According to the Digital Medicine Society, “virtual first medical care combines digital medicine, communications technology, and clinical expertise for patient-centered healthcare.” Virtual first care is care that is accessed virtually first, in place of an in-person encounter.
Components of a virtual first healthcare program can include the use of biometric and sensor technologies like smart devices and wearables, connected (Bluetooth and cellular) medical devices, telemedicine calls, asynchronous communication with clinical providers like messaging and image sharing, synchronous communication like two-way / real time chat, personalized educational content and delivery, interdisciplinary care team collaboration, patient generated health data like symptom surveys, at home lab testing / specimen collection, prescription of medications or digital therapeutics, caregiver supports, and patient technical support.
Virtual-first care technology solutions can be used to maximize patient engagement, increase access to care, and enhance clinical decision making. A virtual first approach provides additional benefits for healthcare organizations by relieving workflow pressure on limited clinical staff, while also helping patients with challenging transportation logistics or reducing unnecessary travel.
A recent survey by McKinsey & Company found that virtual care use has stabilized at a level 38 times higher compared to the pre-pandemic baseline. This same survey found that 40% of individuals believe they will continue to use virtual care moving forward, and 40–60% expressed interest in utilizing additional virtual care solutions. This drastic adoption, and continued interest in utilizing virtual care, is reshaping healthcare delivery, and demonstrates a shift in consumer care preferences.
Virtual care has the potential to provide early insights in patient health status and situational awareness of the environment for optimized decision making. When monitoring large populations of patients, signals can help identify patients in need of care and attention. This first step is necessary to provide “just in time care,” proactive, early interventions. These alerts allow patients to receive care before their conditions become so exacerbated they need a higher level of care, like an ED visit / hospitalization.
Virtual care throughout the care continuum
Patients can benefit from virtual first care and virtual care tools - throughout various stages of health, as they move through the care continuum.
Digital health technologies can be leveraged across the care continuum, beginning with preventative care and moving through chronic care and medical incidents that may involve post-acute care monitoring, or transitional and long term care.
With a growing interest and demand for virtual care tools and care models, we’ve outlined solutions that can be leveraged at different levels of care. Using the appropriate types of solutions and interventions, at the appropriate level of care, is important for maintaining a positive ROI, sustaining patient engagement, and enabling population health management at scale.
Preventative Care
Technology enables us to monitor patient health, engage individuals in their self-management, enroll them in care programs and provide education to help prevent the onset of disease, and help determine which individuals are becoming at risk of developing issues and conditions.
Digital health tools used at this level of care can include; mobile apps that patients can download to their personal devices to monitor biometrics, diet, activity levels, evidence based education programs that can be completed virtually like the diabetes prevention program (DPP), and wearables and sensors that passively capture continuous data.
Chronic Care
The prevalence of chronic conditions is high, with more than 50% of adults aged 18+ having been diagnosed with at least one chronic condition, and nearly 30% of this group diagnosed with 2 or more chronic conditions. Patients play the main role in managing their care, and those with chronic conditions have significant commitments to healthy lifestyle behaviors they need to adhere to, as well as the requirement to follow treatment plans closely. Therefore, it is extremely vital to support patients with tools and resources to be successful.
Leveraging remote patient monitoring technology enables patients to track their measurement readings for trends, patterns, and if they see an abnormal reading, they can reflect on what may have caused the abnormality, and proceed to change their behavior in the future. The data captured can also be shared with clinicians to support the patient between in person visits, adjust therapy remotely, and make in person visits more impactful.
Understanding a patient’s comfort level with technology is key to identifying and deploying the appropriate technology solution for a patient to use, and ease of use will help ensure adherence to using the remote monitoring technology. Functionality options range from more complete systems with telemedicine capabilities, medication adherence reminders, patient education pathways, etc. – to more simplified solutions with functionality that operates passively (“hands off”) capturing biometric data and transmitting to patients and providers for review and monitoring. You can monitor a patient’s ability to self-manage, and adjust the level of support provided, and the technology solution / feature mix the patient utilizes, as needed.
Arming patients with the ability to monitor and reflect is key to self-care maintenance, and long-term behavior change.
Hospital at Home
During the COVID-19 pandemic, in response to capacity concerns / constraints at hospitals, CMS created the Acute Hospital Care at Home Waiver. The waiver program was recently extended to the end of 2024. Hospitals must complete an application process and CMS determines whether the hospital can deliver services under the program safely. You can see a list of participating hospitals, here. As of March 2023, 277 hospitals are approved to participate in the program.
According to the department of HHS, “acute care delivery at home allows for in-home, hospital quality medical care to be administered to interested patients with qualifying acute conditions, instead of admission as an inpatient at a hospital.”
The waiver program allows hospitals to waive the 24-hour on-site nursing requirement, however, there are still requirements that must be met such as multiple in person visits daily by nurses or paramedics, having a physician or APP evaluate the patient daily, and the ability to respond to decompensation within 30 minutes. There is also a requirement to capture patient vitals, and while this can be intermittent or continuous, remote monitoring technology would assist with meeting this requirement. Another requirement includes the capability of immediate, on-demand remote audio connection with a team member who can immediately connect either an RN or MD to the patient. Patients may not have this type of technology in their home, and telehealth solutions can provide the connectivity and the functionality to meet these demands.
Post-Acute Care Monitoring / High Risk Monitoring
Post-acute care monitoring, hospital at home, and monitoring of patients with complex conditions, or complex care needs may require a higher level of clinical monitoring, with more specialized technology capabilities and functionality. These programs can include short term monitoring, for example, monitoring CHF patients post-discharge during the window of time they are most likely to experience a readmittance, or longer term, for example, patients with complex care needs and high costs.
Technology solutions that can be leveraged for these types of care programs can include solutions with two-way video and calling capabilities to facilitate visits with a patient’s provider, the capture of continuous or spot capture biometrics, passive activity level monitoring, educational content, daily symptom and health surveys, medication and appointment reminders, fall detection, personal emergency response systems, in-home care visits and programming, and more.
Long Term Care
While most long-term care is provided at home by family and friends, it can also be provided in a facility such as a nursing home. For this group, digital health technologies can help limit the need for in person oversight, enable individuals to remain independent longer, and keep family and caregivers involved and informed in an individual’s health status.
An individual's home, or a nursing home / long term care facility may lack the necessary technology support, such as wireless connectivity, to implement remote monitoring services internally. Virtual care solution vendors can provide the necessary training, support, and technology to provide individuals with personalized solutions that support their independence, and enable virtual oversight by clinicians, family, and friends.
Summary
A virtual first approach to connecting with patients at home can be implemented throughout the care continuum, with many benefits, including convenience, proactive care models, mitigating staffing shortages, enhanced data insights for better and faster clinical decision making, new revenue opportunities, and more.
While there are many technology options to enable virtual first care available, using the appropriate solution and interventions, at the appropriate level of care, is vitally important for maintaining a positive ROI, creating a sustainable program, promoting patient engagement, and enabling virtual care at scale.
Direct payment available through CPT codes to providers for offering virtual care programs like chronic care management (CCM) and remote physiologic monitoring (RPM) services is available, making it more feasible than ever for providers and health systems to implement these types of technology solutions and on-going care programs that enhance care for patients. While direct reimbursement is available, these types of programs can also assist with quality and value based care metrics that have some bearing on reimbursement, or help to avoid penalties and save costs for those under other types of at-risk care models.
Mobile First Care
Mobile first health care is a first stop to provide care in the comfort of a patient’s home, utilizing trained professionals, such as paramedics, to administer care that would otherwise require a visit to a facility. These types of services extend the traditional brick and mortar healthcare system by providing high quality, affordable care, bridging a gap between physical and virtual care. This enables ultimate efficiency, appropriate utilization of care resources, and convenience.
Virtual first care, together with mobile first care capabilities, results in care delivery transformation. Both work hand in hand to enable care to be delivered outside of the traditional care setting. With early insights from virtual care, mobile healthcare staff can deliver just in time care visits, based on acuity of patient needs, and treat those patients on the spot, or triage to an appropriate level of care.
Life365 Solutions for Virtual First Care throughout the Care Continuum
Life365 Health -
Life365 Health, a division of Life365, Inc., makes it easy for healthcare providers to deploy remote care solutions, gather actionable data, and manage patients remotely. One solution does not fit every patient, and the Life365 suite of patient connectivity options are aligned to meet the needs of patients from chronic care to high risk monitoring. Nearly 60% of US adults have at least one chronic condition, which accounts for 90% of healthcare spending. There is a large population that can benefit from virtual care tools and on-going support, and when solutions are aligned to the appropriate risk level, they can produce positive outcomes for patients and for the bottom line.
LifeConnect -
LifeConnect is a division of Life365, Inc. that develops smart health technology that is light, wearable, and eventually unseen, and includes wearables, patches, and sensors. These options are extremely beneficial for connecting patients and providers beyond traditional points of care, touching large populations of patients or members, and gaining insights from cost effective data. While these types of solutions can be leveraged across the care continuum, the price point and intervention level is appropriately aligned for those needing / wanting additional support for preventative care and chronic care. These solutions can be leveraged to collect behavioral and physical data, that can be fed to AI systems, at a fraction of the cost of more expensive systems and solutions.
avixena -
Integrated to the Life365 platform is avixena. avixena’s cloud-based platform enables hospitals, extended care facilities, health plans, and other risk-bearing entities to assess methodically and systematically the risk of each individual patient using patent-pending, field-tested, decision support platforms and integrated tools. avixena is the first of its kind to incorporate and quantify the impact of social determinants of health on readmissions. These tools can be used for patients across the care continuum, including post discharge to determine readmission risk, care transition assessments, as well as home and community assessments for continuity of care.
Integrating Platforms
One major way in which healthcare organizations and clinicians can simplify workflows for providing virtual first care is by streamlining the technology and administrative processes associated with offering virtual care. Life365’s interoperability engine allows Life365 to deliver patient data directly to an existing EMR or software system, or pass data to an integrated partner platform like Microsoft cloud for Healthcare.
For example, Life365 provides solutions on top of the Microsoft Cloud for Healthcare (MC4H) platform, enabling healthcare organizations to provide a virtual first approach to connecting with patients at home and access to more than 400 medical devices intended for home care.
Collecting data from patients at home can then fuel the AI / machine learning systems within (MC4H). AI can analyze data to streamline workflows, reduce staff burden, triage patient data, provide immediate feedback to patients, and more.
One way in which Life365’s solutions are leveraged, is through Teams on FHIR, the MS Teams application for secure healthcare communication and workflows. Teams connects to the Azure Cloud FHIR server, which can connect to an electronic health record system.
Queues can be created within Teams to manage tasks and data. Machine learning in the MC4H system will begin to be able to appropriately route tasks and data to the appropriate queue folder. This removes manual work for care providers, making workflows more efficient.
Capturing this type of data is the necessary missing piece to provide longitudinal views of patient health and care over time, allowing MC4H to align data “signals” to symptoms and events.
Integrating platforms can be a powerful tool, it can reduce manual work for clinicians, improve workflow efficiencies, and drive scalability for virtual care.