Integrated Healthcare Executive Source | Comments by Matt Zavadsky
Interesting pearls for EMS leaders here – Especially regarding the public’s desire for care in the home, patient navigation and telehealth.
Historical note – “Integrated Healthcare Executive” was a newsletter founded by former EMS World/HMP leader, Scott Cravens and EMS leaders like Dr. Jeff Beeson, Dr. Brent Myers and others.
In their “About Us”, they reference EMS as a component of IHE magazine:
Founded in 2013, Integrated Healthcare Executive (formerly Integrated Healthcare Delivery) profiles leaders and chronicles innovations in the rapidly evolving field of integrated healthcare. It offers insights, analysis and actionable takeaways on key leadership concerns, including patient care, technology, business and regulatory compliance, with an emphasis on nonhospital provider organizations: skilled nursing, home health, hospice, assisted living, EMS, pharmacy, rehab, physical therapy, behavioral health and more.
Patient Telehealth Preferences During and After the COVID-19 Pandemic
Benjamin Isgur, Health Research Institute (HRI) leader at PwC, discusses an HRI survey that analyzed telehealth trends during the pandemic, with an emphasis on what virtual services consumers want most and how the industry might adjust care models to patient preferences.
Can you talk about PwC’s HRI survey? What did it examine and what was learned? Were any of the survey findings surprising?
Consumer sentiment is really important to us. We have been looking at consumer sentiment for the past 15 years in the Health Research Institute. Because after all, for a long time, it seemed like the health system wasn't built around what consumers want and needs are.
The pandemic has been a special case because it's accelerated a lot of trends, but then also brought up some pretty big gaps in the health system. One of the things that we saw from our latest survey is around consumers being bullish about receiving more of their care at home.
This is something that's been talked about for a long time in the health system, that we actually need to provide care closer to where people live. We've seen that to a certain extent, but the pandemic has made it clear we also have to have the ability to bring services all the way into their homes.
There was an incredible need for that, of course, because of the pandemic and many of our—especially if we go back a year ago, in the spring, many of our health organizations had to reduce capacity and utilization in order or to keep people safe from COVID. We saw a lot of movement toward virtual health, telehealth, and other sites of care.
The home is no exception to that. In fact, 13% of consumers said that being able to receive care at their homes would make them feel most comfortable about rescheduling care they had put off during the pandemic.
We asked like, "What would you be willing to do in terms of a do‑it‑yourself care or care at your home?" Eighty-five percent of consumers said they'd be willing to have a DIY strep test, flu test, or remote monitoring. Testing is something really important for consumers to be able to do at home.
Seventy-eight percent of consumers said that they would like to have their chronic care management visits in their home. Seventy-seven percent said a sick visit or some sort of a visit around an injury, they would like to have that at home.
And 75% said that they would like a wellness visit or physical to be able to happen at home. A lot of very clear sentiment from consumers they want more of their care at home.
What should health plans and providers do to increase care opportunities and deliver more cost-effective care?
When we talk about the home, some of that would be in person, but a lot of that is virtual. I think if we talk about what can providers do to close those gaps for virtual.
First of all, we saw a huge increase in the amount of virtual care in the early stages of the pandemic. Some of that is leveling off now that people can go back to in person and going forward, we'll see a hybrid model.
We'll see a certain amount of care that makes sense to be in person, that'll stay in person. Then a lot of care that can be moved virtually will continue to be virtual or maybe increase. There's some great examples of that, like mental and behavioral health visits, those being done remotely. They make a lot of sense because consumers want it and like it.
In fact, clinicians and health leaders tell us that they're seeing lower no show rates for mental health appointments when they're being done virtually. That's just one example, but what does that mean for health leaders thinking about their virtual health offerings?
There's definitely some gaps in the system. Not everyone has great technology at home. In fact, some of our previous consumer surveys have shown that there are technical challenges around it. More than half of consumers said that they had some issue with a telehealth or virtual health visit. Some of it was technical, like I mentioned.
Some of it, though, is just care navigation. They don't know where to go after the virtual visit. How can they get connected to those ancillary services they may need, such as getting an MRI, or an X‑ray, or getting lab tests? I think there is a danger as we move to more virtual that we don't create silos and we don't forget that we need good handoffs.
For health leaders, that means that's something they're going to need to invest in. Not just a virtual health platform and keeping their customers and market in the loop, but they also have to invest in that care navigation and the warm handoffs between a virtual service and the times we need an in‑person service.
Overall, what can professionals take away from this survey? How will the findings help improve the future of care?
One thing that professionals can take away from the survey is that it's very obvious that the way care is going to be delivered is changing. We're moving into an incredible hybrid model. There's more ways than ever, there's more front doors than there ever have been, to receive care, for consumers.
Let me give you just a couple of examples of that, what we're seeing in terms of our consumer survey. Virtual visits, as I mentioned before, a lot of growth, 97% growth, over the last year in terms of virtual visits. Urgent care visits, almost 20% growth over the last year. Retail clinic visits, over 40% growth over the last year.
What that mean is we've created our many front doors to health care. There's a lot of places for consumers to go. If you're a health care leader, you have to make sure that you're providing the best experience, that you're providing good handoffs, that you're providing great navigation, that people are going to the appropriate place.
That's a big issue that's not often thought about. You could frustrate consumers if they think they can get something done virtually that actually should never have been done virtually, it needs to be done in person. That's something to consider. When you've got a lot of front doors, how are you communicating to patients and consumers about which front door they should use in which case?
When they get there and they're using those services, how do you communicate to them where they need to go next so they feel like they've got great care management? A lot of work to be done there.
The other thing I would bring up is we have to be careful that we don't leave people behind in terms of all of this technology. Not everyone has great bandwidth, or not everyone has great smart devices at their fingertips. In fact we've seen some companies invest in the social determinants of health and really helping people in underserved communities get this technology.
We've seen examples of payers who are providing smart tablets for some of their members so that they have access, have one‑click access, to telehealth services. Thinking outside the box in terms of what people need, it's going to be important so that we don't leave people behind.
Do you think care has forever changed following the pandemic, or do you see certain aspects going back to the way it was?
That's a really good question. The answer is yes. Not everything is going to be made for telehealth, or virtual health, or at home visits, or these distributed visits in different parts of the health system. There will be a giant sifting and sorting that will happen over the next year of figuring out where people get the best care.
Let me give you an example of that. As part of our research, we did some field interviews with providers. One of the providers I spoke to runs a large physical therapy clinic. When the pandemic was shutting things down, about a year ago, they attempted to move to virtual visits.
I know that seems tough, right? A physical therapy visit, how do you do that virtually? They set up a system where they can have a physical therapist in one location, with cameras, and then the patient in their home with a camera and smartphone so they can go through the evaluation and the exercises and the range of motion and do that together, but virtually.
What they found was that's pretty difficult. Not impossible, but it is pretty difficult. The other thing they found is for physical therapy and rehabilitation, a lot of people like to do that in a group setting. They need the camaraderie.
For some physical therapy, it's fine to do those exercises at home and alone or at least with some instruction, but for other types of physical therapy, the journey actually requires camaraderie, and it requires having other people in the room and helping people to achieve that.
It's just one tiny example of, there will not be a one size fits all. That we actually need to go through each of the care modalities and figure out what which makes sense for which type of visit.
Also, even dig a little bit deeper because we may find somewhere consumers are split. Certain consumers may want a virtual visit while others want to do it in person because that's just their personal preference.
Is there anything else you want to add to the conversation?
The other thing that I would just add because it's on people's minds right now is about the vaccinations, because that's a big part of the pandemic. The vaccinations are going on right now, and I think it does bring up this concept of consumer preference.
One of the things that we looked at is, where do people want to get vaccinated? There's a split. We saw a split in terms of age between people preferring to get vaccinated at a retail clinic, or urgent care center, or retail pharmacy versus a doctor's office. As we got to the older age cohorts, the preference leaned more towards the doctor's office and those other alternative sites of care.
We saw some other differences based on race. Without diving into all of it, I would just say even with the vaccine distribution, if we want to get to higher percentages of Americans vaccinated, we're going to have to look at the modality.
Where do people want to get those vaccines, and we need to meet consumers where they are. Again, another example right here, a very important one, of how consumer preference is going to drive that way the health system is being set up.
PwC Health Research Institute. Consumer health behavior and the COVID-19 pandemic: What we've learned. PwC; 2021. Accessed June 16, 2021. https://www.pwc.com/us/en/industries/health-industries/library/assets/hri-2021-consumer-survey-Insight-chartpack.pdf