Enhancing Patient Access, Experience at Virtual Care’s Front Door

May 26, 2023 - Virtual care has evolved rapidly since the onset of the COVID-19 pandemic. From telehealth visits to remote patient monitoring to hospital-at-home, various virtual care modalities have become ingrained in the healthcare delivery system. But like in-person care, virtual care has unique bottlenecks that must be addressed to ensure healthcare access and patient satisfaction.

Telehealth use reached record highs during the pandemic, with one estimate showing that visit volumes peaked at 73.7 million in the second quarter of 2020. However, by the first quarter of 2022, this figure had dropped by 37 percent to 46.4 million.

Recently released data also revealed hurdles to virtual care use. Survey results published last month showed that 23 percent of patients said they had experienced issues with audio or video during a virtual visit, 17 percent indicated other connectivity issues, and 18 percent stated that the video platform did not operate well. Overall, only 36 percent of patients preferred video or audio visits post-pandemic, versus 64 percent who preferred to return to in-person care.

With telehealth use plateauing, virtual care access and experience will be critical to ensure the benefits of telehealth do not disappear with the end of the public health emergency. And it will be incumbent upon healthcare providers to break down the bottlenecks and maintain patient satisfaction.

"The reality of it is if we don't break these barriers down…these individuals seeking care just do not receive the care at the right time or the right place," said Brad Schipper, president of virtual care at Sanford Health, in a phone interview with mHealthIntelligence.

VIRTUAL CARE ACCESS, EXPERIENCE CHALLENGES

Though virtual care has widened healthcare access, not all health systems have the operational infrastructure to enable widespread access to virtual care modalities.

For example, sufficient staffing is a significant barrier. If enough clinicians are not available virtually, patients can be left waiting to receive care, mirroring the intractable issue of long wait times in the in-person care setting. 

"We're trying to figure out how we can leverage all of our capacity and all of our providers via technology to help avoid some of those traditional bottlenecks that happen just by the law of small numbers," Schipper said.

In addition, patient throughput can prove to be challenging in the virtual care arena. According to Daniel Stein, telehealth supervisor at UC Davis Health, patients attempting to access virtual care may be put off by the steps they are made to go through during check-in, accessing health records, online scheduling, etc.

This was a focus for Stein and BJ Lagunday, executive director of ambulatory operations and population health at UC Davis Health, with the launch of the UC Davis Health Express Care service in September 2020. The urgent care service connects patients with healthcare providers to address issues like influenza-like symptoms, urinary tract issues, and coughs.

"There tends to be a lot of overhead just getting in and getting access to your medical record and getting visits scheduled and set up," Stein said in a phone interview. "And we tried to smooth that as much as possible with Express Care."

Creating seamless virtual care processes isn't the only factor in ensuring patient satisfaction and improved access. Provider organizations need to consider social determinants of health (SDOH), like technology access and language hurdles, too.

Stein and Lagunday noted that health equity must be embedded into the virtual care journey for the benefits to reach the communities that need them most.

OPTIMIZING VIRTUAL CARE'S FRONT DOOR

Provider organizations have employed various strategies to ensure virtual care access and a seamless patient experience.

For instance, there is no appointment scheduling within UC Davis Health's Express Care service.

"One of the first decisions we made was to not have it scheduled," Stein said. "There's no requirement that you schedule an appointment at a particular time. You join the queue, and it's first come, first serve. I think that helps people in a number of different ways. It makes [care access] more timely. If you want to see someone now, you can see them now. You don't have to go and log into something, and then search for a time that works for you and a provider, and then schedule that."

The health system also leverages a support desk to inform patients about unusually long wait times, set expectations, and provide technical support if patients face difficulties with the technology. But, of course, this raises another challenge: staffing.

Currently, two emergency department physicians are available at all times through the Express Care service, which is open 8:00 am to 8:00 pm, Monday through Friday, and 9:00 am to 6:00 pm on the weekends. An additional telehealth provider is also available in the mornings as volumes increase.

"It's going to be something that's going to need to be closely watched and monitored as the volumes continue to grow," Lagunday said. "We also have a process where if the queue is getting large and we see there's a wait time there, there's basically a text that goes out to all providers that are on this list that are willing to hop on and help clear the queue."

Similarly, Sanford Health has a pool of clinicians available to see patients virtually. If patients cannot connect with their assigned provider, they can move to another who may have had a visit canceled or a patient no-show, Schipper said.  

Not only do health systems need to find a suitable staffing model for their virtual care services, but they also need to ensure that they have a solid technology infrastructure to support patient volumes.

Schipper noted that synchronous virtual visits and asynchronous communication between clinicians and patients could strain internet and technical resource bandwidths, which could result in gaps in access and lower levels of patient satisfaction. Thus, healthcare providers need the technological backbone to optimize the virtual care journey, starting with the digital front door.

Along with staffing and technology concerns, provider organizations must work to close health equity gaps within virtual care.

"We know that 60 percent of our people's health outcomes are determined by their zip code and not their genetic code," Schipper said. "So, we absolutely have an imperative and a call to action."

Sanford Health primarily serves rural populations; thus, broadband access is a key barrier to virtual care in its communities. While this issue is largely outside the scope of what provider organizations can control, Sanford is working with telecom providers to expand broadband access.

To close care gaps in underserved communities, UC Davis Health is working with local federally qualified health centers (FQHCs) to expand the Express Care service. Through an initial partnership that began during the COVID-19 pandemic, UC Davis test-to-treat vans could connect COVID-positive patients to FQHCs in the community for treatment. Now, FQHCs can expand the service to meet other urgent care needs of the populations they serve, Lagunday said.

Further, the health system offers access to interpreters within the Express Care service to ensure that people with limited English proficiency have their medical needs met.

"There's so much variability," Stein said. "It's really important that you don't try to get everyone to fit into a single mold and that you keep on your toes and enable people to communicate between themselves so that they can solve problems on the fly and keep things moving smoothly."

As healthcare providers further integrate virtual care into the healthcare delivery model, Schipper adds that leaders must be especially thoughtful when deciding how the virtual patient care journey will unfold.

"Even though we did certain things during the pandemic, it doesn't mean that we should continue to do them, or it doesn't mean that we shouldn't do them," he said. "So, I think just unwinding in a very thoughtful and meticulous way to understand what works from the lens of both those providing the care and those receiving the care is a really important step."