In the COVID-19 pandemic, as peoples’ daily lives shifted closer and closer to home, and for some weeks and months home-all-the-time, health care, too, moved beyond brick-and-mortar hospitals and doctors’ offices.

The public health crisis accelerated “what’s next” for health care delivery, detailed in A New Era of Virtual Health, a report published by TripleTree.

TripleTree is an investment bank that has advised health care transactions since 1997. As such, the team has been involved in digital health financing and innovation for 24 years, well before the kind of platforms, APIs, and cloud computing now enabling telehealth and care, everywhere.

The report lays out the many components of the virtual health ecosystem in three broad areas covering the continuum of care:

  1. Triage and intake, the front-door of routing patients to the most appropriate pathway for their symptoms
  2. Care delivery that uses both traditional “physical” and virtual modalities, which got stress-tested during the pandemic, and,
  3. Care to the home leveraging remote monitoring and the power of patient engagement.

TripleTree expects a “domino effect from virtual health adoption that will drive waves of demand across areas that complement virtual health and address other vulnerabilities exposed by COVID-19,” the report forecasts.

We must be mindful that hospitals, health systems and physicians quickly stood up and adopted virtual care, especially telemedicine programs, in March and April 2020. In 2019, J.D. Power found that only 10% of health consumers had been using telehealth services. Describing that low-utilization in their report, J.D. Power called telehealth, “the best consumer healthcare experience you’ve never tried.”

The coronavirus and #StayHome mandates were the wild card that changed every normal forecast for telehealth utilization in 2020.

And with patients’ collective exposure to and experience with virtual care in 2020, demand for these services is persisting in and beyond 2021.

Those “waves of demand” TripleTree described will impact every segment of care delivery and sponsor, including small to mid-sized physician practices, employers, behavioral/mental health, public/government-sponsored health care programs, and the pharma and life science industry.

More granularly, TripleTree defines the field first differentiating virtual health from telehealth, and then in terms of the segments that cover the marketscape.

Virtual health is the broad umbrella term used to encompass techs and tools that enable health care to remotely engage and monitor people across the health care ecosystem, shown in Figure 1 here from the report.

Telehealth is the sub-set of delivery methods and tools used to deliver health care services.

The diagram then lists the various segments from triage and virtual visits through tele-pharmacy, in-home monitoring, and virtual clinical trials, among other tech’s.

The report dives into the stakeholder groups, offering market maps with examples of companies and innovators in each innovation space, from digital front doors like Dexcare, Phreesia and Doctor.com, scheduling access via Symplr, ZocDoc and DocASAP, and digital diagnosis and triage from Gyant and K Health, et. al.

Other maps detail live virtual visits (a large category with many players like Kareo, Updox, eVisit, Doxy.me), next-gen primary care (such as Oak Street Health, One Medical, and Parsley Health), and asynchronous virtual visits (with Zipnosis, 98point6, or Babylon, etc.).

Condition-focused providers include hims&hers, LemonAid, Ro and Tia, among others. There are many facility-focused solutions for long-term care and correctional facilities, and eConsult tech platforms.

I laud TripleTree for spending time in the report addressing mental and behavioral health which I spotted by April 2020 as the epidemic inside and beyond the COVID-19 pandemic. The graphic marked Figure 12 illustrates TT’s take on behavioral health implications of COVID-19, clearly depicting the population health implications of the virus on life-flows like financial stress, sleep, feelings of isolation and loneliness in the mainstream; and more severely, violence, PTSD, suicidality, and domestic violence which has ratcheted up in the pandemic era.

Health Populi’s Hot Points:  Home is evolving as an impactful site for health care, we are learning from the pandemic. In fact, hospital-to-home programs were already being implemented in 2019 by innovative health systems, and the public health crisis accelerated pilots into real-time health care programs with increasingly sustainable business models (namely, value-based payment).

The third-leg of TripleTree’s 3-part vision for virtual care is home-based patient monitoring and engagement, detailed in this chart from the report.

As TT notes, the rise in home-based care is a déjà vu back to health care delivered in the 19th and early 20th century before the hospital-industrial complex as we know it existed. Think: grandma’s kitchen table wisdom, the barber-surgeon, and doctors who operated office spaces attached to their houses.

The 2021 version leverages remote patient monitoring, on-demand medical exams, care navigation, medication adherence, chronic care management, and education personalized to the patient and caregiver. There is a growing supply-side of virtual or next-gen home-based care, from Cricket Health, Dispatch, Medically Home, Med-Zed, Remedy, and Signify Health, along with others bring Marcus Welby, MD, up to the 21st century digital health mode.

Remote monitoring in itself has at least two dozen players, according to TT’s market map, with some major names like Best Buy, GreatCall, Medtronic, Honeywell, Optum, and Philips in the category. Tytocare and Everlywell have launched home-based exam tools, and patient communications is a large and fast-expanding era as we know that, “the patient is the most underutilized resource in health care,” Dr. Safran told Congress (and us) over two decades ago.

Indeed, the home is the new health hub. TripleTree’s research helps to continue to define the concept of virtual care, typology and industry organization, along with this chaos-and-creation moment as hundreds of innovators launch telehealth and virtual care platforms serving both niches (like scheduling and medication adherence) as well as enterprise-wide virtual care-first services.

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