In March 2020, TIL commissioned McKinsey & Company toconduct a report to identify the most promising areas of technology growthwhere Tulsa would have an opportunity to position itself as an economic leader.Through this analysis, our city gained a deeper appreciation for theexceptional and nationally unique assets that position Tulsa as a future leaderin Virtual Health.
With the rapidly shifting healthcare landscape duringCOVID-19, we have been asked what exactly “Virtual Health” means.
Virtual Health meets patients where they are throughsoftware, hardware and software-enabled service models/care episodes. Thesecare episodes can be fully digital, digital-first or hybrid in-person andvirtual experiences.
To understand what Virtual Health means for the future ofmedicine, it is helpful to provide historical context. The concept ofdistributed, readily accessible and technology-enhanced care has beencontemplated by medicine for over 100 years. With each generation, this dreamtook on more and more of the bleeding-edge technology of the time. In 1897, TheLancet published an article contemplating the promise of the telephone toreduce unneeded physician visits. In 1925, Hugo Gernsback predicted the use ofradio to allow physicians to interface with patients remotely and provide care.This was first proposed as a theorized “Teledactyl”, where a physician couldnot only speak and see patients, but also feel them. It would be severaldecades before even a portion of this concept — video calls for patients —would become readily available. In the late 2000s, billions of dollars ininvestments poured into telehealth. Starting in the 2010s, risingsophistication of artificial intelligence and proliferation of smartphones ledto the rise in digital health. Virtual Health exists at the convergence oftelemedicine, digital health and hybrid virtual/in-person care that allows fordecentralized delivery of healthcare. Often, Virtual Health technologists andclinicians understand the importance of combining multiple modalities into asingle care episode.
“The busy doctor, fifty years hence, will not be able tovisit 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 doctorare so important that he should never have to leave his office; on the otherhand, his patients cannot always come to him. This is where the teledactyl anddiagnosis by radio comes in.” — Hugo Gernsback, “Science and Invention”, February1925.
Telemedicine ismost commonly defined as providing the remote presence of a physician for direct interaction with a patient (in recent years, theterm has been broadened to also include consults). However, it does not fully capture the “virtual-first”trend coming down the pipes.
Virtual Health, incontrast, encompasses the plurality of technologies and care models that enablethe decentralization of healthcare. This includes telemedicine, but reachesbeyond 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., MovingAnalytics) and continuous patientengagement strategies to enable a virtual-first clinical workflow.
● 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 bythe American Telemedicine Association (ATA)and the Deloitte Center for Health Solutionshas adopted the more inclusive term “Virtual Health” and providescompelling data on the outlook of this sector for investment and potentialeconomic impact.
o This term is alsogrowing in use on the provider side. For example, Kaiser Permanente usesit when discussingthe future of healthcare and their virtual-firststrategy. "Virtual care is the healthcareof today and tomorrow," said Dr. Paul Minardi, president and executivemedical director of Washington Permanente Medical Group.
o More and more, weare seeing “telemedicine” referred to with quotationmarks, suggesting the term we are familiarwith does not quite match what is happening today. According to this article from HIMSS on the future oftelemedicine, “ … ‘telemedicine’ will get mixed in and mashed up with other ‘standard ways’ ofdelivering care to build wholly new care models from the ground up. We will seetelemedicine combined with all forms of in-person care, combined with remotemonitoring from devices, combined with home-based care. We will see a varietyof new virtual-first healthcare delivery models tested in the coming years, butmust wait to see which models will thrive.”
o In January 2021, the ATA and the Digital Medicine Society announced theyhave jumped on the “virtual-first”/Virtual Health nomenclature with the launch of IMPACT, a pre-competitive collaboration of leading digital healthcompanies, investors, payers and consultants dedicated to supportingvirtual-first medical organizations and their commitments to patient-centriccare.
Until very recently, telehealth and digital health had beenless impactful than previously hoped. In fact, one of the leaders intelehealth, Amwell (formerly known as American Well), was the subject of a 2010Harvard Business Review case study that delved into some of thesignificant policy and reimbursement challenges that hindered their adoption.
In 2016, a Forbes article called 98% of digital healthstartups “the walking dead” — companies with just enough funding to subsist,but no traction to scale and generate returns. In 2019, Neal Khosla published atwo-part article discussing the “DigitalHealth Conundrum” and the $30 billion that funders poured into digital healthfrom 2011-2019 in sales traction and investor returns that had been largelyunrealized.
COVID-19 drastically affected digital health in 2020,however. The rapid and necessary change in policy to allow reimbursement parityfor virtual and in-office services, coupled with the physical necessity to keeppatients out of clinics, resulted in the quick adoption of Virtual Healthsolutions. Currently, Amwell is one of the fastest-growing and most fundedtelehealth companies on the market. Today, we are at the precipice oftechnologies and care models that allow physicians to bridge the gap of thephysical exam.
Building on the momentum of Virtual Health adoption duringthe COVID-19 pandemic, we have a unique opportunity to transform care deliveryand use technology to improve access while reducing costs. When we look athistorically underserved and rural populations, particularly, virtual caremodels and current reimbursement plans for this type of care present afirst-ever opportunity to reimagine care. In order to realize this, the rightcombination of data, hardware, software and care delivery models is critical.