In COVID-19’s wake, hospitals look to hybrid model with in-person, virtual care on equal footing

As providers rushed to implement telehealth when the pandemic hit this spring, even hospitals with operations well underway were forced to massively accelerate their plans. The results — patients preferred virtual care in many cases and technical barriers were overcome relatively quickly — mean many systems are pursuing a future of hybrid care that incorporates telehealth as a core piece.

Cohen Veteran Network, a nonprofit network of clinics offering mental health services to veteran and military families, is planning drastic changes to its physical spaces in the future, its chief external affairs officer, Paul Woods, said Tuesday during the American Hospital Association’s virtual conference.

That includes reducing the physical footprint of future clinics by about 50%, he said.

“The other thing that’s been really interesting is it’s opening up potentially entirely new markets to us where we won’t necessarily have a physical presence,” he said.

Comments throughout the AHA conference reflected a clear agreement that not only is telehealth here to stay, but it’s also going to be at the heart of care delivery going forward. And the indications are that patients want more virtual options and actually prefer them in many cases. Once-reticent physicians have little choice but to adapt.

Deborah Hollenstein, vice president of strategic marketing at Vanderbilt University Medical Center, said her hospital is also rethinking the idea of patient care being built on face-to-face interactions, while being mindful that important screenings and other preventive services must be done in-person.

Going forward, all patients will have access to physical and virtual care simultaneously. “We’re really trying to thread that needle,” she said.

At the end of last year, about 18% of Cohen Veteran Network patients had participated in at least one telehealth session throughout their episode of care. The system’s goal for 2020 was about 30%, but after COVID-19 outbreaks hit, it reached 98%.

Woods predicts that after a vaccine is widely available, CVN will settle in at about 40% of patients using virtual services as part of their care.

While telehealth access is still a concern, and some patients will always prefer in-person care, most providers have reported that patients rate their telehealth experiences highly.

Nikki Moll, senior vice president of marketing and communications at Baylor Scott & White Health, said patient satisfaction has risen along with telehealth uptake.

“People are not going to go back,” she said. “I have used our virtual experience and I know I’m not going back as a patient.”

The health system also found a swell of new patients that surprised them, indicating an opportunity for increasing visit volumes and outreach. It sent a single email to all clinic patients and hospital patients going back three years, informing them of an online screening tool that could direct people to virtual visits if needed. It went out to more than 3 million people, some of whom forwarded it.

Of the people who tried the COVID-19 virtual care service, 400,000 were entirely new to Baylor Scott & White.

Future marketing will emphasize those care options, including through more traditional methods like mass media advertising and billboards, Moll said.

“People are not going to go back. I have used our virtual experience and I know I’m not going back as a patient.”

Nikki Moll

Senior vice president of marketing and communications, Baylor Scott & White

Another surprise was the number of city-dwellers eager to use telehealth, the panelists said. Systems that have previously focused on virtual care as a way to reach rural patients may find casting a wider net to be a successful strategy.

The COVID-19 emergency, especially in the early weeks and months of the pandemic’s onset in the United States, pushed health systems over what has been one the stickiest barriers for broader telehealth adoption — reluctant providers.

“They did push back for quite some time on that. They wanted to have that face-to-face contact, which is natural,” Hollenstein said. “But they definitely embraced it at the beginning of the pandemic in March.”

Woods said CVN had a similar experience. “We got a lot of those people, obviously, over the hump quickly,” he said.

Difficulties still exist for wide-scale telehealth use, of course. Woods noted that social and racial inequities are clearly an issue for access. It also remains to be seen how CMS and private payers decide to reimburse for telehealth services once the public health emergency has ended.

Privacy is also a worry, especially as families stay at home together. “We’ve had actually a couple of our clients say they have to conduct their telehealth sessions really in a closet, because that’s the only place they can be alone,” Woods said.

In a separate panel, Atrium Health Chief Physician Executive Scott Rissmiller discussed how the system rolled out its virtual hospital over three weeks to launch in April. The plans were already in place, but the pandemic, as it has with so many things, put the idea into overdrive.

The virtual hospital has had 15,000 patients, 13,000 of whom have been “discharged.” Only 3% have had to seek a higher level of care, Rissmiller said.

Atrium thinks of the hospital as having two floors. One is for more observational care with service like a phone assessment with a nurse. The other is for more acute care, such as monitoring of vitals and home visits from providers.

Rissmiller said he and his colleagues learned they could move “a heck of a lot faster” than they realized before the pandemic hit.

“The silos were completely destroyed,” he said. “People were focused just on trying to care for the patient, as we should be.”

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