Social Impacts of Virtual Healthcare

Social Impacts of Virtual Healthcare

Sarah Knopf & Jenny K. Cohen, M.D.

Before the pandemic began, I met Mr. M while shadowing Dr. Cohen at Alameda Health System (AHS), the safety-net health system serving Alameda County in California. Mr. M had diabetes and heart failure, had difficulties picking up his refills and staying engaged in primary care, and was distraught after his recent discharge from the ER.

Dr. Cohen went into fire-fighting mode, addressing the most urgent and acute needs. When the pandemic began, they switched over to telehealth, which became a vital tool in their healthcare journey. Dr. Cohen recently told me that now instead of playing catch-up, they can dig into preventative care and finally start to address Mr. M’s mental health needs. Telehealth allowed them to be proactive partners in improving Mr. M’s health and wellbeing.

Mr. M’s story is one of millions, and as such, we urge healthcare leaders and lawmakers to continue taking a thoughtful approach to the deployment of virtual care. Whether it’s an issue of technology access, high-speed internet, or having a quiet private place for a video visit, for many of our patients, not having access to resources isn’t a choice, it’s a reality.

All of Mr. M’s care has been done through phone calls in parks, in the bathroom of his job site, in his car, without remote monitoring device data or video capabilities. Yet despite those limitations, for Mr. M, virtual care has been a tool for improved access and outcomes.

On April 27, the California State Assembly passed AB-32 which will provide Medi-Cal reimbursement for phone and video visits at an equal rate. The big question is — what happens next?

Even with limited technology access, Mr. M reports being happy with his care, he had fewer unnecessary hospital and ER stays, and we have closed preventative care gaps which all begs the questions — how will we measure the value of various forms of virtual care and how do we ensure that benchmarking and reimbursement rates do not penalize patients or systems that serve patients who cannot utilize specific technologies?

Telephone and video visits have become a staple of providing care during the Covid-19 pandemic and will likely continue being an important resource for all patients, especially those in the safety-net for whom commuting to clinic, taking time off work, finding childcare, etc. are often at odds with attending clinic visits.

When considering how we want to continue offering telephone and video visits, we need robust data on how visit modality impacts outcomes and experience. We also need to understand the hardware and software barriers that impact our patients and what resources exist to combat those gaps.

Although we lack data to support differential health outcomes associated with video vs. telephone visits, we know that just being engaged in care is vital and decreases waste both by reducing unused appointments and reducing inappropriate utilization of the ER or hospital.

Data from AHS in July 2019 showed that 26% of prenatal in-person visit slots were booked with a 15% show rate, as compared to data from July 2020 when 77% of the prenatal telephone visit slots were booked with a 88% show rate.

Regarding the question of satisfaction, our research shows high satisfaction with telephone visits, with almost 100% (n=24/25) of surveyed patients reporting above a 5 on 1-7 scales of satisfaction, comfort, and ease.

A large number of patients also reported that the telephone appointments were able to achieve everything needed from their healthcare appointments. Patients reported satisfaction with the attention they are given by their providers during phone visits and the ease with which they were able to access the appointment.

We also interviewed close to 1,000 of our patients and found that less than half had a smartphone, less than half had a computer, and less than half had Internet at home.

Our data suggest that virtual care has the potential to prompt social justice by providing more accessible and convenient patient-centered care and decreased waste, however, if we do not understand and seek to mitigate resource limitations and think carefully about how to measure virtual care value, we risk threatening health equity.

We urge everyone in our community to play an active role in guiding how we engage with healthcare and the role technology will continue to play moving forward. What outcomes matter to you? What do you look for in your healthcare experiences? How do you want to leverage technology to drive your care?

Please write to your elected officials, talk to your clinicians and healthcare team, and stay informed by following organizations such as the California Health Care Foundation and California Association of Public Hospitals and Health Systems to ensure high-quality virtual care through evidence-based decision-making.

Sarah Knopf is a degree candidate and Jenny K. Cohen, MD, MPH, is the associate chief medical informatics officer and primary care doctor at Alameda Health System.