How stakeholders are preparing for a new era in digital healthcare

TAKEAWAYS FROM RECENT VIRTUAL CARE EXITS

In the last week of April, two behemoths announced plans to leave the virtual care market, startling stakeholders industrywide.

First, UnitedHealth Group subsidiary Optum closed its virtual care business just three years after its inception. The service provided UnitedHealthcare (UHC) and Surest plan members with virtual access to physicians and nurse practitioners. Then, a few days later, Walmart said it was exiting healthcare altogether, shutting down its 51 health centers and associated virtual care service.

For some digital health stakeholders, these exits point to gaps within the industry that make navigating it so challenging.  

According to Mary Mulcare, MD, chief medical officer at virtual specialty care provider Summus Global, the exits underline the urgent need for a sustainable economic model for virtual specialty care.

“We need to reduce the fractured nature of our healthcare system and increase communication among providers, but the providers need to be supported by the rest of the healthcare system and incentivized by the rest of the healthcare system to be able to do it,” she said. “I think people underestimate the pressures on providers just to keep the lights on financially, and it's not necessarily the providers trying to avoid more work; it's the providers trying to keep their chin above water to be able to provide care for their patients.”

Not only does reimbursement need to catch up with digital health models, but the Walmart and Optum exits also show that digital health players must focus on purpose and integration.

Sameer K. Berry, MD, gastroenterologist and chief medical officer at virtual-first gastrointestinal care clinic Oshi Health, noted that Optum lacked a coherent integration strategy, resulting in a failed execution.   

“We used to work with Optum Virtual Care — the challenge was they had all these in-person care delivery organizations that they own who were all doing virtual, and they weren't integrating Optum Virtual Care with Optum in-person care, which is also doing virtual care…And the takeaway from Optum, in my mind, is if you do telehealth for the sake of doing telehealth, you'll fail.”

He added that one-to-one digitization of in-person care is no longer enough; digital health companies need to establish a purpose-driven virtual care strategy.

Stephanie Lahr, MD, president of artificial intelligence (AI)-powered virtual care platform provider Artisight, echoed Berry, adding that the era of isolated digital health tools and resources is over.

“I mean [isolated tools] might work if all you had was a minor burn injury to your finger…But a lot of medical care is much more complicated than that,” she said. “So having [those tools] sit in an ecosystem that is outside of the health systems that are broadly responsible for [patient care], I think, is part of the challenge. And so, I think as we look at telehealth tools and think about virtual care, it needs to sit somehow inside the [existing healthcare] environment.”

Thus, carving a pathway to success in the digital healthcare arena requires digital health players to examine not only the industry's successes but also its failures and develop strategies informed by both.

NAVIGATING THE EVOLVING DIGITAL HEALTH LANDSCAPE

Numerous factors drive success, or lack thereof, in digital healthcare.

For Lyle Berkowitz, MD, founder and CEO of virtual workforce provider KeyCare, understanding the root of healthcare access and delivery problems will become increasingly essential.

“As we talk to health systems, we're trying to understand their needs so that we can fill that for them… [In] what ways are [they] measuring access? Is it next available appointment? Is it no-shows? Is it the wait time just to call the call center? There are actually a lot of different ways to measure access needs, and we're becoming experts in that,” he said.

The company also aims to address virtual care integration challenges, which is one of the primary reasons KeyCare’s telehealth platform operates within the Epic EMR system. Its goal is to take the burden of treating low-acuity, routine conditions off on-site primary and specialty care physicians so they can care for more complex patients.

However, Berkowitz emphasized that surviving and thriving in the fast-changing digital healthcare arena will require digital health players like KeyCare to scale in various ways.

“We're obviously adding on use cases and value propositions, but we're also adding on technology enhancements to improve efficiency so we can scale,” he said. “We've obviously got ambient AI to improve efficiency, and we're looking at a variety of other technologies — some basic technologies, some very cool technologies — to help ensure we can be as efficient as possible and that we can improve quality over time.”

Artisight is following a similar strategy. Lahr explained that since the company’s executive leadership team comes from healthcare delivery, they are trying to advance technology development using clinical knowledge.

Additionally, Lahr believes that collaboration across the industry will be critical for future success.

“The technology is advancing too quickly to think that [health systems’] IT teams are going to build this on their own,” she said. “So gone are the days of saying, ‘Is there a conversation for health systems around buy or build anymore?’ It's not a conversation.”

Dedicating resources to technology development is not possible for the vast majority of health systems, and as a result, greater collaboration will be essential, with health systems providing technology developers with clinical expertise and the latter offering the former technological resources, she added.

Berry also highlighted the importance of industrywide partnerships, primarily because healthcare is still, at its core, a local business.

“Even the largest healthcare institutions in the country have a relatively tiny market share,” he said. “And so, with that being the case, if you're building a national virtual care delivery organization, you almost have to partner, and you have to be able to understand the local dynamics of that local market, which can only happen through strong partnerships… It's not a one-size-fits-all approach. You can't just say, ‘Oh, I partnered with Mass General, so I'm going to use that blueprint all over the country.’”

Partnering with brick-and-mortar health systems will require digital health companies to understand the local market's value proposition in-depth. As they do so, they must consider where they fit in with that value proposition. According to Berry, their best bet is to identify problems that health systems can’t solve due to a focus on other areas or a lack of resources.

Clinical quality is another critical factor in determining success in the digital healthcare arena. Mulcare noted that volume is no longer more important than value in healthcare, and thus, clinically effective digital tools are non-negotiable. This idea is underscored by a March report by the Peterson Health Technology Institute, which revealed that several digital tools targeting type 2 diabetes did not provide meaningful clinical benefits.

“Quality has become a real big driver for who uses what products and making sure that it's an encounter that people can really walk away satisfied from, understanding what just happened, feeling better educated, and having the guidance that they need beyond just a prescription,” said Mulcare. “And that's so important in the direct-to-consumer market. That's also really important in the peer-to-peer market.”

Despite the shifting digital healthcare landscape and the challenges this new phase will bring, Berkowitz believes there is much to be optimistic about. Health IT innovation is accelerating, transforming healthcare delivery as a whole.

“Let's use all these cool new technologies and blend them and be able to look at virtual care as a whole other way of taking care of patients that can be hyper convenient but also better quality in some ways because of the tools that we can use,” Berkowitz said. “And certainly, scale healthcare in a way we couldn't do in just an office space setting.”