IRL or URL? Many physicians and patients used to see medical care as something best done in-person (in real life, or IRL). But the pandemic has spurred a massive transition to virtual (or URL) care. According to our recent surveys of consumers and physicians, opinions are split on what happens next (see sidebar, “Our methodology”). As the pandemic evolves, consumers still prefer the convenience of digital engagement and virtual-care options, according to our recent McKinsey Consumer Health Insights Survey. This preference could help more patients access care, while also helping providers to grow.
Many digital start-ups and tech and retail giants are rising to the occasion, but our most recent (2021) McKinsey Physician Survey indicates that physicians may prefer a return to pre-COVID-19 norms. In this article, we explore the trends creating disconnects between consumers and physicians and share ideas on how providers could offer digital services that work not only for them but also for patients. Bottom line: a seamless IRL/URL offering could retain patients while delivering high-quality care. Everybody benefits.
The rise of telehealth
At the onset of the COVID-19 pandemic, both physicians and patients embraced telehealth: in April 2020, the number of virtual visits was a stunning 78 times higher than it had been two months earlier, accounting for nearly one-third of outpatient visits. In May 2021, 88 percent of consumers said that they had used telehealth services at some point since the COVID-19 pandemic began. Physicians also felt dramatically more comfortable with virtual care. Eighty-three percent of those surveyed in the 2021 McKinsey Physician Survey offered virtual services, compared with only 13 percent in 2019.
However, as of mid-2021, consumers’ embrace of telehealth appeared to have dimmed a bit from its early COVID-19 peak: utilization was down to 38 times pre-COVID-19 levels. Also, more physicians were offering telehealth but recommending in-person care when possible in 2021, which could suggest that physicians are gravitating away from URL and would prefer a return to IRL care delivery (Exhibit 1).
Three trends from the late-stage pandemic
As COVID-19 continues, three emerging trends could set the stage for the next few years.
The number of virtual-first players keeps growing, and physicians struggle to keep up
The growth (and valuations) of virtual-first care providers suggest that demand by patients is persistent and growing. Teladoc increased the number of its visits by 156 percent in 2020, and its revenues jumped by 107 percent year over year. Amwell increased its supply of providers by 950 percent in 2020.
By contrast, only 45 percent of physicians have been able to invest in telehealth during the pandemic, and only 16 percent have invested in other digital tools. Just 41 percent believe that they have the technology to deliver telehealth seamlessly.
Some workflows, for example, require physicians to log into disparate systems that do not integrate seamlessly with an electronic health record (EHR). Audiovisual failures during virtual appointments continue to occur. To make these models work, providers may need to determine how to design operational workflows to make IRL/URL care as seamless as possible for both providers and patients. The workflows and care team models may need to vary, depending on the physician’s specialty and the amount of time they plan to devote to URL versus IRL care.
Patient–physician relationships are shifting
In McKinsey’s April 2021 Physician Survey, 58 percent of the respondents reported that they had lost patients to other physicians or to other health systems since the start of the COVID-19 pandemic. Corroborating those findings, our August 2021 survey of consumers showed that of those who had a primary-care physician (PCP), 15 percent had switched in the past year. Thirty-five percent of all consumers reported seeing a new healthcare provider who was not their regular PCP or specialist in the past year. Among consumers who had switched PCPs, 35 percent cited one or more reasons related to the patient experience—the desire for a PCP who better understood their needs (15 percent of respondents), a better experience (10 percent), or more convenient appointments (6 percent). Just half (50 percent) of consumers with a PCP say they are very satisfied. What’s more, Medicare regulations now give patients more ownership over their health data, and that could make it easier for them to switch physicians.
Physicians and patients see telehealth differently
Our surveys show that doctors and patients have starkly different opinions about telehealth and broader digital engagement (Exhibit 2). Take convenience: while two-thirds of physicians and 60 percent of patients said they agreed that virtual health is more convenient than in-person care for patients, only 36 percent of physicians find it more convenient for themselves.
This perception may be leading physicians to rethink telehealth. Most said they expect to return to a primarily in-person delivery model over the next year. Sixty-two percent said they recommend in-person over virtual care to patients. Physicians also expect telehealth to account for one-third less of their visits a year from now than it does today.
These physicians may be underestimating patient demand. Forty percent of patients in May 2021 said they believe they will continue to use telehealth in the pandemic’s aftermath.
In November 2021, 55 percent of patients said they were more satisfied with telehealth/virtual care visits than with in-person appointments.
Thirty-five percent of consumers are currently using other digital services, such as ordering prescriptions online and home delivery. Of these, 42 percent started using these services during the pandemic and plan to keep using them, and an additional 15 percent are interested in starting digital services.
Convenience is not the only concern. Physicians also worry about reimbursement. At the height of the COVID-19 pandemic in the United States, the Centers for Medicare & Medicaid Services (CMS) and several other payers switched to at-parity (equal) reimbursement for virtual and in-person visits. More than half of physician respondents said that if virtual rates were 15 percent lower than in-person rates, they would be less likely to offer telehealth. Telehealth takes investment: traditional providers may need time to transition their capital and operating expenses to deliver virtual care at a cost lower than that of IRL.
Four critical actions for providers to consider
Providers may want to define their IRL/URL care strategy to identify the appropriate places for various types of care—balancing clinical appropriateness with the preferences of physicians and patients.
Determine the most clinically appropriate setting
Clinical appropriateness may be the most crucial variable for deciding how and where to increase the utilization of telehealth. Almost half of physicians said they regard telehealth as appropriate for treatment of ongoing chronic conditions, and 38 percent said they believe it is appropriate when patients have an acute change in health—increases of 26 and 17 percentage points, respectively, since May 2019.
However, physicians remain conservative in their view of telehealth’s effectiveness compared with in-person care. Their opinions vary by visit type (Exhibit 3). Health systems may consider asking their frontline clinical-care delivery teams to determine the clinically appropriate setting for each type of care, taking into account whether physicians are confident that they can deliver equally high-quality care for both IRL and URL appointments.
Assess patient wants and needs in relevant markets and segments
Patient demand for telehealth remains high, but expectations appear to vary by age and income group, payer status, and type of care. Our survey shows that younger people (under the age of 55 ), people in higher income brackets (annual household income of $100,000 or more), and people with individual or employer-sponsored group insurance are more likely to use telehealth (Exhibit 4). Patient demand also is higher for virtual mental and behavioral health. Sixty-two percent of mental-health patients completed their most recent appointments virtually, but only 20 percent of patients logged in to see their primary-care provider, gynecologist, or pediatrician.
To meet market demand effectively, it may be crucial to base care delivery models on a deep understanding of the market, with a range of both IRL and URL options to meet the needs of multiple patient segments.
Partner with physicians to define a new operating model
Many physicians are turning away from the virtual operating model: 62 percent recommended in-person care in April 2021, up five percentage points since September 2020. As physicians evaluate their processes for 2022, 46 percent said they prefer to offer, at most, a couple of hours of virtual care each day. Twenty-nine percent would like to offer none at all—up ten percentage points from September 2020. Just 11 percent would dedicate one full day a week to telehealth, and almost none would want to offer virtual care full time (Exhibit 5).
To adapt to these views, care providers can try to meet the needs and the expectations of physicians. They could offer highly virtualized schedules to physicians who prefer telehealth, while allowing other physicians to remain in-person only. Matching the preferences of physicians may create the best experience both for them and for patients. Greater flexibility and greater control over decisions about when and how much virtual care to offer may also help address chronic physician burnout issues (Exhibit 6). Digital-first solutions (for example, online scheduling, digital registration, and virtual communications with providers) could also increase the reach of in-person-only care providers to the 60 percent of consumers interested in using these digital solutions after the pandemic abates.
Communicate clearly to patients and others
Physicians consistently emerge as the most trusted source of clinical information by patients: 90 percent consider providers trustworthy for healthcare-related issues.
Providers could play a pivotal role in counseling patients on the importance of continuity of care, as well as what can be done safely and effectively by IRL and URL, respectively. The goal is to help patients receive the care that they need in a timely manner and in the most clinically appropriate setting.
Potential benefits to providers
The strategic, purposeful design of a hybrid IRL/URL healthcare delivery model that respects the preferences of patients and physicians and offers virtual care when it is appropriate clinically may allow healthcare providers to participate in the near term, retain clinical talent, offer better value-based care, and differentiate themselves strategically for the future.
Telehealth and broader digital engagement tools have enjoyed persistent patient demand throughout the pandemic. That demand may persist well after it. Investment in digital health companies has grown rapidly—reaching $21.6 billion in 2020, a 103 percent year-over-year increase—which also suggests that this approach to medicine has staying power.
That level of demand offers the potential for growth when physicians can meet it. If only new entrants fully meet consumer demand, traditional providers who do not offer URL options may risk losing market share over time as a result of patients’ initial visit and downstream care decisions. What’s more, as healthcare reimbursement continues to move toward value, virtual-delivery options could become a strategic differentiator that helps providers better manage costs.
In all likelihood, one of the critical steps in the process will be engaging physicians in the design of new virtual-care models—for example, determining clinical appropriateness, how and where physicians prefer to deliver care, and the workflows that will maximize their productivity. This has the added benefit of potentially also addressing the problem of physician burnout by offering a range of options for how and where clinicians practice.
Most important, virtual care can offer an opportunity to improve outcomes for patients meaningfully by delivering timely care to those who might otherwise delay it or who live in areas with provider shortages. In addition, patients’ most trusted advisers on care decisions are physicians, so virtual care gives them a meaningful opportunity to help patients access the care they need in a way that both parties may find convenient and appropriate.
Physicians are evaluating a variety of factors for delivering care to patients during and, eventually, after the COVID-19 pandemic. The strategic, purposeful design of a hybrid IRL/URL healthcare delivery model offers a triple unlock: improving the value of healthcare while better meeting consumer demand and improving physicians’ engagement. The full unlock is not easy—it requires deep engagement and cooperation between administrators, clinicians, and frontline staff, as well as focused investment. But it will yield dividends for patients and providers alike in the long run.