Looking at the New Frontiers of Telehealth: Virtual Care

Dr. Schwamm graduated from Harvard Medical School in 1991 and completed his neurology residency and subsequent NeuroCritical Care and Vascular Neurology fellowships at Massachusetts General Hospital in 1996. He is Professor of Neurology at Harvard Medical School and holds the C. Miller Fisher Chair of Vascular Neurology at MGH, where he is also Director of the Center for TeleHealth. He serves as vice president of Virtual Care for the Mass General Brigham health system.

In an interview with Healthcare Tech Outlook, Lee Schwamm, MD, sheds light on the upcoming trends in the virtual healthcare space.

Could you elaborate on your role and responsibilities in the organization?

Currently, I am the vice president of virtual care in our digital health group. I have the responsibility and oversight for all of our virtual care activities across the entire Mass General Brigham health system. It includes both synchronous (virtual video visits between providers and patients, virtual consults between providers) and asynchronous care delivery (e-visits, e-consults), whether they be scheduled in advance or offered as a virtual urgent care service. I also manage our newest program in remote patient monitoring, which is still in its growth phase. 

What are some of the major challenges impacting the healthcare space lately?

The biggest challenge during the pandemic was providing care when the in-person capacity was severely constrained due to the COVID public health emergency protocols that required social distancing and shutting down our ambulatory practices, while at the same time our hospitals were filling up with patients. That was a major challenge as most organizations had no core infrastructure for virtual care at the time the pandemic hit. So while everyone was learning how to swim, we were fortunate that we had been investing in and building up capacity in virtual care for about seven to ten years prior to the pandemic. This helped us to pivot and expand very rapidly. 

The second pain point is the lack of clarity regarding the reimbursement runway. We don’t know if this model of work will continue to be funded, or funded at parity, if it will be confined primarily to risk-based and value-based care contracts, or whether there will be a fee for service reimbursement. We don’t know whether it’ll be confined to specific disease groups like behavioral health or primary care or incorporate specialty care and chronic disease management. So, uncertainty around the virtual healthcare space, medical-legal practices, and patchwork variation across state lines in prescribing, patient location, need for consent, and billing requirements collectively make for a very fragmented and immature marketplace. All of these factors inhibit the proper degree of investment in the not-for-profit established healthcare market.

What are the recent trends that have emerged in the market?

Everyone has seen the ubiquitous rise to the prominence of Zoom and other video platforms for clinical video conferencing capability, as well as administrative and support purposes. 

One of the other solutions that have arisen in response to the capacity problems in hospitals has been the growing desire to change the site of care to home-based care. So both ambulatory care, chronic disease management, or even things like dialysis and hospitalization in the home are an opportunity to declutter over-subscribed inpatient healthcare spaces and distribute the care in a more comfortable and convenient environment for the patient— presuming they are comfortable and convenient to receive care at home. 

Can you tell us about the latest projects that you have been working on and what are some of the technological and process elements that you leveraged to make the project successful?

We have been working on two big new things. The first one is reimagining the inpatient room as a digitally connected space. During Covid, we placed an iPad in every room of our academic medical centers and in most rooms of our community hospitals to reduce the need for personal protective equipment and to make sure families remained connected to loved ones. This helps us to deliver consultative or primary team continuity of care when providers need to be outside of the building or off the floor or when patients are contagious or have a high risk of getting infected. 

"Rather than starting off with devices and software platforms seeking clinical problems to solve, we’re really trying to proceed in the opposite direction by defining the clinical need first and then identifying the appropriate sensor technology, workflow, digital formulary, site of care, etc., to add value to the delivery of healthcare"

That was an incredibly important initiative. Now that the pandemic has eased off a bit, we have begun the process of retooling this into a platform which we call CareTeam Connect to add a host of additional services, including access to the patient health portal, meal ordering, entertainment, personalized education, web browsing, and the telesitter functions and video-enabled rapid response.

The second area that we are focused on is remote patient monitoring and patient-generated health data, where we are in the process of understanding and applying where the services will add value. Rather than starting off with devices and software platforms seeking clinical problems to solve, we’re really trying to proceed in the opposite direction by defining the clinical need first and then identifying the appropriate sensor technology, workflow, digital formulary, site of care, etc., to add value to the delivery of healthcare.

What are the trends that are going to take over the healthcare space 12-24 months from now?

In the next couple of years, we’ll definitely see a better vision of where Big Tech wants to play healthcare. We’ll have a better understanding of how these companies like Amazon, Apple, Google, SalesForce, Facebook, and Microsoft plan to enter the healthcare space and how they will leverage 50-state licensed provider practices, digital-first primary care, and urgent care, and on-demand pharmacy benefits redesign. 

We will also see whether integrated healthcare systems partner with big tech or continue to view them more as competitors. We’ll also see consumer trends continuing to evolve and if consumers increasingly demand convenience and a customized experience over traditional trust in brands based on reputation, research expertise, and the traditional ways patients have selected healthcare in the past.

One big question is whether a hybrid model of care delivery will become the new dominant care delivery model, where virtual, in-person, and tech are infused into healthcare at all levels. It will be interesting to find out if we will keep moving forward with this blending of the models or see a retreat in any way from the virtual activity and go back to pure, old-fashioned, brick-and-mortar medicine. Though the latter is unlikely, it’ll probably be variable across the spectrum, with deeper technological and virtual adoption by some and lesser adoption by others. We will also see if the markets reward the adopters and punish the laggards or if it’s the other way round.