In March 2020, TIL commissioned McKinsey & Company to conduct a report to identify the most promising areas of technology growth where Tulsa would have an opportunity to position itself as an economic leader.Through this analysis, our city gained a deeper appreciation for the exceptional and nationally unique assets that position Tulsa as a future leader in Virtual Health.
With the rapidly shifting healthcare landscape during COVID-19, we have been asked what exactly “Virtual Health” means.
Virtual Health meets patients where they are through software, hardware and software-enabled service models/care episodes. These care episodes can be fully digital, digital-first or hybrid in-person and virtual experiences.
To understand what Virtual Health means for the future of medicine, it is helpful to provide historical context. The concept of distributed, readily accessible and technology-enhanced care has been contemplated by medicine for over 100 years. With each generation, this dream took on more and more of the bleeding-edge technology of the time. In 1897, The Lancet published an article contemplating the promise of the telephone to reduce unneeded physician visits. In 1925, Hugo Gernsback predicted the use of radio to allow physicians to interface with patients remotely and provide care.This was first proposed as a theorized “Teledactyl”, where a physician could not only speak and see patients, but also feel them. It would be several decades before even a portion of this concept — video calls for patients —would become readily available. In the late 2000s, billions of dollars in investments poured into telehealth. Starting in the 2010s, rising sophistication of artificial intelligence and proliferation of smartphones led to the rise in digital health. Virtual Health exists at the convergence of telemedicine, digital health and hybrid virtual/in-person care that allows for decentralized delivery of healthcare. Often, Virtual Health technologists and clinicians understand the importance of combining multiple modalities into a single care episode.
“The busy doctor, fifty years hence, will not be able to visit his patients as he does now. It takes too much time, and he can only, atbest, see a limited number today. Whereas the services of a really big doctor are so important that he should never have to leave his office; on the other hand, his patients cannot always come to him. This is where the teledactyl and diagnosis by radio comes in.” — Hugo Gernsback, “Science and Invention”, February 1925.
Telemedicine is most commonly defined as providing the remote presence of a physician for direct interaction with a patient (in recent years, the term has been broadened to also include consults). However, it does not fully capture the “virtual-first”trend coming down the pipes.
Virtual Health, in contrast, encompasses the plurality of technologies and care models that enable the decentralization of healthcare. This includes telemedicine, but reaches beyond to include other domains like remote patient monitoring (e.g., Phillips new initiatives), hybrid in-person/virtual care models (e.g,. Medically Home), entirely virtual ways of delivering care (e.g., Moving Analytics) and continuous patient engagement strategies to enable a virtual-first clinical workflow.
o The Virtual-First Movement refers to the growing momentum to decentralize healthcare and go “virtual-first”, or have a Virtual Health mindset initially.
o A recent report by the American Telemedicine Association (ATA)and the Deloitte Center for Health Solutions has adopted the more inclusive term “Virtual Health” and providescompelling data on the outlook of this sector for investment and potential economic impact.
o This term is also growing in use on the provider side. For example, Kaiser Permanente uses it when discussing the future of healthcare and their virtual-first strategy. "Virtual care is the healthcare of today and tomorrow," said Dr. Paul Minardi, president and executive medical director of Washington Permanente Medical Group.
o More and more, we are seeing “telemedicine” referred to with quotation marks, suggesting the term we are familiar with does not quite match what is happening today. According to this article from HIMSS on the future of telemedicine, “ … ‘telemedicine’ will get mixed in and mashed up with other ‘standard ways’ of delivering care to build wholly new care models from the ground up. We will see telemedicine combined with all forms of in-person care, combined with remote monitoring from devices, combined with home-based care. We will see a variety of new virtual-first healthcare delivery models tested in the coming years, but must wait to see which models will thrive.”
o In January 2021, the ATA and the Digital Medicine Society announced they have jumped on the “virtual-first”/Virtual Health nomenclature with the launch of IMPACT, a pre-competitive collaboration of leading digital health companies, investors, payers and consultants dedicated to supporting virtual-first medical organizations and their commitments to patient-centric care.
Until very recently, telehealth and digital health had been less impactful than previously hoped. In fact, one of the leaders intelehealth, Amwell (formerly known as American Well), was the subject of a 2010 Harvard Business Review case study that delved into some of the significant policy and reimbursement challenges that hindered their adoption.
In 2016, a Forbes article called 98% of digital health startups “the walking dead” — companies with just enough funding to subsist,but no traction to scale and generate returns. In 2019, Neal Khosla published a two-part article discussing the “DigitalHealth Conundrum” and the $30 billion that funders poured into digital health from 2011-2019 in sales traction and investor returns that had been largely unrealized.
COVID-19 drastically affected digital health in 2020,however. The rapid and necessary change in policy to allow reimbursement parity for virtual and in-office services, coupled with the physical necessity to keep patients out of clinics, resulted in the quick adoption of Virtual Health solutions. Currently, Amwell is one of the fastest-growing and most funded telehealth companies on the market. Today, we are at the precipice of technologies and care models that allow physicians to bridge the gap of the physical exam.
Building on the momentum of Virtual Health adoption during the COVID-19 pandemic, we have a unique opportunity to transform care delivery and use technology to improve access while reducing costs. When we look at historically underserved and rural populations, particularly, virtual care models and current reimbursement plans for this type of care present a first-ever opportunity to reimagine care. In order to realize this, the right combination of data, hardware, software and care delivery models is critical.