The Future of Virtual Chronic Care Management

As our nation’s baby boomers age, the demand for health care services is on track to outpace our ability to supply care. How we meet this coming challenge will be due in large part to the groundwork happening now as the industry shifts to encompass value-based care, population health initiatives, and virtual chronic care management.

By 2030, nearly one in five US residents will be age 65 or older. As people continue living longer, our current age distribution will also shift, with those over age 80 comprising 21% of our older population by 2050.

According to the Centers for Medicare & Medicaid Services (CMS), two-thirds of Medicare beneficiaries have multiple chronic conditions (MCC) and account for 93% of overall Medicare spending. Chronic diseases often complicate other health care treatments, and patients with MCC frequently struggle with the effects of various negative social determinants of health (SDoH), such as poor nutrition, a limited support network, and lack of access to care. Most recently, the pandemic has shown that patients living with chronic conditions are much more likely to be severely impacted by COVID-19.

In the next nine years, our growing Medicare population will require extensive caregiving support and will account for the lion’s share of our national health care costs. How will the United States cope with the increased demand for health care services? As any microeconomics professor will tell you, when a fixed supply cannot accommodate surging demand, higher costs are the inevitable result. After years of rising health care costs, however, we have reached a saturation point. The industry is now in a position where it must embrace new, more creative approaches to increasing health care access. One of the answers may lie in virtual chronic care management.

The Need for Virtual Support

While providers are already reimbursed for chronic care management services provided in the office, CMS recognizes that extending patient care beyond the office setting improves clinical outcomes. In 2015, Medicare began paying providers separately under the Medicare Physician Fee Schedule for non-face-to-face care coordination services delivered to beneficiaries with MCC.

As many chronic conditions—including diabetes, heart failure, and kidney disease—are incurable, establishing an effective chronic disease management program is essential for managing outcomes. Getting a better handle on the daily ins and outs of the older adult population’s health status will soon become a clinical and financial necessity not only for physician practices, but also for health plans.

The intersection of new technology-enabled devices, the telehealth explosion, and the regulatory push toward patient-centric care are creating the perfect climate for a tectonic shift in the way providers manage care. It is no longer sufficient for a diabetic patient to simply check in with their endocrinologist twice a year. Given the physician shortage, in fact, a specialist is highly unlikely to have the capacity for more frequent appointments—and the burden of encouraging patients to make healthy behavioral choices should not fall exclusively on their shoulders in the first place.

To avoid the risk of a setback, patients with chronic conditions need more available outlets than just their specialists. Studies have shown that patients are more compliant with their treatment regimens and experience far better outcomes when their care includes virtual coaching and support. To meet the increasing demand, chronic care management ecosystems will need to rely in large part on health care providers without a medical degree. According to CMS rules, qualified providers of chronic care management services can include nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse midwives, among others.

New payer and provider partnerships are offering specialty support services to populations living with chronic conditions, many of which center on technology-enabled devices, such as blood glucose monitors, coupled with multichannel communications and education networks. These technology-enabled ecosystems are built to surround patients with the type of personalized care they need to proactively manage their conditions and avoid the risk of additional complications.

Friction Fatigue and the Convenience of Telehealth

Even before the pandemic hit, 29% of health care consumers had used some form of virtual care at least once, and all signs indicate that consumers are increasingly more comfortable with nontraditional care. When it comes to virtual visits, the genie is all the way out of the bottle.

After an initial spike in telehealth utilization in April 2020, baseline levels have stabilized at 38 times higher than before the pandemic, according to a recent McKinsey analysis; 13% to 17% of office and outpatient visits across all specialties now occur virtually. Patients have realized that they can get the results they need via a digital appointment, rather than having to take time off work to drive to the doctor’s office and sit in the waiting room.

Although the rise of telehealth was precipitated by COVID-19, the widespread appeal of virtual care is not surprising. Health care consumers have long been ready for the kind of frictionless user experience that they already enjoy in every other area of their lives, from retail to banking to social networking.

For a patient, the acts of refilling a prescription, scheduling regular doctor’s appointments, pursuing a referral, or even accessing emergent care are friction points—and at each of those points, patients may well abandon their efforts before they succeed. Providers sometimes fail to recognize that the real risk of friction points is not that patient will delay care, but that they will neglect their care altogether, leading to a cycle of avoidable complications, poorer outcomes, and more costly care episodes. Research shows that telehealth visits help reduce the number of patient friction points and contribute to higher patient satisfaction levels.

Expanding Our Technological Comfort Zone

Unsurprisingly, patients aged 65 and older are the least likely to agree that telehealth technology is easy to use, according to a survey from the COVID-19 Healthcare Coalition. By 2030, however, patients will have accumulated nine more years of technological knowledge and become more accustomed to virtual care delivery—and vendors will have improved the interoperability of their products.

While that does not seem like a great deal of time, the rapid widespread adoption of smartphones shows how quickly a cultural technological revolution can occur. Today, fully 85% of US adults use a smartphone, including 61% of those aged 65 and older. In just 14 short years, beginning with the introduction of Apple’s iPhone in 2007 and the first Android smartphone in 2008, smartphones have become ubiquitous. We now live our lives online, and the longer we do, the more adept we are at navigating new apps and digital user experiences.

Health care consumers will continue to grow their technological comfort zone as virtual care communities and products are released. As pharmaceutical companies get better at integrating their patient-focused technology experiences with other platforms, we will see advances like blood glucose meters that pair with smartphones, vital sign reporting via Bluetooth synchronization, and new virtual care technologies yet unimagined.

Improving the Patient Experience

Over and over again, patients are confirming that what they value most is a personalized health care experience. Creating a meaningful care experience is about much more than driving portal adoption, developing targeted post-op care paths, or increasing email messaging. It is about understanding the lifestyle habits, health conditions, and friction points of any given population—and designing a multi-touch system that engages each patient in making better health care choices as the decision point arises. Meeting patients where they are, to change their behavior in the moment, is the future of virtual chronic care management.

While payers and providers might have different financial incentives for driving consumer engagement—whether to reduce provider network leakage or clinically inappropriate spend for a targeted population—they have a shared interest in improving patient outcomes across the board. Providers and health plans should be thinking about how to partner with each other and other vendors to develop effective virtual care management strategies.

As technology-enabled care management services proliferate, patients might find they have to switch between five different apps to manage their health, which is clearly not ideal. In the future, we are likely to see more interoperability and consolidation aimed at improving the user experience not only for the patient, but also for the clinicians who are looking at the collected data.

Ideally, providers would receive one data stream from disparate technology platforms that serve to manage the patient’s condition. Instead of connecting to each individual app, providers would be able to monitor a patient’s medication adherence, current health status, and condition-specific factors in one holistic record. At the same time, payers would be able to ensure that providers are checking in as required under their managed care contract.

Ultimately, patients living with MCC will benefit the most from virtual chronic care management. They will have the daily support they need to self-monitor vital stats and adjust their behavior as necessary—and their providers will have the information they need to determine when an in-person visit is required. When virtual chronic care management reaches the pivotal period of alignment—when providers, payers, and technology vendors work together to focus on what is best for patient outcomes—we will be able to make a material change in how chronic care conditions are managed.

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