AMA initiative explores challenges, real-world examples of virtual care
Now that the digital health era is upon us, how should providers move forward?
The American Medical Association (AMA) has launched a new initiative on digital care, saying that the COVID-19 pandemic has created an opportunity to reassess how health care is delivered.
The “Return on Health” report noted that as the pandemic spread, many health care visits were moved to virtual, or telehealth settings, and that this was enabled by the relaxing of some policies and regulations by both government and insurance carriers. The question, the report said, is how to move forward—with many providers unsure whether telehealth visits will continue to be covered.
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“As the pandemic ebbs, policymakers and payers are deciding whether and how much to pay for virtual care services in the future, leaving clinicians uncertain as to whether they will be able to afford to continue their virtual care programs,” the report said. “Clinicians, payer executives and policymakers are often making these decisions based on outdated telehealth measurement strategies that are overly generalized and do not account for the realities of how health care will be delivered and paid for in the future.”
The AMA initiative calls for a balanced, long-term approach to virtual care, which it called “digitally enabled care,”—an approach based on evidence that provides the best overall care for patients. The report stressed that virtual and in-person care should be coordinated and holistic, to avoid gaps in care for patients and inefficiencies among providers.
Emerging issues around virtual care
The report said that the quality of care, not short-term savings, should be the driving factor in how virtual care is used in the future. It went on to outline issues around digitally enabled care, which include care coordination, data collection from both home and clinical settings, improved accessibility, and consideration of equity issues.
Equity in care is mentioned frequently—the AMA noted that virtual care technology has not been equally available to different communities. “We know that advances in virtual care are not reaching, improving health, or generating value for all communities equally,” the report said. “Communities historically marginalized by the health care system, including Black, Indigenous, People of Color, Immigrant, LGBTQ+ and People with Disabilities, have experienced the perpetuation and exacerbation of inequities in access to and quality of care in this increasingly virtual setting.”
A new framework
The report included specific examples of how real-world virtual care efforts have evolved in communities around the U.S. It also explores the challenges in payment for virtual care, including the need for more data and research on payment models.
In looking at the value of digitally enhanced care, the AMA suggests adopting six “value streams” to help define care delivery. These include clinical outcomes, quality and safety, access to care, patient and family experience, clinician experience, financial and operational impact, and health equity.
“Understanding the value of virtual care is vital to inform decision making that facilitates the shift to digitally enabled care models that blend the best features of in-person care with those of virtual care,” said AMA board member Jack Resneck Jr., MD. “The AMA’s framework fills a critical need to inclusively define and measure the various benefits generated by virtual care as decision-makers design new care models, prioritize investments, and determine appropriate coverage and payment policies in the future.”
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