Cynthia Horner, MD, is the medical director for Amwell and has been a board-certified family physician for 25 years.

Cynthia Horner, MD, FAAFP 

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For three out of five consumers who experienced a virtual visit last year, COVID-19 prompted their first foray into telehealth, according to a 

. But while urgent care was once the biggest draw for telehealth consumption, that trend flipped during the pandemic, when scheduled visits—especially with specialty and primary care physicians—took center stage.

Now, as healthcare leaders consider where and how to embed telehealth into their member or patient experience for the long haul, it’s critical to examine how virtual care can lead to better health outcomes.

The following use cases provide insight into why virtual primary care (VPC) is quickly becoming the new house call and what it takes to provide optimal value with a VPC program from a physician’s perspective.

Case Number 1: Jumpstarting A Relationship With a Primary Care Provider

Lisa*, 26, a newly diagnosed, insulin-dependent person with diabetes, recently moved to the East Coast. She graduated law school, started a job, and acquired new insurance, yet she did not have a primary care physician in her newly established community. When it came time to refill her medication, Lisa chose telehealth for its convenience—as an attorney, she works 65 to 70 hours a week—and to establish a new relationship with a primary care provider.

It quickly became clear that Lisa’s health needs went beyond the request for a prescription refill. Lisa had not been seen by a clinician in six months, and her blood sugar levels had skyrocketed to 250, even while taking medication. Because of her struggles with keeping her diabetes under control, Lisa showed signs of retinal inflammation, a condition that is typically accompanied by kidney damage and, if left unchecked, could quadruple her risk of heart disease and triple her risk of stroke.

Lisa’s virtual primary care provider assessed her condition with the help of a home glucometer, digital blood pressure cuff, and a scale. She also used video to examine Lisa’s overall physical condition, looked for swelling in Lisa’s feet and ankles and worked with Lisa to determine whether she had lost any sensation in her feet. With these tools, Lisa’s virtual primary care provider could perform 90% of the exam that otherwise would have been conducted in person.

The virtual primary care provider adjusted Lisa’s medication and ordered laboratory tests to dig deeper. She also referred Lisa to an ophthalmologist for a retinal screening and to a diabetes educator and an endocrinologist. When Lisa expressed concern regarding how she would find an ophthalmologist in a new city, her virtual primary care physician worked with her to find a close-to-home option and sent an electronic referral. Today, Lisa’s blood sugar levels are at non-diabetic levels, the strain on her retina and kidneys has been resolved, she’s exercising regularly, and she feels great.

Key to success: digital reminders for follow-up care

. So many patients with chronic disease become lost in the follow-up process, primarily due to difficulties in accessing care. While telehealth helps eliminate access-to-care challenges, digital reminders ensure that patients stay on top of follow-up appointments.

Case Number 2: Providing More Personalized Care Intervention

Gerald*, 54, suffered from chronic obstructive pulmonary disease (COPD) after a long history of smoking. He had recently changed insurance and did not have a primary care provider. He was also afraid to leave his house to receive in-person care, given his increased risk for developing a severe case of COVID-19. When Gerald learned that his health plan offered virtual primary care visits, he sought treatment for an increasingly productive cough.

It did not take long for the virtual primary care physician to discover that Gerald faced significant challenges controlling his COPD. Gerald used his steroid inhaler at twice the maximum dose to help with his cough, and he relied on his rescue nebulizer every four hours. His overuse of these medications was causing heart palpitations—a concern if left unchecked.

Often, patients with chronic disease purchase personal biometric monitors to keep track of their vital signs at home, so Gerald’s physician incorporated tools such as a pulse oximeter into his exam. She could also tell by listening to Gerald’s cough that he was wheezing. She prescribed medications that would help Gerald with his breathing and help prevent pneumonia from mucus buildup. She also changed the type of medication Gerald used in his inhaler to decrease the impact on his heart. Today, Gerald not only feels much better, but he’s also reduced his risk of heart failure, stroke and other complications, while avoiding having to seek care in the hospital.

Key to success: getting a glimpse into a patient’s home life.

One of the benefits of meeting with Gerald via video is that the virtual physician could ask Gerald to demonstrate how he used his inhaler and could take a look at Gerald’s nebulizer machine. The physician discovered that Gerald used his inhaler incorrectly, while the tubing on the nebulizer machine, which was 10 years old, was cracked. Gerald’s physician taught him a better technique for using his inhaler during that first video session and ordered new tubing for his machine—small changes that ensured he would receive the full benefit of his medications.

It’s important to note that patients do not need to have chronic health problems to benefit from virtual primary care. The experience of Isabella*, 34, is one example. Isabella chose virtual primary care for a mild residual cough that she developed after recovering from COVID-19.

Prior to her virtual primary care appointment, Isabella hadn’t seen a primary care physician in three years. A close look at her medical history indicated that Isabella underwent a pap smear a few years earlier that came back with mildly abnormal results, but Isabella never scheduled a follow-up appointment

The primary care provider discussed the need for further testing with Isabella and connected her with an OB/GYN who could meet Isabella’s needs.

Key to success: paying attention to patients’ care needs beyond the stated reason for the visit

 In Isabella’s case, the convenience of telehealth prompted her to schedule a virtual primary care visit, but the careful eye of her virtual provider enabled Isabella to avoid delayed care, reducing the potential for worrisome health risks. This approach also can help to improve Healthcare Effectiveness Data and Information Set (HEDIS) measure performance.

COVID-19 demanded that providers find creative ways to safely interact with patients, catapulting telehealth into the mainstream. As leaders continue to look for ways to leverage telehealth to provide affordable, evidence-based care that result in better outcomes, virtual primary care should be a top-of-mind consideration in 2021 and beyond.

Cynthia Horner, MD, is the medical director for Amwell and has been a board-certified family physician for 25 years. She has conducted more than 22,000 telehealth visits, having served as a full-time telehealth provider since 2016.

* Names have been changed to protect patients’ privacy.

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As healthcare leaders consider how to embed telehealth into their member or patient experience for the long haul, it’s critical to examine how virtual care can lead to better health outcomes.

Cynthia Horner, MD, FAAFP

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