In a captivating episode of the Edelheit Experience podcast, Chairman and Co-founder of Global Healthcare Resources, Jonathan Edelheit, sat with Kate Brown, head of Mercer's Center for Health Innovation, to discuss the latest trends and disruptive innovations in the employer-sponsored healthcare space.
Kate Brown is an expert in managing and improving employee population health through corporate wellness initiatives and also holds a master's degree in kinesiology and a Certified Employee Benefit Specialist (CEBS) designation. She is also a speaker at this year's Healthcare Revolution conference, the nation's largest event for self-funded employer healthcare, benefits, and well-being. Register for free to learn how the top employers in the country are working their way to the conference's 3 moonshots:
1) Reduce employer healthcare and benefits costs by 25% by 2025.
2) Reimagine engagement and well-being.
3) Provide 40% of healthcare services virtually and through technology by 2025.
Jonathan: Could you give us some brief background about who Kate Brown is?
Kate: I lead the Center for Health Innovation at Mercer within our US health business. I have been in an innovation role for Mercer for about four years. Prior to that, I was a Total Health Management consultant, which, in Mercer parlance, is similar to population health management from the employer side of things, and before that, I was getting a master's degree in kinesiology.
Jonathan: One of the most innovative changes in healthcare is the acceleration of virtual care; could you tell us more about this?
Kate: I think since the coronavirus pandemic, everybody who has paid attention or even has lived life during this period has probably had some sort of interaction with a virtual care experience. We've seen huge upticks in the use of telemedicine and virtual visits for seeking healthcare. I believe one good thing that came out of COVID is that we've realized that you don't necessarily always have to be in a brick-and-mortar setting in order to receive appropriate care.
We've also seen that virtual care is starting to encompass things that employers previously would call point solutions. So when you think about the different digital health companies that are focused on specific conditions or specific condition management protocols, all of that also falls into virtual care delivery. Virtual care also offers bigger, disruptive opportunities in the employer setting as it is scalable and provides wider access to more people.
Jonathan: What is the difference between virtual care and virtual-first care?
Kate: I love that question. If you read about virtual care, you'll see a lot of different terminologies. In part, that's because, as I mentioned, digital healthcare is at its early stages. There aren't a lot of formal definitions around this space, so everybody's trying to plant a flag and figure out what virtual care and virtual-first care are.
Virtual first-care, however, has a formal definition that was put together by a group called Impact, a coalition that was formed by the Digital Medicine Society and the American Telemedicine Association, and with which Mercer is involved. The group defines virtual first care as medical care for individuals or a community accessed through digital interactions guided by a clinician and integrated into a person's everyday life. So although this is a succinct, one-sentence definition, it describes a lot of the things that are already happening in digital health. However, the struggle today is that most of those digital health companies I mentioned that deliver virtual care, say for a specific condition, are all fragmented.
Jonathan: You just mentioned "fragmented." Could you give more insight into that phenomenon and the impact of fragmentation in care delivered virtually?
Kate: I'll take it from a patient perspective. Suppose a patient has coverage through a carrier but also has point solutions or digital health solutions for managing diabetes, cardiovascular issues, or their behavioral health needs. In that case, the employer might have set it up so that they have a different company that's specifically focused on each of those conditions. So if you're a patient who has those comorbid conditions altogether, you don't necessarily know what the right front door is for you to get your needs met. That fragmentation comes out because you might get into one front door but not be able to go to a side door to access a related solution for you. You might have to go back outside and find a different door. So that's what I meant by the fragmentation in virtual care, at least from a patient perspective.
Jonathan: What do you think are the risks or challenges of this fragmented system of virtual care with multiple companies providing different solutions for one patient?
Kate: Certainly, if the patient data isn't shared across those entities on a patient-specific basis, you run the risk of poor outcomes and medical mismanagement. A lot of those issues could actually be solved if health records were actually owned and organized by the patient rather than by the entities that are managing that individual's health or a specific condition. That's not how it exists today. Today, all of the data exists in silos. And so if the data are not shared appropriately, and if there's not usually somebody looking holistically across the patient, all of the risks of poor patient outcomes, poor treatment, and unnecessary treatment are possible.
The other thing that's important from an employer perspective and, to a certain extent, a patient perspective, depending on what plan they're enrolled in, is duplicative cost. If employees are getting services from one provider that's being duplicated in another place, that's unnecessary spending and not good for the system.
Noncompliance is another factor that we see within the consumer patient population, which is driven by the confusion caused by the multiplicity of solutions. If you don't know where to go when you need a certain type of care for a specific condition, you're more likely to just not take action, and you get lost in trying to navigate it all.
Certainly, there are solutions out there trying to stitch those point solutions together and create a better-navigated experience and a concierge-level experience. To some extent, we've seen success with those solutions.
To solve this problem at an organizational level, employers with multiple vendors should audit and understand how their vendors work together and integrate their processes. However, the challenge here is that a lot of these companies are relatively new and don't have the infrastructure to integrate these systems on behalf of some of these employers. But from what I've seen, there are currently a lot of efforts in the market to integrate data and drive interoperability.
Jonathan: In regards to virtual-first care, how big of a focus and how important is user engagement?
Kate: The focus on consumer preference and consumer engagement as opposed to patient engagement is definitely an important thing that we're watching. It's something that the disruptors are more focused on than the traditional carrier incumbents basically because they come from a different place philosophically. For instance, if you're one of these startup companies, particularly if you started in the direct-to-consumer space, your focus on engaging people will be different from an insurance carrier.
Regardless, I do think that for these types of solutions to be effective and to deliver on all of the promises that they make around better quality, better outcomes, lower cost of care, and therefore more efficient care delivery; people have to actually use the systems and use them appropriately. So the engagement piece can't be undersold at all. That's why there's so much attention on the Googles, the Apples, and the Amazons of the world getting into this space because they clearly have a big advantage from a consumer engagement perspective. It's only a matter of time until they figure out what exactly is happening within healthcare and start to crack that nut as well. That's a big threat to the existing healthcare ecosystem.
Jonathan: With the virtual-first care solutions intersecting with traditional health plan offerings and how they've been offered in the past, what does that mean for healthcare?
Kate: Yes, we are starting to see more of this fusion happen. For instance, we're seeing the emergence of virtual primary care, which essentially is when you access your primary care physician via virtual means. And oftentimes that primary care physician you'll never need to see in person, you'll get your care provided via an app or via video chat, and then if you need to be referred to a specialist or need to be referred for in-person care, you're directed to a physician.
Typically this plan is within a network that those physicians are already partnered with. A lot of the carriers have made announcements about these types of plans. Over the last few months, we know Aetna's doing something with Teledoc. We know UHC is launching a pilot. Kaiser is another example of an integrated delivery system with their doctors being the providers themselves. Nonetheless, we're starting to see the carriers realize that the trend of the last couple of years of virtual visits wasn't just a temporary thing. It really represents a new care delivery mechanism that should be paired with traditional health plans.
Kate: Personally, I'm excited. I think that it'll do a lot from a convenience and access perspective. For instance, when you need to seek care today, you can have a telemedicine vendor that you can see for an acute issue immediately. Further, you can have access to the same provider every time, which is a nice feature for those who might not have a lot of health concerns, but maybe occasionally need something. Knowing that they're going to see this same virtual care team and that their health records are all going to be there and accessible by the providers is a great thing from the customer's perspective.
Further, we have seen a lot of rural hospital systems closing. As healthcare providers move out of some of those rural facilities, there's lower access in the community. However, virtual visits could solve some of that problem and bridge the gap in healthcare access in these areas.
Jonathan: What do you think could go wrong with this new model?
Kate: As optimistic as I am about virtual care, I think we have to watch carefully and try to influence what goes on from a cost perspective. Cost and associated cost savings are a big unknown here. These virtual care plans are, in some cases, in the pilot stage for a year. Others are just launching. We're seeing that a lot of the carriers are saying that these virtual-first plans will yield savings, but we don't really have the real-world data yet to back that up.
Therefore, the risk is that these plans aren't structured appropriately in terms of reimbursement for virtual visits versus in-person. If they're not structured appropriately in terms of engaging the right people to use the plans, then there's the potential that those cost savings that they're projecting may not come to pass. And certainly, we're a country that doesn't need to add any additional cost into the healthcare system.
The other factor that could influence the success of this virtual-traditional model is the cost structure between in-person visits versus virtual visits. If not done appropriately, you could risk that being a duplicative spend. If somebody goes to the virtual visit, for example, and virtual care can't solve their problem, they get referred and basically pay twice for the same medical need. That's another case that would not be so good. So it will be interesting to see how some of these carriers think about addressing that. I think this is a big opportunity for bundled pricing and value-based care models because, ultimately, those are shifting away from the fee-for-service model that clearly doesn't work.
Jonathan: Will the cost be cheaper for virtual versus in-person? I've heard some employers complain that they're being charged the same amount for virtual as in-person instead of paying less.
Kate: Yes. It's a hot point of contention right now. From an employer perspective, if a visit is shorter and it doesn't require the same brick-and-mortar infrastructure, and it doesn't require the same office staff to make sure that the visit is proceeding as planned, then there are fewer costs associated with that virtual visit than in-person. Consequently, they should be charged less. However, the perspective is different from the provider community. The providers feel it is still the same time that they're spending with patients, and it shouldn't matter whether that care is delivered in-person or virtually because the whole argument is that the quality should be the same or better.
Again, I believe that bundled pricing arrangements would be ideal for addressing this. If you're a patient and you go to a virtual visit, and that need can't be resolved, you have to go to in-person care rather than getting charged every single time interact with the care system as it's set up today. If instead we looked at it from a holistic perspective and said, for instance, for this ear infection, regardless of what the touchpoints were, this is the rate that you pay to get it treated. That's an ideal model. That's where I hope this goes, but we have a lot of work between here and there.
Jonathan: Now, if we fast forward to the future to 20 or 30 years from now, what do virtual-first care and virtual health plans look like for everyone?
Kate: It may be hard to tell, but I believe that healthcare systems in every state here in the United States are going to adopt some sort of virtual component. And it won't just involve connecting patients with some random provider as most brick-and-mortar providers will be the ones delivering the virtual visits. So it's a bit of a jump from where we are today, where it's bifurcated. If you have a primary care physician with whom you have a relationship, you would probably prefer to see that provider virtually, and during COVID, we saw a lot of that, but some of that has shifted back. By 2030, it will be really upon the patient's choice to schedule a virtual visit with their regular, everyday doctor instead of driving miles to see them.
In the next ten years, I also see employers driving the de-fragmentation of digital healthcare to optimize patient care and cost savings. Employers will get out of that game and get carriers to become the conveners of these different digital health companies for all of these different solutions. Employers will change the narrative and ask these carriers to build the infrastructure to integrate patient data flow so that the user experience from a healthcare perspective is as comprehensive and easy as possible rather than having HR teams across the country try to do this same work over and over again.
Jonathan: Now, are there other digital trends you're watching?
Kate: Yes, remote patient monitoring is definitely something I'm watching and, in particular, combined with the end-of-care at home. So this is something that has popped up much more in Medicare space than it has in the commercial population just yet. But I think there's this recognition that using remote patient monitoring technology enables people to receive a lot more care at home than they did previously. That's an interesting shift. As I mentioned earlier, during COVID, a lot of stuff happened at home, right; a lot of care delivery happened at home, but it's built on older systems of care and because we were responding to what was going on with the pandemic and what we had in front of us.
Going forward, the deployment of RPM or remote patient monitoring technology in a built-for-purpose standpoint for care delivery at home holds huge potential, especially for the senior population. Therefore, seniors do not have to travel a long distance for a follow-up, and their caregivers don't have to go through that stress to seek medical care for them either. So knowing that you could seek medical care either for yourself or for the person you're caring for without leaving your home is a big area of growth regardless of the population we're talking about.
Jonathan: Would you say that the COVID pandemic will influence massive investment in virtual care in the future?
Kate: The pandemic definitely came with intense fear, deaths, and disease, but a big silver lining from where I'm sitting is that a lot of people have realized that you can do things differently and the world won't implode, and that to me is kind of the most encouraging thing. It's been a huge opportunity for us to try and do things differently within the healthcare system, and there's a lot more openness and appetite for that because the circumstances have dictated. This has driven the massive adoption and acceleration of virtual care and would also stimulate more investments in this area.
Further, another silver lining that's come out of the pandemic is increasing mental health support. More employers, in particular, have recognized that mental health is something that everybody has and everybody needs to manage. And so, we've seen corresponding growth in that space.
Jonathan: Any final words of wisdom before you go?
Kate: If you piloted anything during the COVID pandemic, keep doing it, keep piloting, and keep innovating. Even after things go back to "normal."
To get a more in-depth view into Kate's views and experitse, check out the Healthcare Revolution session "Cutting the Fat in Virtual Care" which Kate is hosting on April 26. Remember, all you have to do to be able to attend this session, and many more, is register for the conference for free.
Telehealth has the potential to reduce healthcare costs, improve patient outreach and health outcomes, and change the way providers treat their patients. As time goes on, telehealth technology will only get more advanced, further accelerating its influence in the healthcare industry.What are the benefits of virtual care for providers? ›
Virtual care allows providers to improve their team's efficiency and meet the needs of more patients while reducing wait times for patients. It can also reduce healthcare employee burnout by decreasing the workload for their staff.How might this telemedicine service and others play a role in the provision of healthcare in the future? ›
The benefits of telemedicine include convenience, increased access to care from a distance, especially for patients living in rural areas, and decreased healthcare costs. Studies have shown that telemedicine appointments can be equal to in-patient visits in a variety of specialties.How will telemedicine change healthcare in the future? ›
The rise of telemedicine is changing healthcare by allowing doctors to treat patients more effectively and quickly, bypassing the need for expensive hospital visits.What are the future predictions for telehealth? ›
Use of telehealth during the pandemic set the expectation for patients as consumers of healthcare for an on-demand, seamless, and comprehensive telehealth solutions and experiences. It is because of this momentum that I predict in 2023–2024, we will see increased uptake and usage of telehealth.What are the pros and cons of virtual healthcare? ›
- Pro: Telehealth minimizes the spread of infectious diseases.
- Con: It's impossible to conduct a physical exam virtually.
- Pro: Telehealth is convenient.
- Con: Regulations can be confusing.
- Pro: Telehealth can reduce unnecessary ER visits.
A VR rehabilitation therapy that simulates real-life situations to improve physical functions for patients who have experienced a physical disability associated with a stroke or other medical condition.What problems does telemedicine solve? ›
Telemedicine streamlines the appointment scheduling process by providing a single platform where patients can schedule online — freeing up your staff's time and giving back control to your patients. They'll be able to see which days and times are available and book it hassle-free.Do the benefits of telemedicine outweigh the risks? ›
Our results show the benefits of telemedicine outweigh its operating costs in almost any scenario. Improvements in patient outcomes benefit not only the patients but can also be hugely beneficial for the entire healthcare system as well.What impacts will telemedicine have on health care now? ›
Telemedicine has improved medication management, patient quality of life, and reduced healthcare costs. Telemedicine app growth is now a key target for healthcare providers who want to deliver healthcare services to patients online and remotely.
While telehealth includes all forms of technology used to transfer digital information for remote health care, virtual care focuses exclusively on communication between healthcare providers and their patients.What is the difference between telemedicine and virtual care? ›
Simply put, the term virtual care is a way of talking about all the ways patients and doctors can use digital tools to communicate in real-time. While telemedicine refers to long-distance patient care, virtual care is a much broader term that refers to a variety of digital healthcare services.Why telehealth is an important option for providing health care services? ›
Telehealth connects patients to vital health care services through videoconferencing, remote monitoring, electronic consults and wireless communications. By increasing access to physicians and specialists, telehealth helps ensure patients receive the right care, at the right place, at the right time.What is the future of virtual reality in healthcare? ›
The investment community is bullish about prospects for VR's future in health care. One recent market research report estimates a 35% compound annual growth rate for VR in the health care market. By 2026, the report notes, the VR market in health care will surpass $40 billion vs.How will telemedicine improve healthcare? ›
With telemedicine, you don't have to drive to the doctor's office or clinic, park, walk or sit in a waiting room when you're sick. You can see your doctor from the comfort of your own bed or sofa. Virtual visits can be easier to fit into your busy schedule.How telemedicine is transforming health care? ›
Increased access to healthcare services
Through telehealth, patients have access to urgent medical care when they are unable to visit a doctor in person because of after-hours needs, absence of local specialists, urgent problems, etc.
Despite the looming end of the PHE, Congress has, with the passage of the Consolidated Appropriations Act 2023, extended most - but not all - of the telehealth waivers until December 31, 2024.What are the potential technology needs for telehealth? ›
In summary, telemedicine technology can be stripped down to the following basic needs: broadband connection, video platform, technology support and possibly peripheral devices and capability to record video. The scale of this enterprise will depend on resources and location.What is the projections for the telehealth industry? ›
What is the global telehealth market growth? b. The global telehealth market is expected to grow at a compound annual growth rate of 24.0% from 2023 to 2030 to reach USD 455.26 billion by 2030.What is an disadvantages of a virtual business? ›
No Permanent Physical Location
If you use your virtual office space a lot, this might result in higher costs, as opposed to just leasing physical office space. Most virtual offices have features that permit you to occasionally use these facilities on an hourly or daily basis.
Side effects of virtual reality
Cybersickness and perceptuomotor after-effects have been reported as the potential side effects of VR. In fact,the main concern for VR users is simulation sickness, or cybersickness. Also, headaches and eye strain are seen in prolonged exposure with VR systems.
Exposure to virtual reality can disrupt the sensory system and lead to symptoms such as nausea, dizziness, sweating, pallor, loss of balance, etc., which are grouped together under the term "virtual reality sickness".Why is telehealth becoming more popular? ›
Willingness to participate in video telehealth may have increased with exposure forced by the pandemic and with positive experiences, researchers found. It may also have helped that telehealth was being offered by more providers.What are the financial benefits of telehealth? ›
A 2017 study found that telehealth visits cost patients an average of $79, compared to $146 for an office visit. That is in addition to savings associated with time and travel costs, estimated to total $89 billion a year in lost time.What are the barriers to telemedicine? ›
Low or no reimbursement (64 percent) Technology challenges for my patient population (54 percent) Licensure in additional states (40 percent) Liability (29 percent)How will virtual reality change the healthcare industry? ›
VR in healthcare is used for many purposes. The technology enables surgeons to virtually examine a patient before a procedure, allows medical personnel to train in life-like simulations and supports virtual sensory tests for patients with muscle weakness.What are the business benefits of virtual reality? ›
Advantages of Virtual Reality in Business
This can help to improve safety procedures and increase productivity. Other benefits include the ability to create customized training programs, improve customer service, and even increase sales.
Virtual reality is a simulated 3D environment that enables users to explore and interact with a virtual surrounding in a way that approximates reality, as it is perceived through the users' senses.What is possibly the biggest disadvantage to telehealth? ›
The largest downside to telehealth may be inequitable access. People without reliable internet or wireless service and those who do not have a computer, tablet, or smartphone cannot participate in telehealth.What are two cons of telemedicine? ›
Downsides to telehealth
It isn't possible to do every type of visit remotely. You still have to go into the office for things like imaging tests and blood work, as well as for diagnoses that require a more hands-on approach. The security of personal health data transmitted electronically is a concern.
The highest rates of telehealth visits were among those with Medicaid (29.3%) and Medicare (27.4%), Black individuals (26.8%), and those earning less than $25,000 (26.7%). There were significant disparities among subgroups in terms of audio versus video telehealth use.What are some of the risks and benefits to using telehealth? ›
- Benefit 1: Reduced Exposure to Infectious Illness. ...
- Benefit 2: Family Connections. ...
- Benefit 3: Improved Access to Care. ...
- Risk 1: Standard of Care. ...
- Risk 2: Potential Technical Issues. ...
- Risk 3: Incorrect Diagnosis.
We found that the number of telehealth services in those states increased dramatically—15x the pre-pandemic level (from 2.1 million the year prior to 32.5 million in the 12 months from March 2020 to February 2021). Learn more about this increase by listening to our podcast with GAO's Medicaid expert, Carolyn Yocom.What are telehealth limitations? ›
Limitations of Telemedicine
For example, technology does not always work smoothly, and technical difficulties may interfere with delivery of care. A significant limitation is the inability to conduct an in-person physical examination.
With easier patient monitoring, fewer in-person visits, and lower admissions to the emergency department (ED), telehealth and RPM can improve patient outcomes and help reduce the total cost of care for both patients and providers.Why is virtual care important? ›
Virtual care can improve health outcomes.
Improved access to highly qualified specialty care providers for faster and more accurate diagnoses and treatments. Improved medication adherence, which leads to fewer clinical problems and complications.
Today, telehealth encompasses four distinct applications. These are commonly known as live video, store-and-forward, remote patient monitoring, and mobile health.What are the three components of telemedicine? ›
Telehealth clinical services (or telemedicine) are currently delivered in three major ways: Video conferencing, which is used for real-time patient-provider consultations, provider-to- provider discussions, and language translation services.What is the difference between digital health and virtual health? ›
Digital health encompasses everything that virtual health has to offer – and much more. Digital health is the larger universe of digital devices, algorithms, and apps that support informed decision-making as well as collaborative communication across the care continuum.What is virtual healthcare called? ›
Telehealth — sometimes called telemedicine — lets your health care provider care for you without an in-person office visit. Telehealth is done primarily online with internet access on your computer, tablet, or smartphone.
One of the most common technology configurations for telehealth applications uses two-way audio and video, or teleconferencing equipment. This technology allows patients and caregivers to communicate effectively, while allowing caregivers the benefit of seeing the patient.Why is telehealth a good business decision? ›
Telehealth opportunities and remote care options can create a variety of these touchpoints in personalized and case-specific ways, ranging from an overview of patient consultations to implantable cardiac monitors. Remote monitoring especially holds tremendous potential to profit from telehealth applications.Why is telemedicine important in healthcare? ›
With telemedicine, you don't have to drive to the doctor's office or clinic, park, walk or sit in a waiting room when you're sick. You can see your doctor from the comfort of your own bed or sofa. Virtual visits can be easier to fit into your busy schedule.How telehealth is evolving healthcare? ›
Telemedicine increases access to healthcare for patients who face barriers such as distance (especially those in rural areas), transportation, or caretaker availability. Immunocompromised patients no longer have to risk acquiring infectious diseases.How telehealth is improving healthcare? ›
Telemedicine has improved medication management, patient quality of life, and reduced healthcare costs. Telemedicine app growth is now a key target for healthcare providers who want to deliver healthcare services to patients online and remotely.What is telemedicine and why is it important in healthcare? ›
Telehealth connects patients to vital health care services through videoconferencing, remote monitoring, electronic consults and wireless communications. By increasing access to physicians and specialists, telehealth helps ensure patients receive the right care, at the right place, at the right time.Who benefits the most from telemedicine? ›
Caters to special health needs
Telehealth benefits those with specific healthcare needs, whether they require a special provider or need extra accessibility. Groups that might be especially likely to benefit from telehealth include: People who live in rural areas with limited access to care.
The main objective of telemedicine is to provide the same quality of care as in-person treatment. It is a cost-effective way to give healthcare services and reduce the burden on the healthcare systems.What needs to be improved in telehealth? ›
- Choose a telehealth platform that offers accessible features such as: ...
- Ensure staff are trained on how to utilize accessibility features.
- Provide closed captioning for all pre-recorded patient video resources.
- Use Telecommunication Relay Services as an alternative to video appointments.
Telemedicine streamlines the appointment scheduling process by providing a single platform where patients can schedule online — freeing up your staff's time and giving back control to your patients.
Additionally, most survey respondents using telehealth said their confidence in their physician (90%) was the same or better via telehealth compared to an in-person visit. For patients with chronic diseases that require consistent treatment, telehealth can improve the quality of care by streamlining disease management.Why is telemedicine more efficient for providers? ›
With fewer in-person visits, staff has more time to handle administrative tasks such as patient scheduling, data entry, billing and more. Remote consultations also reduce staff's exposure to patients with viruses, influenza, measles and other contagious illnesses.