care visits among Medicare beneficiaries in 2020, a dramatic increase from the 0.1% recorded the previous year.

The Rise of Virtual Primary Care Platforms

The widespread acceptance of virtual care is reflected in online search trends. Searches for “doctor online” now yield specialized tools showcasing platforms like Teladoc, Amwell, Doctor On Demand, and MDLive. Additionally, providers such as Doctor on Demand, MDLive, Galileo, and Firefly have launched “virtual primary care” services focused on delivering ongoing, non-urgent primary care remotely.

While these services can cater to the needs of generally healthy individuals, the lack of a physical location for examinations, diagnostic testing, and procedures may limit their overall applicability.

Potential Advantages of Virtual Primary Care

Virtual primary care offers several potential benefits. Observing patients within their home environment can provide valuable insights into their safety, social support systems, and social determinants of health. It can also reduce the stigma associated with seeking behavioral health services.

Remote monitoring data can be seamlessly integrated into virtual care platforms, and visits can be conducted in group settings with multidisciplinary teams. More frequent, shorter “microvisits” are also possible, enabling closer monitoring of patient progress and facilitating quicker treatment adjustments.

Cost-Effectiveness and Accessibility

Virtual visits can lower costs for physicians by reducing overhead expenses associated with physical locations. Some services offer 24/7 access, potentially decreasing reliance on urgent care or emergency department visits. Moreover, patients may gain access to clinicians who better align with their preferences regarding ethnicity, LGBTQ orientation, and gender, particularly in underserved rural areas.

Requirements for Successful Virtual Models

Effective pure-play virtual care models depend on the use of connected devices and active patient participation. Devices like connected blood pressure cuffs, stethoscopes, oximeters, thermometers, and scales can replicate many aspects of a traditional physical exam.

Virtual providers can order lab tests, similar to in-person care, although performing rapid tests like urinalysis or strep tests remotely requires the necessary supplies to be readily available.

Data and Relationships in Virtual Care

Virtual providers collaborating with health plans may have access to more comprehensive cost and quality data, potentially informing referral decisions. However, they may possess less familiarity with local healthcare resources and specialists. This could lead to more transactional relationships with specialists and traditional providers.

Clinical Outcomes and Evidence

Evidence suggests that virtual care can improve clinical outcomes in specific situations. Studies have demonstrated reductions in emergency department visits and antibiotic overprescribing. Chronic conditions, such as Type 2 diabetes, have shown improved management through virtual care, and virtual physical therapy has resulted in cost savings and fewer back surgeries.

The Future: A Hybrid Approach

Despite the benefits of purely virtual care, a hybrid model combining virtual and in-person interactions is likely to be the most effective approach to primary care. A projected mix of 80% virtual and 20% in-person interaction is anticipated.

Visits will likely be initiated by clinicians responding to changes in remotely monitored data, such as a new fever, altered sleep patterns, or weight fluctuations in patients with heart failure.

Implications for Healthcare Practices

This shift towards predominantly virtual, data-driven visits has significant implications. Healthcare offices will evolve into centers for problem-solving and procedures. Clinicians will spend their time responding to patient signals and may have less rigidly scheduled days.

Patients will need to embrace passively collected and remotely monitored data as a standard part of their care. This model will foster more frequent, shorter virtual interactions – facilitated through text, email, phone, and video – leading to improved clinical outcomes and faster disease progression monitoring.

Challenges and Considerations

This model presents challenges. Patients require access to mobile phones and devices, and they must actively engage with clinicians and maintain the functionality of their remote monitoring equipment. Crucially, patients must adhere to the guidance of virtual providers and seek in-person labs, diagnostics, or care when necessary.

Clinicians will need specialized training to conduct virtual clinical examinations and effectively integrate and respond to remote monitoring data.

Embracing the “Click-and-Mortar” Vision

The COVID-19 pandemic has spurred the adoption of virtual care, creating demand from patients and a willingness among clinicians to embrace a “click-and-mortar” vision for healthcare. These models hold the potential to deliver more proactive, engaging, and ultimately, superior care.