Stahl Melissa, Cheung James, Post Kevin, Valin James P, Jacobs Ira
The Health Management Academy, Arlington, VA, United States.
Avera Medical Group, Sioux Falls, SD, United States.
JMIR Form Res. 2022 May 16;6(5):e32819. doi: 10.2196/32819.
The COVID-19 pandemic accelerated drivers for virtual health adoption and triggered the US federal government to implement regulatory changes to reduce barriers to virtual health implementation. Consequently, virtual health solutions have been increasingly adopted, and health systems in the United States have been reorganizing their care delivery process with unprecedented speed.
This study aimed to assess and make recommendations on the strategy, business model, implementation, and future considerations for scaling and sustaining virtual health solutions based on the views of executives from the largest health systems in the United States.
In September 2020 and October 2020, the Health Management Academy conducted 29 quantitative surveys and 23 qualitative interviews involving 58 executives from 41 of the largest health systems in the United States. Participating health systems were approximately equally distributed across size categories (small, medium, and large, defined as annual total operating revenue US $2-3 billion, $3-6 billion, and >$6 billion, respectively) and US Census Bureau regions (Northeast, Midwest, South, and West).
Based on the Health Management Academy's assessment of approaches to governance, financing, data infrastructure, and clinical integration of virtual health, most participating health systems (13/24, 54%) had a mid-stage level of maturity in virtual health implementation. Executives reported the pandemic is forcing health systems to re-examine strategic priorities; the most commonly raised key impacts were increased access (15/21, 71%) and flexibility (10/21, 48%) as well as lower costs of care delivery (9/21, 43%). Most executives (16/28, 57%) reported their organization had a defined budget for virtual health, and many noted that virtual health is best supported through value-based payment models. Irrespective of health system maturity, reimbursement was consistently rated as a key challenge to virtual health scaling, along with patient access to and understanding of virtual health technology. The success of virtual health implementation was most commonly measured by patient satisfaction, health care provider engagement, and proportion of health care providers using virtual health solutions (reported by 7/8, 88%; 6/8, 75%; and 7/8, 75% of information technology executives, respectively). Almost all health systems (27/29, 93%) expect to continue growing their virtual health offerings for the foreseeable future, with user-friendliness and ease of integration into the electronic medical record as key factors in making go-forward decisions on virtual health solutions (each selected by 9/10, 90% executives).
The increased demand for virtual health solutions during the COVID-19 pandemic is expected to continue postpandemic. Consequently, health systems are re-evaluating their current platforms, processes, and strategy to develop a sustainable, long-term approach to virtual health. To ensure future success, health system leaders need to proactively build on their virtual health solutions; advocate for payment, site flexibility, and reimbursement parity for virtual health; and demonstrate continued engagement and boldness to evolve care beyond established models.
新冠疫情加速了虚拟医疗应用的推动因素，并促使美国联邦政府实施监管变革，以减少虚拟医疗实施的障碍。因此，虚拟医疗解决方案得到了越来越广泛的采用，美国的医疗系统也以前所未有的速度重新组织其护理提供流程。
本研究旨在根据美国最大医疗系统高管的观点，评估并就扩大和维持虚拟医疗解决方案的战略、商业模式、实施及未来考量提出建议。
2020年9月和10月，健康管理学院对来自美国41家最大医疗系统的58名高管进行了29次定量调查和23次定性访谈。参与的医疗系统在规模类别（小、中、大，分别定义为年度总营业收入20亿至30亿美元、30亿至60亿美元和超过60亿美元）和美国人口普查局区域（东北、中西部、南部和西部）中大致均匀分布。
根据健康管理学院对虚拟医疗的治理、融资、数据基础设施和临床整合方法的评估，大多数参与的医疗系统（13/24，54%）在虚拟医疗实施方面处于中期成熟水平。高管们表示，疫情迫使医疗系统重新审视战略重点；最常提到的关键影响是可及性提高（15/21，71%）、灵活性增强（10/21，48%）以及护理提供成本降低（9/21，43%）。大多数高管（16/28，57%）报告称其组织有虚拟医疗的既定预算，许多人指出虚拟医疗通过基于价值的支付模式得到了最佳支持。无论医疗系统的成熟度如何，报销一直被视为虚拟医疗扩大规模的关键挑战，患者对虚拟医疗技术的获取和理解也是如此。虚拟医疗实施的成功最常通过患者满意度、医疗服务提供者参与度以及使用虚拟医疗解决方案的医疗服务提供者比例来衡量（分别有7/8，88%；6/8，75%；7/8，75%的信息技术高管报告）。几乎所有医疗系统（27/29，93%）预计在可预见的未来将继续扩大其虚拟医疗服务，用户友好性和易于集成到电子病历中是做出虚拟医疗解决方案未来决策的关键因素（各有9/10，90%的高管选择）。
新冠疫情期间对虚拟医疗解决方案的需求增加预计在疫情后仍将持续。因此，医疗系统正在重新评估其当前的平台、流程和战略，以制定可持续的长期虚拟医疗方法。为确保未来的成功，医疗系统领导者需要积极发展其虚拟医疗解决方案；倡导虚拟医疗的支付、地点灵活性和报销平等；并展现持续的参与度和大胆创新，以超越既定模式发展护理。
