How a virtual-first approach can boost patient, provider experience

Four years after the COVID-19 pandemic set off a chain reaction transforming healthcare delivery in America, it has become apparent that virtual care is here to stay; however, it cannot fully replace in-person care delivery. Thus, healthcare providers are turning to hybrid care models that weave virtual and in-person care services together to meet the demand for convenient care access among healthcare consumers.

Research reveals that though telehealth use is down compared to peak utilization during the pandemic, the United States healthcare consumer returns to telehealth repeatedly for the convenience and expanded care access it offers.

A recent study published in The American Journal of Managed Care showed that convenience was a key motivation for most United States adults (65.7 percent) to use telehealth. The study, which analyzed survey responses from 5,317 adults, also showed that telehealth users primarily received care for minor or acute illnesses (30.4 percent) and chronic disease management (21.5 percent).

At Tufts Medicine, the ongoing effort to meet healthcare consumer needs in the post-public health emergency era has resulted in the launch of a new virtual-first initiative. The initiative provides patients with a virtual entry point into the health system with escalation to in-person care if necessary.  

“The key to good patient care is to have an unmatched patient experience,” said Frank Osborn, MD, chief medical officer of ambulatory care at Tufts Medicine, in an interview with mHealthIntelligence. “I think there's a subset of patients who are craving a different experience and an immediate experience throughout the marketplace.”

The initiative's cornerstone is a digital personal assistant available through the MyTuftsMed mobile application. The digital assistant performs triage functions, helping users decide how and when to seek care.

For instance, if a patient reports symptoms in line with depression, the digital personal assistant will conduct a depression screening and determine whether the patient is also at risk of other mental health concerns like suicidal ideation.

“It's [based on] the algorithmic triaging books that everyone is supposed to have for their triage nurses in their office,” Osborn said. “It's quantified there and layered on with some AI [artificial intelligence] capabilities to help make that process thorough. That is a full soup-to-nuts capability.”

In April, users will also be able to use the tool to virtually consult with a clinician and connect to in-person care when needed. Osborn noted there will be a seamless handoff between the digital personal assistant and clinician when this capability is launched.

Tufts Medicine partnered with Clearstep and Curai Health for the virtual-first initiative, with Clearstep powering the triage functionality and Curai Health providing virtual primary and urgent care.

Osborn explained that after going through the triage process, patients would either be connected to Curai for virtual care or Tufts Medicine brick-and-mortar facilities for in-person care.

AI will play a critical role in the virtual-first initiative, with Osbron stating that it will support more realistic interactions and provide emotional engagement that helps boost patient satisfaction.

“We're also building out that [AI] capability to know the patient, much like Amazon, as they come in,” he added. “We should know if they're our patient or not our patient, we should know their gender, we should know their allergies, we should know those other things that make it as seamless and easy as possible for the patient.”

Further, the initiative aims to prioritize health equity. However, Osborn believes that health equity issues can only effectively be addressed once patients are using the tool. He emphasized that rather than trying to anticipate health inequities and build solutions based on assumptions, it is better to encounter the problems and solve them in a targeted way.

The virtual-first initiative goes beyond creating a seamless and satisfying patient experience to focus on the other side of the healthcare equation: the clinical teams.

According to Osborn, using the digital personal assistant and virtual provider network will enable patients to seek the right level of care at the right time, freeing time and resources on the provider side and allowing clinicians to work at the top of their license.

“The impetus to do this is, much like Uber or Lyft or something, is this is going to be a way we can flex capacity for our PCPs [primary care providers] in our community so that they're able to have larger panels and really take care of patients with good quality and efficient care,” he said.

However, getting physician buy-in for the virtual-first initiative was challenging. While some physicians were on board from the jump, others had to be brought around to the idea, Osborn said.

For example, one PCP told Osborn that he felt using virtual-first options would result in him losing business. Osborn explained that a virtual-first approach would, in fact, help keep patients within the system by allowing patients to seek care as it suits them best.

“We often talk about insurance companies trying to disintermediate primary care physicians and physicians in general, and us, kind of, disrupting from within is another opportunity to stop that disintermediation,” he said.

As the virtual-first initiative ramps up, Tufts Medicine plans to use the data it generates from the initial use of the digital services to determine strategies for scaling.

Osborn pointed to the airline industry as the inspiration behind this approach. In the 60s, Pan American World Airways (Pan Am) was the top dog. Still, it subsequently went out of business after American Airlines revolutionized the airline ticketing process by launching a new software product for buying tickets.

“So, as we're ingesting [early use] information, it's going to better allow us to understand how our patients utilize this service, what are their demographics, who they are, and I think that's going to give us the focus on how we really grow that product and make sure we're delivering to our consumers,” Osborn said.

The health system also plans to partner with an insurance company to grow the virtual-first initiative. The ultimate goal is to help bend the cost curve, giving patients “better value and accessibility in a way that they want,” he added.

The digital health landscape, though not without its challenges, is an exciting one. For Osborn, the virtual-first initiative is part of the unexplored territories within the landscape, meaning that Tufts Medicine can play a vital role in assessing the approach, how best to implement it, and how to expand it.

“The exciting part is being able to work on that [initiative], and figure out where does it excel? What are its limitations, and where does it go?” Osborn said.