As we continue to identify the benefits of telehealth, we must delineate how this form of technology most efficiently impacts primary care services. One can view such digital interventions as either substitutive or additional. If one utilizes an electronic visit instead of an in-person visit, this is an example of substitution. We are now categorizing this modality as “virtual-first” primary care, where one’s initial interaction with a primary care clinician or service is virtual. Historically, episodic care has been the dominant use case for virtual care, but we are now seeing complete primary care models pivoting to a virtual platform, including for chronic disease management.
As a result, many questions arise; will people wish to be viewed this way? Is there a degradation in diagnostic ability? How is the quality of care impacted? How will reimbursement look for such a model? How is liability managed? Does our present licensing model work in a virtual scenario? All of these questions, and many others, will take time and experience to answer.
However, we do need to decide how we view these services within the context of consumer desire. I am not sure if the analogy fits perfectly, but this scenario reminds me of the early days of online banking and ATMs. Countless envisioned that this technology would replace brick-and-mortar banks and financial institutions, but they have not. However, I am not sure anyone could have dreamed how banking has progressed from a consumer perspective and how efficient it has become. Yes, it is a substitution model that was historically in-person for certain services, but many activities still require face-to-face interactions. Additionally, in a consumer-driven environment, having a choice is incredibly important.
One key advantage of the multiple points of entry model is the ability to deliver certain services much more efficiently, with increased convenience and improved access points. As we learn and explore newer technology, more and more use cases will abound.
Although there is a lot to be reviewed and considered when changing models of care, we also need to remember we are at the early stages of a journey. Because of this, we will need to continue to experiment, pivot, reengage in new and creative ways, and be extremely adaptable. One size will not fit all, and we will not address every problem at once. Additionally, it’s imperative to be cautious not to negatively impact health equity, especially as we transition to technological solutions. These point-of-service devices are not equally distributed across all populations, nor is broadband service accessible to all.
Let us embrace all the possibilities and problems that encircle new ideas and technologies. Regardless of the outcome, we must remember our goal is to enhance value by providing quality and service at an affordable price.