Virtual Care Adoption: Barriers to Access, Engagement Strategies, and Opportunities for Growth

With a marked increase in virtual care use amid the COVID-19 pandemic, several strategies can continue to evolve its effectiveness and adoption. These include addressing disparities in usage among older populations and underserved communities, as well as improving home monitoring and interoperability, said Mike Funk, vice president of Humana's office of the chief medical officer.

Transcript

AJMC®: Hello, I'm Matthew Gavidia. Today on the MJH Life Sciences’ Medical World News, The American Journal of Managed Care^® is pleased to welcome Mike Funk, vice president of Humana's office of the chief medical officer, who will speak on a recent study by Humana and MGMA, titled, “No Time to Waste: Deferred Care and Pandemic Recovery.”

Great to have you on, Mike. Can you just introduce yourself and tell us a little bit about your work?

Funk: Sure, Matthew. Thanks for having me. I work in the Office of Health Affairs and Advocacy, and much of my time is spent representing the voice of the provider across the enterprise. And then I also work around some strategic planning and thought leadership around the value-based space.

AJMC®: Delving into the study, 97% of medical practices reported a drop in patient volumes in early April 2020, with safety cited as the major reason for deferring care. Can you speak on the impact that this marked reduction in in-person care had for medical practices nationwide, and what efforts were made to re-engage patient populations and physicians whose productivity also dropped during this time?

Funk: Back in the early spring of 2020, much of the medical industry came to a standstill, if you will, based upon the pandemic. And as you saw from the study, most of that was driven by safety concerns from our members [and] their patients, which I think is completely understandable. I think we all found ourselves in that particular space, but what transpired with that was access issues for our membership, and again, their patients, as well as cash flow issues with the medical practices themselves and their financial viability and stability—which we all know is important to the overall health care system.

I think many practices over that prolonged period of time were looking at laying off staff, maybe even closing their practices altogether. So we very quickly had to figure out how to help in this particular space, and there were really 2 concerns for us. One was, how do we get access for our membership so that they continue to get the medical care that they need? And 2, how do we help bring some stability to the medical practices who truly are suffering from cash flow restriction.

So, there were a number of different ways we did that. One was through telehealth, and I think there's been obviously a lot written about that since the pandemic began. We found ourselves prepandemic probably with a couple of thousand visits a month. And once we were into the pandemic, we were seeing well over 1 million visits a month. So, it took off in a big way, and it did help bridge the gap.

Clearly, it did not take care of all the issues, because we found a number of barriers—just using telehealth as an example—as they relate to just the comfort level, especially of the more senior population not wanting to do virtual visits, maybe not having access to the technology and being able to do the virtual visits, or perhaps being in a more rural area where bandwidth didn't allow for virtual visits.

We did find a number of our practices, though, who brought very innovative approaches to to telehealth access. I know one practice actually put a sign out in front of their offices for reserved parking spaces, and they would bring iPads out to their patients and allow them both the technology, as well as the bandwidth in order for those visits to take place. So there were a number of those things. And again, while it helped, it didn't completely return practices back to the level of volume that they were seeing previously.

We also did a number of things in terms of trying to just do outreach to our membership to make connections, to make sure if there were things they needed or connections we could help with around their care or gaps in their care. Later on, we got into transportation and meals, as well as other ways. We provided masks to members. Just Humana alone, we invested over $2 billion by the end of 2020 in helping to support both practices and our membership during this pandemic.

AJMC®: Something you just alluded to: while the emergence of telehealth has been seen as a silver lining amid the pandemic, there are still notable disparities in usage with the study finding that although more than half of surveyed patients required immediate attention for a medical condition, nearly 60% had still not tried a virtual visit by July. What can be done to better educate patients on virtual care who may not be technologically proficient or trust the quality of care given through virtual visits?

Funk: That continues to be a struggle. We talked a little bit about that just a few minutes ago, and some of the barriers that we ran into. One of the things that we have recently done is we've entered into a partnership with OATS, Older Adults Technology Services, where the goal is really to get more than 1 million seniors online with improved technology access and engagement.

OATS recently received a $3 million investment from our Humana Foundation, which is our philanthropy arm of Humana Inc. So, that's an example of what we and others within the industry can do in terms of trying to reduce the barriers. I think if the pandemic were 10 years out, and if we look at how the younger population has embraced technology, it probably would be less of an issue for us. But today, while many seniors are very, very savvy, there is a large number who don't have access, who don't have the knowledge, who haven't been indoctrinated, if you will, to the more technology that's available today.

Quite frankly, some people just aren't comfortable with virtual care. Health care is a very hands-on business, and some people just aren't comfortable not having the ability to sit in front of their physician with hands on for their care.

AJMC®: What are the next steps for medical practices and health care providers nationwide as COVID-19 continues to change the way in which care is perceived and delivered?

Funk: So, first and foremost, again, this particular study—and I know there are studies going on outside of Humana—to really again, to my earlier point, hit that pause button, and now that we're out of the crisis, to really be able to understand more about behavior, behavior change, technology, what we could have done differently. So, I think we'll see all of us within the industry beginning to look at that and really spending some time there.

I think the other thing is—again, back to the safety issuewhile practices have taken measures around public health, I think we'll learn a lot more about that. I'm curious myself to see how public measures change as a result of the pandemic. Technology certainly is another area. I think we will see an explosion in digital health, not just in telemedicine, but I think home monitoring, interoperability.

As fortunate as we were to have telehealth available to us, we have probably—I lose track of time—talked about telehealth and the emergence of telehealth for the last 15 years. And again, as I mentioned, we were only seeing a few thousand visits a month, and it exploded when the pandemic hit. Thank goodness we had been working on it for the last 15 years. We'd all been figuring out how do we get more engagement around telehealth, and again, it took a pandemic to do that. But, thank goodness we were working on that technology, because I'm not sure what we would have done had we not had that capability.

As I stepped back and said, "Well, what more could we have had available to us," had we had true interoperability within health care, and the ability to have data at the fingertips of the care provider, regardless of the entry point of the patient or our members, that would have gone a long way as well. So, I just think there's a host of things that we have to look at.

Lastly, I would say just communication. We've spent a lot of time just looking at the communication and how we can do a better job of cutting through some of the chaos and the confusion, and just helping members understand more about access to care and technology, and a host of other issues that will just make it a better system going forward.

AJMC®: To learn more, visit our website at ajmc.com. I’m Matthew Gavidia, thanks for joining us!