As part of an integrated care delivery approach, virtual health can complement in-person care by improving coordination and continuity of care and reaching patient populations that are underserved and underresourced.1 It has the potential to benefit both consumers and physicians by improving access, convenience, and the experience of receiving and providing care. We know that consumers enjoy the convenience and accessibility of virtual health—but first we need to solve for some of the challenges standing in the way of a frictionless, consistent, and high-quality experience.
Two surveys conducted by the Deloitte Center for Health Solutions in January to March 2022 give us insight into how, when, and where physicians and consumers like to use virtual health solutions—and conversely, how health care organizations might respond to slowing uptake and adoption gaps. In the biennial Deloitte Survey of US Health Care Consumers, 4,545 consumers shared their experiences and attitudes related to their health, health insurance, and health care in general. And in the biennial Deloitte Survey of US Physicians, 660 US-based physicians shared their perceptions of market trends that impact the current and future state of practicing medicine.
With respect to virtual health, the data we collected during the past five years reveals that consumers’ appetite for virtual health and digital health tools has steadily increased, but there is significant variation in physician adoption. Our findings show that some physicians are unsure how to best use virtual health in a clinical setting while others are concerned about losing the human connection that is an integral part of in-person care.
The survey results highlight a few ways that health organizations could better:
The key is ensuring that the human touch remains central to care delivery—and that can be best accomplished by inviting all health care stakeholders from physicians and consumers to frontline clinicians to actively participate in reimagining and redesigning how care is delivered.2
Our research revealed that consumers who aren’t satisfied with a virtual visit are less likely to schedule another one—and the reasons why reveal opportunities to improve the process and the experience. In the 2022 Deloitte Survey of US Health Care Consumers, 30% of respondents who had a virtual visit in 2022 (vs. 33% in 2020) selected, “I did not feel the quality of care was as good as my own doctor” and 27% (vs. 18% in 2020) selected, “I was not able to connect with the clinician the same way I would in-person” as the top reasons for not having a return virtual health visit. These responses point to a disconnect—personal or otherwise—when care is delivered virtually.
The physicians who participated in our survey agreed that virtual health encounters can lack the personal touch that is associated with in-person care. In open-ended responses about what works well virtually and in person, physicians said that easy communication (37%), including establishing patient rapport (17%), is the key benefit of in-person encounters—and that it leads to better patient follow-through and adherence. In contrast, only 11% of physicians said that communication is a general benefit of virtual health and just 1% said that virtual health is conducive to establishing patient rapport (figure 1).
What physicians say about patient communications during in-person encounters
While the communication piece is important, it isn’t the only aspect of care delivery that works better in person. In fact, the physicians we surveyed said that workflow and operations, clinical decision-making, and the “entire care process” are more effective during an in-person visit. Workflow and operations are more streamlined for in-person visits (26%) than for virtual patient encounters (13%), including resources and established processes that support operational efficiency and better care coordination (figure 1). As such, there’s an opportunity for health care organizations to optimize workflows for virtual visits that could remove friction for physicians, enable them to better engage with patients, and deliver higher quality of care.
What physicians say about the workflow for in-person visits
In addition, physicians said that the clinical considerations are more straightforward for in-person visits: They can take vitals, perform physical exams, comprehensive assessments, and in-office procedures. In contrast, physicians said that the clinical considerations for virtual visits are nuanced, and some clinical decision-making is tougher—for instance, determining when to triage a patient to a higher level of care. At the same time, they acknowledge nonclinical benefits of virtual health visits, such as patient access and convenience.
What physicians say about clinical and nonclinical aspects of virtual health visits
To improve upon these aspects for virtual visits, health care organizations should:
Call to action: Invest in virtual health as part of a comprehensive care management program
The Deloitte Survey of US Physicians found that adoption of virtual health, especially video visits, grew during the COVID-19 pandemic, with 68% of physicians using video visits in 2022, up from 14% in 2018 (figure 2).6 Nearly one-third of physicians (30%) also reported that they implemented chat with patients.7 Our consumer survey, too, shows a large increase in use of virtual visits from 17% in 2018 to 42% in 2022. Wide adoption of video visits was made possible by regulatory changes that were implemented out of necessity during the pandemic, but it remains to be seen how changing regulations might shape future adoption.8
However, physician adoption of nonvideo virtual health modalities did not increase in 2022 and these findings are in line with results from the AMA 2021 Telehealth survey report.9 We found that in general, large practices were more likely than their small and medium counterparts to sustain adoption of nonvideo virtual health modalities.10 Between 2018 and winter 2020, on a total basis, we observed an increase in the adoption of remote patient monitoring, integration of data from patient wearables, and physician-to-physician virtual consultations (figure 2).
Between 2020 and 2022, however, physician-to-physician consultations increased in large but not in small or medium practices; the availability of remote patient monitoring at home decreased in medium and small practices, and there was an erosion in the implementation of other virtual health modalities (remote patient monitoring at other facilities, patient-reported outcome collection, and wearables) across the board.
It is possible that with the onset of the pandemic in spring 2020, the focus on emergency care and a lack of resources (especially in smaller practices) contributed to a slowdown in the implementation and optimization of nonvideo virtual health modalities.11 Furthermore, the uncertain fate of telehealth regulations at the end of the public health emergency may have hindered adoption.12 Another possibility is that physician practices failed to realize the benefits from nonvideo virtual health modalities, such as wearables, especially in the fee-for-service environment.
Video visits were the one exception to this trend, with adoption in outpatient settings growing to 81% in 2022, up from 14% in 2018 and 19% in 2020.
To achieve consistent adoption across all virtual health modalities, health care organizations should:
While virtual health visits are more convenient because they often eliminate the need to travel, find child care, and take time off work, the issue of access isn’t always as straightforward. Studies of virtual health utilization from claims and EHRs show that in the period of 2020–2021, patients with all types of insurance had similar access to virtual health, while the uninsured population had lower access.14 Some studies found that access for underserved populations has improved as a result of virtual health, while others indicate that the digital divide (known as the gap between those with and without access to technology) has exacerbated inequities. For instance, underserved populations were more likely to rely on audio-only and messaging services.15 On balance, virtual health’s effects on access appear to be mixed.16
In our consumer survey, the digital divide is expressed by differential use of virtual health based on income and reliability of internet service. Nearly half of consumers (46%) with very good/reliable internet service had a virtual visit in the last 12 months, compared with 31% of those with very poor/unreliable internet service. Although most consumers (81%) have broadband access, only half (52%) describe it as reliable and meeting their needs. Not surprisingly, households with the highest incomes are the most likely to have reliable internet service. Sixty-three percent of consumers with an annual household income greater than US$100,000 have reliable internet, compared with 46% of those making less than US$50,000.
When we asked physicians about the effects of virtual health on access to care for underserved groups, more said virtual health has increased access (39%) than decreased (7%) while 12% said it had no effect and 25% said the effects were mixed. This is a relatively optimistic view when compared to utilization studies and our consumer survey findings that show mixed effects on access. Interestingly, physicians who have implemented virtual health in their practice are much more positive about its effect on access.
To narrow the digital divide, health care organizations can collaborate with local governments, utility providers, and businesses in their community (such as shopping centers, schools, shelters, libraries, and pharmacies) to provide free Wi-Fi and digital devices that can be used to receive virtual health services. For instance, Texas A&M Health Science Center collaborated with OnMed to place kiosks in a rural Texas community to measure patients’ vital signs, dispense common medications, and facilitate on-demand video visits with a nurse practitioner.17
Our view is that virtual health is not a substitute for how care has traditionally been delivered. Instead, it offers new ways of care delivery that were not possible in the past. When done well, virtual health can improve care quality and continuity, reduce friction, and address health equity. And although there is still a lot to learn and improve on, organizations should assess their current maturity, reflect on how virtual care can help align with strategic goals, and begin to implement the following steps:
These steps can help satisfy consumers’ appetite for virtual health and digital technology and position health care organizations for a Future of HealthTM that centers on digitally enhanced, frictionless, affordable, high-quality, and equitable care.
Since 2011, the Deloitte Center for Health Solutions has surveyed a nationally representative sample of US physicians on their attitudes and perceptions about the current market trends impacting medicine and the future state of the practice of medicine.
The biennial survey was fielded between January 18 and March 20, 2022. This survey of 660 physicians is nationally representative of US primary care and specialty physicians with respect to years in practice, gender, geography, practice type, and specialty.
The general aim of the survey is to understand physician adoption and perception of key market trends of interest to the health care industry and policy. In 2022, 660 US primary care and specialty physicians were asked about a range of topics, including virtual health, digital technologies, care teams, health equity, and value-based care.
We selected a random sample of physician records with complete mailing information from the American Medical Association (AMA) Physician Masterfile, and stratified it by physician specialty, to invite participation in an online 20-minute survey.
The resulting study sample is representative of the AMA Physician Masterfile with respect to years in practice, gender, geography, practice type, and specialty to reflect the national distribution of US physicians.
The AMA is the major association for US physicians and its Physician Masterfile contains records of more than 1.4 million US physicians (including AMA members and nonmembers) and is based upon graduating medical school and specialty certification records. It is used for both state and federal credentialing as well as for licensure purposes. This database is widely regarded as the gold standard for health policy work among primary care physicians and specialists, and is the source used by the federal government and academic researchers for survey studies among physicians.
Appendix 2. Methodological notes: 2022 Deloitte Survey of US Health Care Consumers
2022 Deloitte Survey of US Health Care Consumers: Since 2008, the Deloitte Center for Health Solutions (DCHS) has surveyed a nationally representative sample of US adults (18 and older) about their experiences and attitudes related to their health, health insurance, and health care in general. The national sample is representative of the US Census with respect to age, gender, race/ethnicity, income, geography, and insurance source. As part of this effort, from February 24 through March 14, 2022, DCHS conducted an online survey of 4,545 US adults.
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