Digital Health in the Post-COVID-19 New Reality - From Telehealth to a Comprehensive Digital Care Strategy - Guidehouse
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Digital Health in the Post-COVID-19 New Reality From Telehealth to a Comprehensive Digital Care Strategy
Delivery, operations, and competitive dynamics are
poised to undergo rapid, fundamental transformation in
$300B
response to the pandemic
What Industry Observations:
Happened? • Initial duration expected 2-3 mos. COVID-19 expenses and lost
revenues on the year, AHA
• However, ‘flattening the curve’ has not reports
48 day
indicated stoppage of the curve, and science
suggests there will be a second wave, surges,
and no end yet in sight
Decrease in average hospital
• Unemployment accelerating to unprecedented days cash on hand (pre vs post-
highs and further degrading case-mix COVID projection ~190 vs. 140)
60%
• Despite federal funding and relief sources (e.g.,
CARES, FEMA, etc.), organizations are likely to
experience substantial operating gap
Decrease in physician
• With a boom in demand for telehealth visits, practice visits (55% decline in
organizations that can pivot and scale a physician revenue), with
product focused on consumer / provider systems cross-subsidizing
engagements stand to win integrated practices further
Digital Health in the Post-COVID-19 New Reality 1
Overnight, it’s now assumed virtual care is
a growing part of the care delivery model
• The adoption of telemedicine shifted into ”hyper-drive” since March, with
virtual health-care interactions on pace to top 1 billion by year’s end.
(Forrester Research)
• Consumer adoption has skyrocketed, from 11 percent of US consumers
using telehealth in 2019 to 46 percent of consumers now using telehealth to
replace cancelled healthcare visits.
• Providers have rapidly scaled offerings and are seeing 50 to 175 times the
number of patients via telehealth than they did before.
• Analysts now expect general medical care visits to top 200 million this year,
up sharply from their original expectation of 36 million visits for all of 2020.
• Researchers note that $250B of Healthcare Could Be Virtualized
• Investment in a robust Digital strategy is paramount
• COVID-19 has resulted in a dramatic telehealth adoption rate • Payers and providers must
Takeaway acceleration that is likely to increase patient comfort with the quickly develop a strategy
technology and permanently alter digital health volumes to realize value
Digital Health in the Post-COVID-19 New Reality 2
We believe the future is more nuanced…
Here’s our viewpoint
• Although volumes may dip immediately post recovery, telehealth is a permanent, material feature of a health
system… but to what extent is unknown.
• Regulations will be reviewed, and rather than returning, they will change to facilitate telehealth
• Reimbursement will go down, but not to where it was
• A material number of patients prefer having a consumer experience similar to banking
• More caregivers will appreciate working virtually
• Many risk based and chronic diseases management programs value ‘touches’ – not office visits – as the best
way to curb preventable morbidity
• Payers will support reimbursement for telehealth as a value substitute and will embrace it as a lower cost
platform for value-based care and Population Health management. But many payers will provide this directly
or thru partnerships and may not look to health systems to provide digital services.
Consumer preference paired with regulatory and reimbursement support
will expand the business model for Health Systems and introduce new competitors
Digital Health in the Post-COVID-19 New Reality 3
Our Integrated Health Network
Our Team:
• 12,000 employees
• 2,000 physician
partners
• 1,200 volunteers
Our Facilities:
• 6 hospitals, with a
7th managed
through MSA
• More than 150
outpatient locations
• More than 140 MD
practices
Digital Health in the Post-COVID-19 New Reality 4
Cone Health Quality of Care
Digital Health in the Post-COVID-19 New Reality 5
Informing Broader Digital Strategy from
Current Baseline
As the business model changes, a comprehensive digital strategy will be required for organizations
to grow and thrive.
Integrated Digital Strategy Telehealth
Incorporate digital (D2C, Urgent Suring up platforms and
Care, Telehealth, Population Health, implement / augment missing
etc.) into overall organizational components to harden
strategy platform to support scalability
Provider Engagement
Reimbursement Ensure platforms and tools are
Strategy designed to optimize functionality
Develop a comprehensive payer (e.g., MyChart), incorporate
and reimbursement strategy to communication / feedback, and
support the new business model leverage clinical needs (e.g., care
mgmt., med adherence, patient
Personalized Care safety alerts, etc.)
Engaged comprehensive access, digital
front door and direct-to-consumer approach
Digital Health in the Post-COVID-19 New Reality 6
Cone has tracked volume and patient experience to
bring new info to the discussion
I think the genie's out of the bottle on this one. I think it's fair to say that the advent of telehealth has been just
completely accelerated, that it’s taken this crisis to push us to a new frontier, but there's absolutely no going back.”
- Seema Verma, CMS administrator
CONE BACKGROUND:
• Pre-COVID, 99.9% of outpatient care was face-to-
face
• Overall patient satisfaction scores were high at 90+
• Patient opinion of “access” was low at 83
• COVID-19 has resulted in a dramatic telehealth
Source: CareCloud COVID-19 Practice Pulse
adoption rate likely to permanently alter physical
appointment volumes… and unlike most
organizations, Cone has seen a corresponding
improvement in telehealth billing/revenue and
patient satisfaction
• The alignment of those 3 elements IS CRITICAL…
so, what does it take?
Digital Health in the Post-COVID-19 New Reality 7
The Complexities of the Patient and Provider Experience
Technology certification vs physician autonomy
Cone
Health
Website
Social
The tension… Media
Clinics/Dept.
unplanned, yet
experienced Urgent
Care
Cone App
Patient &
Provider
Patients and Providers Telepho
Experience
ne
must interact with a (PEC/
Clinic)
myriad of tools and
technology to effectively Nurse
Triage
navigate care MyChart
Confidential information for the sole benefit and use of Cone Health.
Digital Health in the Post-COVID-19 New Reality 8
Acceleration of Purpose-Built Disruptors threatening
your business
Reimbursement changes and suspension of regulations are also accelerants to startup digital providers
Evolving payer models threaten
Care Care delivery models focus on ambulatory Payer traditional, incumbent payers and seek
Delivery care and a patient-centric care continuum Innovation out innovative provider relationships
• CVS Health is expanding their • Bright Health entered NC in 2020,
HealthHUB stores to increase care partnering through a narrow network with
access Novant Health
• Iora and Oak Street Health have • Lumeris has an operations center in
opened primary care centers in RDU and is strategizing to grow in NC’s
GSO and across the state, and population health and health plan spaces
BCBSNC has partnered with • Health Alliance (Carle) acquired
CareMore and Aledade in additional Employers and payers pressure for pricing
State Dynamics & majority of FirstCarolinaCare
primary care efforts negotiations and cost decreases, and favorable
Pricing Pressures legislation invites innovation
(FirstHealth) in Pinehurst to expand
• Novant has expanded its differentiating capabilities in a saturated
ambulatory presence in GSO via a • CLT and RDU are growing in population and economic power, with a large MA market
new primary care center and has uninsured population necessitating creative solutions • Haven Healthcare, a new venture
partnered with GoHealth to expand supported by JP Morgan, Berkshire
their urgent-care network across the • The state is innovating, as evidenced by its Managed Medicaid efforts and launch of
NCCARE360, the state’s first coordinated care network Hathaway, and Amazon, has begun
state offering plans for 20K JPMorgan
• Atrium and WFB have • Accelerating prevalence of alternative payment models signals a population ready to employees via Aetna and Cigna across
communicated intentions to form a be managed four states, including NC.
“strategic combination” for shared • Walmart has expanded its healthcare innovation into NC (e.g., partnership with Grand • United is one of seven national payers to
AMC and size / scale benefits Rounds, a healthcare navigation resource for employees, and health service bundles report significant growth attributed to MA;
for customers) it plans to add 700K MA lives in 2020
Digital Health in the Post-COVID-19 New Reality 9Expected shift in business model for providers requires
reimagining business from a strategy and operations
perspective
Leverage Short Term Consumer Engagement to Mitigate Market Share Losses Post-Emergency
Guard revenue in the short term To grow in the long term
Identify opportunities for short-term access and market
Captive patient base to restore elective procedures and
growth for digital health services including ensuring, as
outpatient revenue streams
possible, that all covered services are being offered
Deploy consumer marketing and education for digital Consumers continue to engage with digital platforms,
health service offerings encouraging use of lower cost sites of care
Intake remotely and continuing managing volume of Tele- Grow market share as the incumbent building on brand and
visits and Phone interactions expertise instead of as the new entrant
Shift resources and provide training to cover volume
Develop new revenue streams like provider-provider
shifts to different types of digital health services during
partnerships for telehealth and enter new markets
covid-19 and after
Digital Health in the Post-COVID-19 New Reality 10• Will their current digital strategy be relevant in the new normal?
What is the • What will drive value in the new reality as they build a framework
for understanding the return on investment and total impact on
implication their customers?
for Payers? • Do they have the capacity and infrastructure for digital care
delivery to become the standard of care?
• How will they adjust their provider contracts to effectively support
stakeholders?
• What measures will they put in place to measure and report on
quality using telehealth?
• How is the transition in volumes impacting PMPMs? And what
does that mean to providers?
Digital Health in the Post-COVID-19 New Reality 11Question: Do you generally provide e-health benefits? Or do you
direct patients to narrow network / owned e-health panel?
Integrated Digital Solutions Member Impact/ROI
• Reduced ER & acute care
Single platform with diagnosis (EMR) & claims data with
Wellness • Chronic disease avoidance
predictive analytics generating real-time prompts for
Services • Member satisfaction
members to seek preventative & wellness services
• More time at work
Real-time provider directory presented through various • Reduce unnecessary utilization
Accessing /
channels (text, app, website, IVR) with symptom checking • PMPM improvement based on appropriate site of care
Finding Care embedded in the solution • Rate of engagement
Centralized data sharing throughout healthcare systems to • Member satisfaction
Coordinating
ensure seamless transition of care and comprehensive • Greater outreach and care for vulnerable populations
Care
digital care records with optimized feedback loops • Administrative costs for payer and provider
• Improved documentation of burden of illness
Telemedicine solution that is embedded within the existing
Delivering • Member satisfaction
payer/provider experience and ensures seamless, real-time
Care • Access to care
documentation, referrals and prescriptions
• Reduced ER care
Real-time provider payment before the patient leaves the • Member satisfaction
Paying
provider with single bill given to member between both payer • Billing accuracy
for Care
and provider • Provider satisfaction
Digital Health in the Post-COVID-19 New Reality 12It is a “Battlefield” Out There!
If the Digital Strategy “playing field” is currently flat…time is of the essence to beat your competition
to the next phase of Digital Health
While the duration of the public health crisis Play to Shape:
Play to Grow:
is uncertain, most believe the longer term Focus on driving down total cost of care; create
Leverage strong market position and sizable
balance sheet to acquire growth while
new value proposition that supports the
outlook will be shaped by downturn in expansion into new markets
redesigning operating model in multiple
markets
economic performance
Market Growth
(Population )
Leading payers and providers will have
the opportunity to leverage their strong
balance sheets to shape their local
markets as smaller players struggle to invest Play to Survive: Play to Defend:
Make minimum investments with no strategic Focus on new operating models, cost of service
given challenged cash flow through the public direction and defending existing market share
health crisis
Competitive Position
(Market Share)
Digital Health in the Post-COVID-19 New Reality 13Discussion
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