Building on existing research, the American Medical Association, in collaboration with Manatt Health, developed a "Return on Health" framework to articulate the value of digitally enabled care that accounts for ways in which a wide range of telehealth (also referred to as virtual care) programs can increase the overall health and generate positive impact for patients, clinicians, payors and society.
The goal of this work is threefold:
- Define various ways in which virtual care programs generate—and how they can generate—value, with a focus on value for provider organizations, including physician practices.
- Demonstrate how the framework is being used today and how it can be used in other practice environments to more precisely and holistically measure the value of virtual care through detailed case studies..
- Highlight opportunities for health care stakeholders to realize the full potential of digitally enabled care in the years ahead.
The COVID-19 pandemic has spurred a dramatic increase in telehealth adoption. The rise has been driven out of the necessity for social distancing and enabled by a wide range of policy flexibilities implemented by federal and state legislators, regulators and payors.
Many of these allowances are still temporary, creating uncertainty among clinicians, policymakers and payors on whether and how much to pay for virtual care services in the future. Providers, payor executives, policymakers and clinicians often make these decisions based on outdated telehealth measurement strategies that are overly generalized, do not consider the various value streams virtual care provides and do not account for environmental factors including:
- Type of practice.
- Payment models.
- Virtual care modality.
- Clinical use case.
- Social determinants of health for patient population.
The integration of new digital health solutions into digitally enabled care models offers the potential to address the quadruple aim in a new era of high access, high quality, lower cost and high experience care.
The existing body of evidence regarding the value of virtual care has grown substantially in recent years. However, it is often narrowly focused on direct reimbursement, program costs and short-term clinical benefit measures for "parallel care." A broader and more holistic value framework is needed to measure virtual care value for the digitally enabled care era on the horizon.
The AMA's Return on Health framework describes several environmental variables that impact six distinct value streams, which collectively seek to fully capture the "value" derived from a specific digitally enabled hybrid care model. The impact of a digitally enabled hybrid care model should be measured on all of these value streams, which can drive the financial performance of organizations and help realize the full potential of virtual care.
The Return on Health report (PDF) includes ten case studies that explore the value of virtual care through the framework. Four real-world examples were designed and developed in collaboration with organizations that are currently measuring the value of their virtual care programs and six illustrative scenarios were developed to show how to apply the framework considering different environmental variables. For a brief overview, see "How to measure the value of virtual health care" (Barron, Mishra, Lloyd & Augenstein; Harvard Business Review).
Virtual care case studies
- Virginia Commonwealth University Health–Telepsychiatry during COVID-19
- Ochsner Health–Hypertension digital medicine program
- Massachusetts General Health–Teleneurology and telestroke
- Cityblock Health–Complex care coordination
Virtual care scenarios
- Summerhill Hospital–Remote patient monitoring (RPM) for diabetes management (PDF)
- Grand Plains Community Hospital–Tele-intensive care unit (Tele-ICU) (PDF)
- BonaCura Children’s Hospital–Urology postoperative video visits (PDF)
- Green Street Dermatology Associates–Teledermatology (PDF)
- High Rock OBGYN Associates–Prenatal/postpartum video visits (PDF)
- Viridian Family Practice–Primary care video visits (PDF)
In addition, the AMA Telehealth Implementation Playbook proposes 12 distinct steps that practices can take to support efficient, successful implementation of telehealth programs. The framework proposed in this report can support those practices in completing four of those 12 steps:
- Defining success.
- Making the case.
- Evaluating success.
Virtual care is here to stay, but how do we realize the full potential of digitally enabled care? The report also outlines key challenges and opportunities for industry stakeholders to address to accelerate their evolution to digitally enabled care.
Thank you to our generous contributors for sharing their experiences and expertise in the development of the Return on Health report (PDF).