Vibhas Ratanjee is a senior practice expert with Gallup, based in Gallup's Irvine, California office. Vibhas is a well-known speaker and author and has contributed several articles on leadership and organizational development as well as how new technology will alter the future of work and the customer experience. His writing has featured in several global publications, including the Gallup Business Journal and the Harvard Business Review. Vibhas specializes in organizational development, culture change, and executive-level engagement strategies, including strengths-based leadership and succession management. Vibhas is also an executive coach and a leadership consultant to senior executives and CEOs. Vibhas works extensively in the health care and financial services sector.
This article was co-wrote by Vibhas Ratanjee and Dan Foy. Foy is a managing consultant at Gallup.
Many health care executives believe that their industry is on the precipice of a significant transformation following COVID-19. The primary drivers of this transformation will be disruptions and the consequent digital opportunities, along with a constant focus on patient access and experience.
One of the most dramatic examples of pandemic-induced disruption is the heightened use of virtual health care. The spark for this acceleration came near the onset of the pandemic as CMS loosened telehealth and HIPAA guidelines for Medicare and commercial payers quickly followed suit. Since then, there has also been runaway venture capital (VC) growth for digital health companies: Global VC funding for digital health companies in Q1 2020 came to a record $3.6 billion in 142 deals, compared to $1.7 billion in 142 deals in Q4 2019. COVID-19 precipitated the single largest funding quarter ever for Digital Health.
Gallup’s research shows a complementary shift in patient behavior, with significant upticks in telehealth usage and preferences. A 2019 Gallup survey of more than 30,000 Americans revealed that just 14% had used telemedicine in the past year, and only 17% anticipated using it in 2020. But a March 2020 survey showed that 34% of Americans now say they have used telemedicine, and nearly half (46%) say they are likely to use it in the future — almost 3 times greater than 6 months or so ago.
Provider-reported data echo this surge. For example, Cleveland Clinic was on track to log more than 60,000 telemedicine visits in March, compared to a monthly average of 3,400 visits before the pandemic. Telehealth research shows that its benefits span beyond access; for example, Gallup has found that those who used Telehealth are more than 1.3 times more likely to rate the overall quality of health care they receive as “excellent” than those who have not experienced Telehealth.
Health care providers must get their telehealth strategy and value proposition right before investing precious resources on full-scale telehealth adoption. At the same time, providers must maintain an agile footing to adapt to the continued evolution of consumer demands, market competitors, and inevitable technological innovations to come. Gallup sees 4 essential strategies for striking that balance.
Strategy 1: Get the value proposition right
The potential for telehealth has generated considerable excitement. But more needs to be done to understand whether patients will see value in telehealth innovations. In many ways, the development of telehealth can be compared with the introduction of 5G in telecom. There are regulatory and compliance issues. But perhaps more significantly, telecom operators must navigate challenges with customer perceptions, such as questions, doubts, and concerns.
Because health care leaders will face similar challenges with telehealth, they must go beyond the hype and acquire a comprehensive perspective of patients’ needs and discover what patients’ value most in telehealth. In the future, telehealth usage will be both synchronous — remote audio and video clinician interactions — and asynchronous — a hybrid, blended approach popularized in behavioral health. Matching these approaches to the needs of different patient segments will be necessary.
Gallup’s 2019 health care study offers some clues on what health care organizations must do. Only 29% of Americans believe their health care providers integrate new technology that improves the quality of care. But there are interesting generational differences: Gen Z and Millennials are 2 times more likely than Baby Boomers to use health-related apps. However, these younger generations are as much as one-third less likely to believe their health care provider uses new technologies to improve quality of care. In other words, younger, more tech-savvy patients are likely to respond favorably to virtual care options, but only if they can meet their higher expectations for technical quality.
COVID-19 will fundamentally alter how Gen Z see medical care, and telehealth might become their primary care relationship. This creates an opportunity for health care leaders to integrate holistic wellbeing elements in virtual health care technology for younger patients. For older patients, leaders’ primary challenge might be technology aversion and delivering an easy-to-use, straightforward interface. Patient needs might also differ by condition, for example, managing chronic diseases such as diabetes and hypertension, and even behavioral health. The value proposition must address all these distinct patient needs and expectations.
Strategy 2: Promote a ‘digital-ready’ mindset and culture
Integrating telehealth will require significant investment in infrastructure and capacity. Once the threat of COVID-19 passes, hospitals will need to invest sufficient time and resources - ramping up in places and scaling back in others. Speed will be of the essence because the return of elective surgeries might coincide with future waves of the virus. When that happens, organizations that have effectively deployed and integrated telehealth will be better prepared to defeat the virus and reduce the burden on health care workers.
But introducing telehealth effectively will require more than just logistical plans; leaders also need to shift their workplace culture and employee mindsets, especially amongst doctors and the nursing staff. Research published in the Journal of Telemedicine and Telecare showed that resistance to change was a significant barrier in telehealth initiatives that is exacerbated by the high cost of the technology and the lack of reimbursements available for care delivered through telemedicine. Physicians might consider telehealth as a threat to their existing practice or they might be unclear about reimbursements. This means hospitals will need to review existing performance management practices and incentives to ensure that doctors do not feel under-compensated for the care they deliver via telehealth.
Other doctors might feel they lack the technological savvy to operate telehealth, while others might consider the technology a poor substitute for the traditional, face-to-face physical exam they are accustomed to. Navigating such concerns requires significant change management. Leaders must aim to strengthen buy-in, create clarity, and communicate how telehealth can function effectively for physicians — and perhaps drive greater effectiveness. One crucial strategy in this endeavor is involving doctors and nurses in the planning and deployment of telehealth: Leaders should seek their opinions, support, and validation.
Health care leaders should also take a leaf out of the EMR implementation playbook. The estimated failure rate of EHR implementation projects ranges from 20% to 70%. There are a host of issues responsible for this, including poor organizational alignment, insufficient funding for education, training, and ongoing support, especially for doctors and the lack of collaboration. There is research that indicates that EHR failure can lead to some serious consequences — including clinician burnout, low job satisfaction, and according to a Stanford Medicine survey, a decline in clinical effectiveness for 1 out of 2 clinicians.
Smart leaders will implement strategies to avoid these challenges with Telehealth. To start, leaders should capitalize on the opportunity to standardize care delivery and establish consistent practices and default protocols in Telehealth. Effective telehealth requires a ‘whole systems’ approach, with leaders soliciting strong cross-functional participation and shared governance. The CIO cannot be the 1 who owns the initiative; leaders must assemble a team or a committee that does rigorous due diligence, creates broad-based buy-in, and builds a clear operational plan for integration. This team must be cross-functional and include physicians, RNs, and other health care technologists such as lab, radiology, imaging, and others.
Strategy 3: Engage the entire health care ecosystem
Health care technology companies have introduced a spate of new technology to help with the fight against COVID-19, from AI and remote patient monitoring to wearables for health care workers. Technology is being harnessed for effective diagnosis and treatment as well as to gain a better epidemiological understanding of the disease. While these are important innovations, their long-term success will hinge on their effective integration with the patient experience.
Introducing innovations is complex when the investment decision is dependent on many stakeholders, such as providers, payers, health-tech, medical devices, pharma, etc. These stakeholders influence how decisions are made, how priorities are defined, and where critical financial resources are directed. And though all claim to be working towards the same goal — to help patients lead better, healthier lives – there is limited collaboration.
These players need to come together to make digital health a success, whether through patient experience and journey mapping across the continuum of care or via specific projects aimed at making the technology more effective yet affordable.
An ongoing, collaborative focus on Telehealth integration will be valuable in the long term. As Telehealth evolves, it will be essential to ensure that upgrades, updates, and structural policy changes are designed and implemented collaboratively — with alignment of cross-industry stakeholders instead of in specific industry silo. A more comprehensive multi-stakeholder action plan is required, with greater involvement and collective leadership from all industry stakeholders. Our response to future outbreaks and pandemics will require collective, not disjointed action.
Strategy 4: Humanize the digital experience
As health care goes from brick to click, leaders should aim to humanize the digital patient care experience. For example, leaders must align their digital footprint with their organization’s care philosophy and care priorities. A hospital’s telehealth narrative must tie directly to its core philosophy. It must also demonstrate its purpose, including how telehealth will drive greater patient care or community impact by alleviating disease burden and enhancing overall population health.
Humanizing the digital health experience will require leaders to understand the specific emotional drivers of telehealth. For instance, family members can play a more direct and regular role in the health and emotional wellbeing of patients through more significant interaction with physicians on telehealth. In a challenging economy, telehealth will have critical financial benefits too. A 2019 study showed that telehealth could save patients up to $1,500 per visit. Gallup research has consistently shown that a customer's emotional or psychological attachment to a brand, product, or company is the definitive predictor of business growth. Leaders should use insights like these to create a unique digital offering that is rooted in what truly matters to patients’ emotional wellbeing, not merely technological capabilities, and innovations.
Hospitals will also need to find specific ways of measuring and monitoring Telehealth performance. A critical indicator is likely to be the degree of adoption — including uptake and utilization. Patient experience and emotional engagement will also be important to measure and track. The 27 traditional HCAHPS questions currently do not measure Telehealth. Measures of Telehealth must be included in HCAHPS assessment.
Ultimately, Telehealth must deliver on the key outcomes of the quadruple aim — health, patient experience, cost reduction, and staff engagement – and leaders should gauge progress based on rigorous measurement and testing against that rubric.
The technological evolution of health care
Telehealth is another step in the ongoing transformation of health care — and it is an important 1. Understandably, health care leaders are wrestling with how best to approach telehealth. Some view telehealth as simply an extension of the current care delivery model with audio and video technologies. Leaders at the other end of the spectrum see telehealth as a transformation of health care delivery and recognize how the health care ecosystem (hospitals, clinics, ambulatory settings, and home health), digital platforms, and new business models support it.
Leaders at any point of this spectrum must remain singularly focused on patients’ emotional needs and what patients’ value. Providers who get this balance right will secure a competitive advantage in the emerging national market for telehealth services.
Leaders investment in state-of-the-art virtual health technology is no longer optional. But to make these investments pay off long-term, health care organizations must invest equally in talent, culture, and leadership. People — not technology – will make a difference. After all, the future of health care – and the future of the world is at stake here.