CHAPTER 36
Virtual Care
Ian Vasquez
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TELEMEDICINE AND TELEHEALTH HAVE long been perceived as an emerging space in health care, one characterized by high technology and niche applications. Before 2010, much of the buzz within telemedicine was the result of grant-funded pilot programs that concentrated on military, rural-health, and acute specialty-care applications. Telestroke, telepsychology, tele-ICU, and remote patient monitoring were the most commonly discussed systems and services in an evolving industry that was once perceived as being on the fringe of health care.
A dramatic shift began around 2010. Telemedicine is extending health-care access to US consumers in need of routine episodic care. Numerous services are now available (with new and different entrants every day) offering telephonic or online video chat consultations (e-visits) with medical providers that result in a diagnosis and possibly a prescription. Patients who access the service from home or a remote medical kiosk are able to forgo a traditional office visit for many common ailments that necessitate a generic prescription or a medication refill.
Many virtual-care services are the result of recently formed start-up ventures focused on an exclusively telemedicine business model. Increasingly, however, primary-care clinics, physician-management groups, accountable care organizations, and health systems are launching services or assessing how to approach the virtual-care space to extend their traditional medical offerings.
Adoption of such services among employers with self-funded health insurance has outpaced broader consumer adoption thus far. However, as consumer awareness grows and the availability and variety of such services increase, the competitive landscape for the traditional urgent care center will be inexorably shifted by competition from virtual-care providers. You should therefore have a thorough understanding of what virtual-care services are, how they are potentially competing for your clinic’s patients, and whether virtual care is an appropriate offering in your business. You should assess regulatory concerns, compliance with the Health Insurance Portability and Accountability Act (HIPAA), technology requirements, and reimbursements before launching virtual services.
Until recently, virtual care was challenged by a number of obstacles (Figure 1):
Figure 1. Changes in aspects of virtual care over time. (Illustration courtesy of MeMD, Inc.)
