In 2021, Our Health System Will Be Largely Virtual-First, Not Virtual-Only

The impact of the COVID-19 pandemic on all aspects of our health cannot be understated. People continue to be infected at record rates and many others are grieving the loss of loved ones and dealing with financial distress—it’s all wearing us down, physically and emotionally. All of this while so many people can’t access their usual health-care services, including therapists, chronic disease specialists, and OB/GYNs. But with limitations come new innovations: The use of telehealth services has grown exponentially, and this new virtual-first approach will lead to care that is centered on the patient, not a health system.

“The pandemic really pushed us beyond what we thought was possible with telehealth capabilities, and pushed patients to become more comfortable connecting with health-care providers virtually,” says One Medical regional director and provider Natasha Bhuyan, MD. In 2019,11 percent of Americans used telehealth, according to data from McKinsey & Company. This year, 46 percent of U.S. patients have used telehealth to replace in-person appointments and 76 percent report they’re interested in using digital health services in the future.

Changes in regulation early in the pandemic were instrumental in allowing this rapid growth. Pre-pandemic, in order to adhere to the health privacy standards laid out in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), doctors had only a few video platforms to choose from for appointments. But in mid-March, the government eased HIPAA restrictions on telehealth services, allowing practitioners to use any kind of video platform for virtual visits. The federal government also increased funding for telehealth and added 144 new items to the list of telehealth services covered by Medicare and Medicaid. The list of actions being taken at the state and federal level to expand telehealth is long and complicated (and if we listed them all here, we’d be here all day), but the result is clear: More providers are able to offer their services digitally, enabling more people to access the care they need. And bills are currently working their way through Congress to make these changes permanent.

Carolyn Witte, CEO and co-founder of Tia, believes that these telehealth expansions will help to make for a health-care system that better integrates virtual and non-virtual services (something she calls “virtual-first,” rather than “virtual-only,” care) long after the pandemic is over, which is good news for patients. “A virtual-first care approach allows Tia to fill local market care gaps quicker and more efficiently, allowing us to provide whole-person physical, mental, and emotional care sooner to communities who need it,” she says.

These communities include ones that are historically underserved. “Telehealth has the potential to increase access for certain populations, such as people in rural areas, who would not otherwise have access to doctors or specialists,” says Dr. Bhuyan. “It also allows us the ability to reach groups—like people who are transgender or adolescents seeking sexual health resources—who might not feel safe going into a physical office.” Plus, telehealth is often less expensive for patients. “Telehealth typically costs around $60 to $70 per visit, which is half that of an in-person office visit with a primary care doctor,” says Sachin Nagrani, MD, medical director of the telemedicine platform Heal.

Yet, while this time has sparked positive changes, the pandemic also showed just how systemic our health failings are, and how urgently governments and health-care leaders need to address said failings. Black and Latinx communities were hit the hardest by the pandemic, in large part because the social determinants of health (the conditions in which people live and work) have disproportionately affected queer, trans, Black, Indigenous, and people of color (QTBIPOC) for centuries. “There are many things in health care that need to be addressed in order to eliminate the health disparities that minorities face,” says Shakevia Johnson, MD. “Lack of trust is a major issue. Minorities do not feel safe. Minorities do not feel heard. This contributes to the stigma of seeking [and] participating in health care, especially mental health. We need to openly acknowledge that these issues exist and have open dialogues with Black and Latinx communities so we can work together to build safe, trusting relationships.”

As we enter 2021, many Americans are joining the fight for health equity; in her Anti-Racism Daily newsletter, for instance, Nicole Cardoza notes that localized health equity task forces are organizing to fight COVID-19 in cities including Boston, New York, Houston, and Michigan. And new resources that are specifically targeted to marginalized groups will help bridge the gap in care. Folx, for one, is a direct-to-consumer health-care platform for trans and queer individuals that launched in late 2020 and will expand with new product offerings in 2021. Another is Exhale, a well-being app that launched in August to address the needs of Black, Indigenous, and women of color (BIWOC) and has plans to grow in the new year. And She Matters, a community focused on supporting Black women’s mental health, will launch an app to help users find culturally competent therapists in 2021.

All of these factors together will fuel the lobbying of the government (at all levels) for better access to doctors for all who need it. “The health-care system is amidst a tectonic shift from one-size-fits-all care to people-based care with different care models being built to serve the distinct needs of different populations…who each have unique clinical needs, but also sociocultural and financial needs that impact how different groups access or do not access health care,” says Witte. “With COVID-19 revealing such harrowing differences in outcomes across different populations, the need for people-based care has become even more paramount.”