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Editor’s note: This article is based on a meeting of the Health Evolution Forum Work Group on Reinventing Primary Care and Preventative Care Models. The Health Evolution Forum is underwritten by Leadership Partners AmeriHealth Caritas and Change Healthcare as well as Work Group Partners Amwell, Chicago Pacific Founders, Landmark, P3 Health Partners and Welltower.

During a meeting of the Health Evolution Work Group on Reinventing Primary Care and Preventative Care Models, CEOs and Fellows discussed a future wherein virtual care will be more widespread than it was before the pandemic.  

“We look at what Amazon is trying to do, or companies like Teladoc, that are saying ‘the future of care delivery is virtual and clinics are high overhead but not needed very much,’” said Gaurov Dayal, President & COO, Everside Health, a Health Evolution Fellow and Co-Chair of the Work Group. “This group has talked a lot about integration of digital care delivery with traditional care delivery in clinics and believes that virtual care in the absence of physical care delivery will not improve cost or outcomes. Which one is it and why?”  

While the Work Group did not intend to arrive at a concrete answer — and to be fair next-generation care models will likely comprise all three aforementioned options in various modalities — three key considerations came to the fore in the discussion.  

    • Virtual-first models are effective at patient engagement
    • Virtual models will vary by state
    • Obstacles to widespread virtual care are on the horizon

Virtual-only care models are effective at patient engagement
Marcus Zachary, MD, Global Lead for Value-Based Care at Babylon Health, joined the Forum meeting to discuss the company’s experience in virtual-only care, which began with taking on a 1,500-member general practitioner clinic from the NHS in England.  

“We were able to grow that clinic to almost 100,000 members today with very little necessity to increase our clinical footprint,” Zachary said. “As we came into the United States, for a lot of different reasons and a lot of consolidation and maturity of primary care networks, it is really unnecessary, except when it is absolutely necessary, for us to have our own clinics.” 

Zachary outlined Babylon’s work in Missouri as an example. In October 2020, the company rolled out digital-first primary care services to a target Medicaid population of 17,000 people in underserved locations. Since then, more than 3,100 care transactions have been performed, 20 percent of the population is registered and actively using the platform, 45 percent of homes were penetrated in the first five months, 47 percent of engaged people have either avoided or diverted an emergency or urgent care visit and the average number of appointments per user per year is two.  

“Here’s a population that if you were just to look at the performance, you would say these people were just not engaging with their health care, maybe not taking it as seriously and always going to the emergency room for primary care,” Zachary added. “It’s pretty significant change that definitely helps part of this population.”  

Virtual-only models will vary by state  
Babylon, which is primarily a virtual-only care organization, acquired California-based Meritage Medical Network along with its physical facilities and nearly 700 physicians. When a Work Group fellow questioned whether the Meritage acquisition validated that virtual-only care is not adequate on its own, Zachary responded that Babylon was embracing a new opportunity.  

“California is the most heavily regulated state and it’s very hard to get into global risk compared to the to the rest of the country,” Zachary said.  

Zachary added that Babylon views its presence in California as something of a simulation center with enough scale to create proof points the company can then potentially take to other provider groups around the country. 

“But let me be clear about our intent that, as much as possible, we would rather not get into the business of building a physical footprint in the United States,” Zachary said.  

That’s not to suggest virtual-only care will never succeed in California. Rather, various states will present different challenges.  

Obstacles are on the horizon  
Technologists, health system and health plan CEOs alike are anticipating an increase in virtual care moving forward at least when compared to pre-pandemic times. That said, many obstacles must be worked through to enable widespread usage of digital health and virtual visits.  

Among the many, three specifically arose during the Forum meeting: sorting video versus telephone for reimbursement purposes, the need for new skill sets and skepticism about digital tools.   

Andrew Watson, MD, Vice President of Clinical information Technology Transformation at UPMC and a Forum Fellow explained that in underserved areas in Pennsylvania a tremendous number of phone calls are being used as part of virtual care.  

“We’re having some coding issues that are making it hard to tease out how much we’re using video versus phones,” Watson said. “We’re going to have to look at how these types of claims are processed and coded because we need to tease out some of the differences to better understand what’s actually happening.” 

Watson also said that it will be interesting to see over time how well the medical community, and specifically physicians, are able to train leadership and peers for a future where virtual care is more common.  

“To look at virtual-first offerings, it’s a new type of skill set to learn and, much like minimally invasive surgery or other new skill sets, there is a pretty steep learning curve,” Watson said.  

Even after the marked increases in telehealth and other digital tool utilization during the pandemic, that learning curve also applies to the broader population. 

“There are still a lot of places where I go and talk about digital health solutions around the world and there is skepticism about the adoption of digital health,” Zachary said. “Pre-COVID, that made a lot of sense. But not now. And I still find that there isn’t more of a commitment or belief that this is where innovation and health care are going.”  

The Health Evolution Roundtable on New Models of Care Delivery, along with the Roundtable on Next Generation IT in Health Care and the Roundtable on Community Health and Advancing Health Equity, will convene at the upcoming 2022 Summit* in sessions that will include a discussion on the future of primary care. 

 *The Health Evolution Summit will take place April 6-8, 2022 at The Ritz-Carlton Laguna Niguel and Waldorf Astoria Monarch Beach Resort & Club hotels in Dana Point, CA. View the agenda. 

Tom Sullivan

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website.