Although the COVID-19 pandemic greatly accelerated the adoption of telehealth, the use of virtual-only care has declined as U.S. COVID cases have decreased. However, telehealth is increasingly being incorporated into hospitals' digital roadmaps, with some organizations even increasing investment in the model amid slowing visit volumes—according to experts at the annual HIMSS healthcare conference.

This brings hope to supporters of hybrid care models, who emphasize the value of "meeting patients where they are" to reduce costs and improve health outcomes.

Before the pandemic, telehealth usage was relatively low, accounting for less than 1% of outpatient visits by one measure. However, during the peak period from March to August 2020, telehealth accounted for 13% of outpatient visits, before declining to about 8% during the same period the following year.

Despite fluctuating consumer usage, "the genie is out of the bottle. We have to keep moving forward with telehealth," said Donna Roach, chief information officer at University of Utah Health.

Video conferencing giant Zoom saw a surge in telehealth business during the pandemic, and a survey it conducted with Qualtrics found that 61% of people who used virtual care during the pandemic said they want both digital and in-person healthcare in the future.

"The overall hyper-digitization of healthcare and the virtualization of medicine has been quite significant," Ron Emerson, Zoom's global head of healthcare, told Healthcare Dive at HIMSS. "What we're seeing is post-COVID—well, I won't say post-COVID, but as we go through different phases of COVID, telehealth and virtual care remain a persistent delivery model."

Hybrid care models—where applicable

In-person care will never completely disappear. Certain medical services must be provided face-to-face, such as surgical procedures. Even in areas like primary care, telehealth advocates point out that with tools such as wearables, health coaching, and artificial intelligence, nearly the entire experience can be digitized, but physical touchpoints will remain.

The simple fact is that some patients want virtual care and some don't, said Rani Khetarpal, head of value-based care partnerships at CVS Health.

So, "how do we treat that individual patient? Through what means do we reach that patient?" and how care teams use digital and physical pathways to meet their health needs and personal preferences, Khetarpal asked.

Experts say these hybrid models can best improve care and reduce costs in the inpatient setting.

Research shows that hospitalization is one of the most expensive types of healthcare utilization, and hospital costs continue to rise year after year.

"For certain patients, in-person care by a physician always plays a critical role," Chris McCann, CEO of Current Health, a home care technology platform, told Healthcare Dive. "There is tremendous value in physically touching a patient. But it's fair to say that a portion of care currently delivered does not need to be provided in an inpatient facility."

Experts believe that, ideally, healthcare providers should let the needs of a specific patient determine how they receive care. Hybrid models, such as hospital-at-home care, will become more prevalent, using technology to coordinate care, and will require inclusion and exclusion criteria to ensure patients receive the type of care best suited to their situation.

"Under the premise that 'accessibility is related to quality,' let the level of interaction required by the situation determine what care should be provided," said Ron Emerson of Zoom. "First, clinicians and patients have become accustomed to technology, and we live in a more consumer-driven world. I think 'meeting patients where they are' has become a de facto requirement."

This also aligns with the shift toward value-based care. If healthcare providers have a set amount of funding to care for a specific population, rather than being paid per visit, they can choose the most effective delivery method based on that population's clinical presentation.

This makes programs operating under capitation or other value-based models the "low-hanging fruit" for hybrid models in the near term, including accountable care organizations, payer-provider organizations, self-insured employers, and Medicare Advantage plans, Emerson said.

But even in the fee-for-service ecosystem, hybrid models should save costs by reducing the number of in-person consultations and by increasing access to care to prevent more serious—and more expensive—outcomes later. Experts say this can have a particularly significant impact among the few high-need patients who consume the majority of healthcare resources.

Some worry that if virtual visits are added on top of in-person services rather than replacing them, the greater accessibility of telehealth could actually increase system costs. Early research results are mixed, with telehealth proving cost-saving in some cases and cost-increasing in others.

But some evidence, even predating the COVID-19 pandemic, has shown the effectiveness of virtual care in diverting patients from more expensive care settings.

Data from Jefferson Health in Philadelphia from 2019 showed that using a telehealth platform to prevent unnecessary emergency department visits saved providers about $1,500 per patient visit. And hybrid models, such as hospital-at-home platforms—an integrated model where telehealth plays a huge role—showed savings of 30% or more per hospitalization in one pilot, with fewer complications than inpatient care.

More futuristic models

In the future, a significant portion of healthcare services could be digitized. But some in the industry are no longer satisfied with merely offering virtual visits permanently.

A McKinsey 2020 claims-based analysis found that about 20% of emergency department visits and 24% of office visits and outpatient volume could be delivered virtually, with another 9% of office visits nearly virtual. Up to 35% of home health services could be virtualized, and another 2% of outpatient volume could be shifted to the home through technology-assisted medication management.

But as technology becomes more deeply integrated into care delivery—which, according to McKinsey, has stabilized at 38 times pre-pandemic levels—and becomes more commoditized and comprehensive, simply offering video calls "is no longer a unique selling point," McCann said.

Penn State Health is currently attempting to build its own virtual care company as a separate for-profit division, said Cletis Earle, chief information officer at Penn State Health.

The timing is interesting, given that telehealth services have waned, but digitally delivered care is becoming indispensable, not only to prepare for the next pandemic but also for the next business imperative, Earle said.

"We keep saying—we need to push back and ask, 'Well, is this the right thing to do?' The answer is absolutely yes," Earle said. "Telehealth is just one component among many other things... It's a combination and collection of multiple efforts. Building a telehealth business is not the only thing that will make you successful."

Hybrid models could ultimately give rise to more futuristic applications, such as augmented reality, said Alysa Taylor, corporate vice president at Microsoft.

Taylor cited an example of a doctor in Uganda using HoloLens (mixed reality smart glasses) to invite experts from around the world to consult on a case.

"The future of care is adding these new models"—including remote work, said BJ Moore, chief information officer at nonprofit giant Providence.

Like other industries, after the pandemic, most healthcare workers say they prefer some form of hybrid work model when possible. According to Deloitte, by the end of 2020, most healthcare employers either planned or had begun implementing new ways of working, although for exhausted frontline workers, this was often not an option.

But this increased virtualization of the workforce is a silver lining of the pandemic, revitalizing family life and helping combat isolation, said Bill Fera, a principal at Deloitte Consulting and a family medicine-trained physician.

"There's a renewed sense of community where we are," Fera said.

Aging population accelerates interest

As the population ages, demand for these connected care models is expected to increase. Older adults, though not digital natives, embraced telehealth during the pandemic far more than many market observers expected.

According to government data, in the first year of the pandemic, more than two-fifths of Medicare members—about 28 million beneficiaries—used telehealth. Before the pandemic, less than 1% (about 341,000 beneficiaries) had used virtual care.

According to a report this month from the HHS Office of Inspector General, telehealth was "critical" in serving Medicare beneficiaries during the pandemic, demonstrating "telehealth's long-term potential to increase beneficiary access to healthcare."

Experts at HIMSS said this elderly population represents a huge opportunity for hybrid models, as healthcare organizations can use telehealth and technology to keep them out of more expensive care settings like hospitals and nursing homes, and help them age gracefully in place.

This opportunity is growing as the U.S. population ages, with the number of Americans aged 65 and older expected to more than double by 2060, reaching a quarter of the total population.

"What the pandemic showed us is that telehealth isn't that bad," said Joe Drygas, vice president of healthcare at AT&T Business. "What does this mean for our loved ones and those who are aging?"

Most Americans over 65 say they want to die at home, but only 24% actually did in 2009. However, in Medicare fee-for-service and Medicare Advantage, the proportion of beneficiaries dying at home or in community settings appears to be growing, possibly in response to inadequate end-of-life care, as for many older adults, spending their final days in a hospital can mean aggressive and expensive treatments that don't always extend life.

Emerging startups and models focused on technology-driven solutions for home health, chronic disease, and end-of-life care are continually appearing and raising funds.

Aging-in-place technology is an area of interest for healthcare venture capitalists, such as Yaniv Sadka, an investor at Israel's aMoon Fund.

"As baby boomers age, more and more people want to receive care at home," Sadka said during a panel discussion on how VCs view the future of health IT.

But even as hybrid care models gain acceptance, barriers to adoption remain. One of the biggest barriers is culture, with some providers cautious about the increasing use of digital health.

"Culturally, if your organization isn't open and your community isn't open, you can make small improvements, but you won't get very far," Roach said. "Culture is the biggest barrier."

Financial issues are also a barrier, as in most fee-for-service environments, building new care models aimed at reducing inpatient visits threatens providers' revenue. Additionally, the future of virtual care reimbursement is still being written, and the extent of digitally delivered care allowed by the government post-pandemic has yet to be determined.

Now, more than two years into the COVID-19 pandemic, many states have legislation requiring telehealth reimbursement, but a few do not. The biggest concern for virtual care providers is that the broad telehealth flexibilities that drove the surge in usage could be rolled back when the public health emergency ends, said Zoom's Emerson.

Currently, there are multiple bills on Capitol Hill that would extend this access in various forms. A bipartisan proposal with strong industry support is the CONNECT for Health Act, which would permanently eliminate all geographic restrictions on telehealth services and allow patients to receive telehealth services at home and other locations.

Equally important, as healthcare delivery becomes increasingly virtual, no population—regardless of race, age, socioeconomic status, gender, or location—should be left behind, as some worry that the increasing use of telehealth will exacerbate the digital divide in the U.S.

Many older adults, especially low-income seniors and those in rural areas, face serious difficulties accessing telehealth services. A study conducted in 2020 found that more than 41% of Medicare beneficiaries lacked a computer with high-speed internet access at home, while nearly 41% did not have a smartphone with a wireless data plan.

More than a quarter of beneficiaries had neither option, making real-time video visits with a doctor from home nearly impossible.

Since the start of the pandemic, the federal government has allocated millions of dollars to improve the digital divide and expand rural telehealth access. But experts at HIMSS said the private sector can do more as well.

One solution is to ensure that the communities you serve have access to the broadband or devices needed for their care delivery, said Current Health's McCann. In some of its patient populations, more than half lack internet or a smartphone. Among other measures, Current Health works with telecommunications companies to try to improve cellular connectivity in rural areas.

"It's a daunting challenge," but excluding these patients is not an option, McCann said.