2020 was the year virtual care went mainstream. Given this new visibility — and the confluence of strong regulatory, behavioral and technical tailwinds — it is easier and more attractive than ever to stand up a virtual clinic.
But not all virtual care models are created equal, or have equal benefits to patients. Entrepreneurs and operators building this next generation of virtual clinics must ensure that the level of care provided equals — or better yet, exceeds — that of brick-and-mortar counterparts. So how do builders in this space guarantee the highest level of care? I believe that it is by valuing and integrating clinical rigor throughout.
In this piece, I will break down what it means to be clinically rigorous in this virtual care context, how this creates a flywheel that benefits patients and creates the strongest and most durable business models, and lastly, how technology is enabling clinical rigor in ways that are inaccessible to traditional care models.
The term clinical rigor typically triggers mental images of peer-reviewed journal articles and is often synonymous with methodological rigor and reproducibility for specific clinical interventions. While this version of rigor is a critical piece of a virtual care model, an expanded mental model of clinical rigor is important to drive durable, sustainable impact on the health and well-being of patients.
Clinical rigor can also be thought of as the clinic being rigorous. That is, an end-to-end care model — not just an isolated intervention — that can: (1) reliably deliver high-value care, (2) create a positive patient experience, and (3) continually improve over time. With that lens, clinical rigor goes far beyond the validation of the specific intervention and permeates into the entire care model, from the design of the patient-doctor interaction, to the business model, to the organizational structure of the company. Taken this way, clinical rigor is part of the core ethos and fabric of the company.Clinical rigor can also be thought of as the *clinic* being *rigorous*.
When I am evaluating the clinical rigor of a virtual care model, I ask the following questions:
It’s unrealistic to expect that virtual care companies will check every one of these boxes from day one, but having the strategic and product roadmaps of the company aligned to these as true north will pay dividends at each stage of the company’s growth.
It is clear how integrating clinical rigor into a virtual care model will, by definition, drive differentiated clinical outcomes for patients. But perhaps less obvious but equally important, is its role in building transformational, durable businesses in healthcare.
A confluence of tailwinds has accelerated the uptake of virtual care in a way many would not have predicted. Numerous companies are experiencing immense growth by solving access challenges and relieving pent up patient demand. The quickly maturing virtual care tech stack is also enabling this shift. But, just like we are seeing with legacy care models, we anticipate a transition from volume to value in virtual models. Successfully navigating this shift from fee-for-service to value-driven constructs (like pay-for-performance, centers of excellence, bundled payments, and full capitation) will require extensive integration of clinical rigor into all levels of the care and business model.Successfully navigating this shift from fee-for-service to value-driven constructs will require extensive integration of clinical rigor into all levels of the care and business model.
I believe that the most impactful models will be those that build on the flywheel of a clinically rigorous model. This flywheel can take a variety of shapes, but in a generalized form can be thought of as:
We are seeing this flywheel start to spin for a number of companies. For example, we have seen a handful of companies parlay differentiated clinical outcomes into preferred (semi-exclusive) provider relationships with payors, leading to simplified patient acquisition channels and higher reimbursement rates. This near-term success can drive long-term impact by activating this feed-forward loop as preferred relationships drive higher patient volumes, which leads to more data to refine the care model both clinically and operationally. A more refined care model then leads to even further differentiated clinical outcomes on top of better operational efficiency and business fundamentals. As competition in virtual care continues to rise, I see this as being a viable path to defensibility long-term.
There are parts of the virtual care ecosystem where clinical rigor is table stakes (e.g. products sold to payors or at-risk groups as carve out offerings). However, the huge recent push towards virtual care has unlocked and accelerated paths to scale in other parts of the virtual care ecosystem which demand less attention to clinical rigor at the outset. While enticing to build aggressively in these areas, this can create a large amount of what I think of as “clinical debt” that will eventually be called in.
We have already seen this start to play out in several areas of the market, with a prime example being remote patient monitoring (RPM). When the novel RPM reimbursement codes were launched in late 2019, there was a flurry of activity as companies sprung up using the new codes as a long awaited business model scaffold for remote care. These companies exhibited a wide range of attention to clinical rigor with some broadly deploying RPM devices without clear ties into a surrounding clinically rigorous model. Over the past several weeks, however, CMS has clarified and tightened the guidelines around the RPM codes. Will less rigorous models be able to meet these new (and future) guideline updates? Time will tell, but by not investing in clinical rigor at the outset, they are now exposed to existential risk. More broadly, this move is a clear signal that CMS (and other payors) will increasingly demand and reward higher-value, more clinically rigorous care models.
One of the most exciting features of virtual care companies is that, in many ways, they are better positioned to deploy clinically rigorous care models than their brick-and-mortar analogs. Here are a few ways that I see tech enabling clinical rigor:
With the various technical, regulatory, and behavioral tailwinds aligning behind virtual care, I couldn’t be more excited about the opportunity to launch and scale clinically rigorous virtual care models. I see a unique window to not only drive significant patient impact, but also build a new generation of transformative healthcare companies. It’s time to build in virtual care.