How Virtual Care Can End Healthcare’s Fragmentation
Today’s healthcare system is plagued by fragmentation and friction. When patients seek care services, they face a myriad of entry points without clear guidance to the most appropriate option for their personal needs.
And, as the number of digital health solutions continues to grow, patients are increasingly directed to siloed and transactional telemedicine, prescriptions management, mental health support, or other services. However, many of these solutions fail to establish a whole-person model to guide patients through the entirety of the healthcare journey.
The silver lining is that patient comfort/expectations for virtual alternatives are growing. The time is now to leverage virtual care in a way that addresses the issues that make healthcare complicated, difficult, costly, and fragmented – for both patients and providers.
Four Strategies to Make Care Delivery More Seamless
1. Focus on Better Consumer Experiences, at Scale
Healthcare innovation has long focused on better diagnostic technologies and progress across the hard sciences. But as an industry, it’s becoming increasingly important to treat the whole person, rather than the isolated condition. New technologies allow us to scale contextual care, relationship building, and asynchronous condition management in a way that was previously impossible in traditional care settings and structures.
To scale and deliver this vision, we must create consumer-friendly, omnichannel care and support entry points that align with consumer expectations. This requires designing for asynchronous, chat-first preferences, bringing in user experience (UX) best practices, training for empathetic and user-focused interactions, and using a patient’s contextual and social information to personalize how care is provided. Meanwhile, advances in automation through bots and natural-language processing can enable care team members to operate more efficiently by managing multiple patients simultaneously.
By focusing on scaling a positive consumer experience, patients get a better way to connect with the support most appropriate for them and the industry gets to invest in solutions that offer real engagement and measurable results.
2. Unify Care and Support Services With a “No Wrong Door” Approach
A better patient experience begins with the recognition that care and customer service need to work together. To a patient, questions about costs, billing, schedules, access, and availability overlap with questions about care and medical issues. The root cause of many billing and coverage questions is driven by clinical needs, and a lack of clinical compliance with health recommendations is often interwoven with questions about affordability and access.
More and more, drawing a strict dichotomy between care and service results in less effective resolutions, lack of compliance, and poorer outcomes. Care coordination, advocacy, and case management – once health plan-driven value adds – are becoming more important for any healthcare organization's service design.
By unifying the various services – as we do at Pager with triage, telehealth, scheduling, coordination, follow-ups, Rx fulfillment, benefits, financial support, and more – we have a chance to help patients save money, get more preventative and early care, and keep members and consumers proactively engaged. This experience saves money and keeps consumers coming back. Repeat utilization is driven by the fact that a consumer only needs to come to one place to get all of their questions answered.
3. Provide Care Navigation and Guidance
Once organizations unify care and service delivery, it makes sense to provide support to help patients navigate those services.
Care coordinators can direct patients to nurse triage or health plan customer service agents and help schedule appointments. Nurses can triage a patient to the most appropriate care, whether that be a telemedicine visit, an urgent care center, or at-home self-care (which as we’ve seen at Pager also reduces costs for health plans, with an average of $190 in savings per clinical encounter).
This level of guidance reduces the burden on patients to understand the complexities of healthcare. It also helps care organizations reduce unnecessary overutilization of higher-cost care services such as urgent care centers and the emergency room. Navigation then becomes mutually beneficial for both patients and healthcare organizations.
4. Consider the Provider Experience, Too
As care delivery continues to become increasingly multidisciplinary and team-based, these often-distributed care teams need effective tools to coordinate with each other to provide the most comprehensive consumer support. True collaboration is key – solutions need to allow each nurse, physician, care manager, or administrator to access, share, and act on the information they need about a patient in a compliant and secure way.
Given the unprecedented levels of burnout healthcare professionals experience, communication and collaboration tools need to complement existing workflows, rather than adding on top of them. With the click fatigue providers are already facing, success means embedding tools within an existing clinical and digital ecosystem. This allows organizations to improve the provider experience while also delivering better care.
Virtual Care Solutions Usher in the Next Innovation Wave
In recent years, we've learned a lot about what makes digital health successful. By combining these learnings and capabilities, we can create a seamless patient experience and direct individuals to the services and care they need, when they need them, in a way that works for them.
With this approach, we also open the industry up to novel solutions, such as virtual-first health plans, whereby patient preferences for better care access and lower costs come together with payer-guided steerage and virtual-first benefits design. By reimagining virtual care, we can make access to healthcare more streamlined, less confusing, and more equitable.