The COVID-19 pandemic has elevated the speed at which we have converted to virtual care. Physicians and consumers have substantially increased their use of virtual visits and digital applications. This care includes interactions concerning diagnosis, evaluation, and management of conditions that historically have occurred in person. Because of this, many questions arise concerning the quality and utilization of such services. Are in-person visits better or worse from a quality perspective than those performed via telehealth? With increased access, are increased visits occurring, thereby increasing costs without benefit? Are health disparities rising as a consequence of the lack of technology in underserved populations? And should the cost of telehealth be the same as it is for an in-person visit?
As we expand in new ways, solving for all these issues is imperative. Regarding quality, taking a scientific approach will allow us to address whether virtual care is as effective as in-person care or possibly could it be enhanced? One could argue that it leads to improved outcomes while others will adopt the opposite point of view. Delivering care in the comfort of my home will significantly lessen the stress involved with a visit, but does the lack of a physical exam negate those benefits? Only through outcome trials will we answer this question.
Also, it’s necessary to consider and address payment for such services. Overhead decreases with the use of telehealth which should, in turn, pass those savings to the consumer for greater affordability. Undoubtedly telehealth should increase access when it is appropriate, rather than merely accumulating doctor-patient “visits.”
Most importantly, as we expand this methodology of care, we need to consider health disparities and their potential lack of access to such technology. During the pandemic, we learned that this factor became a limitation in our educational system. Those who need the services the most were determined to also be those with the least technological savvy and understanding of its utilization. If we want to be able to expand this solution for care, internet access and having devices to access the web is paramount to success, along with enhanced technology literacy of these populations.
If we are able to do all of this, virtual care has the potential to achieve comparable safety and effectiveness as traditional care. However, how the care is delivered, and the variation of its delivery necessitates monitoring. This oversight is achievable by scientific study design, protocol-driven activities, and limitations on services offered via technology until we know how outcomes compare to traditional methods. Additionally, virtual care should achieve net efficiency, meaning it should also improve affordability.
We must strive to decrease the total cost of care as we embrace technology and avoid scope creep that might increase the overall costs. There will be times when increasing visits will improve outcomes and costs. The opposite is likely to occur as well if we do not monitor utilization. Finally, we must solve for the use of technology in low-income and minority populations to avoid the use of virtual care exacerbating our present health inequities. This change will require infrastructure to be in place, devices readily available, and technology literacy increased.
Since our current delivery-of-care model is suboptimal by anyone’s standards, let us embrace these barriers and overcome them. We are at an inflection point. Let us not waste such an opportunity to enhance the care we deliver in ways that are consumer-friendly, reverent to everyone’s needs, and that impact the cost of care.