Virtual care, the delivery of care via remote clinical interactions and consultations enabled by technology, presents a transformative investment opportunity for healthcare systems and payers. Return on investment (ROI) increases as virtual care adoption grows across larger populations, providing economies of scale and amplifying savings.
Integrating virtual approaches into systems of care and benefit designs can drive success in value-based care reimbursement models by:
- Lowering the total cost of care
- Increasing access to cost-effective, high-quality care
- Improving experiences of care for patients and caregivers, and
- Achieving sustainable cost containment while improving outcomes for chronic and acute conditions
Yet, virtual care is often underutilized by health systems and payers due to underestimates of financial returns resulting from limitations of estimation methods currently used.
Limitations of Current ROI Estimation Methods
Limitations in current methods to estimate the return on investment (ROI) from virtual care can artificially narrow the financial opportunity, leading decision-makers to view it as a peripheral expense. A resulting cycle of underinvestment and lower utilization rates, in turn, limits measurable savings and further hampers adoption.
Key limitations of existing approaches are:
Fragmented Analysis. Virtual care is often evaluated on a solution-by-solution basis rather than as an integrated and additive system of solutions. This piecemeal approach misses the achievable cumulative savings when virtual care is scaled.
Limited Population Scope. ROI methods frequently focus on participants actively using virtual care. This neglects the broader population of potential candidates who could benefit, and it prevents the creation of a suitable group against which to compare benefits.
Data Gaps. Insufficient integration between claims data and virtual care clinical outcomes, collected via EMRs and/or virtual delivery technologies, makes it difficult to track long-term savings or improvements in patient health trajectories.
Attrition Rates. High drop-off rates in virtual care programs can skew realized savings compared to initial projections.
Diverse Outcomes Across Conditions. The financial impacts of virtual care vary significantly by condition, making it challenging to generalize ROI across multiple solutions.
Opportunities to Improve Measurement
Improving how ROI is measured can unlock the true potential value of investing in virtual care and increase its adoption.
Opportunities to increase the precision of ROI estimates include:
System-Wide Impact Analysis. Shifting to the evaluation of virtual care across multiple solutions and conditions reveals its cumulative value, highlighting greater savings opportunities.
Broader Population Inclusions. Including non-enrolled but eligible individuals in ROI studies provide a more accurate picture of potential savings.
Data Integration. Combining clinical and claims data provides a fuller picture of patients’ outcomes and enables the creation of comparison groups to determine the effectiveness of virtual care to generate both immediate cost reductions and long-term benefits, such as improved chronic disease management.
Incorporating Intent to Treat (ITT) Approaches. Originally used in clinical trials to analyze participants regardless of whether they completed treatment as planned, ITT approaches can be used to impute financial and clinical outcomes for patients who leave before a course of virtual care is completed.
Cost Avoidance Metrics. Capturing utilization avoidance and associated costs, such as expected reductions in hospitalizations and emergency visits, includes in estimates of ROI the impacts of virtual care on decreasing exacerbations of acuity and related care needs.
ProNexus: Your Partner in Virtual Care Adoption
At ProNexus, we provide comprehensive support to healthcare organizations at every stage of their virtual care journey. From conducting independent assessments to hands-on implementation support, we help align investments in virtual care with strategic goals. Our expertise includes estimating and measuring returns from those investments, developing and tracking success metrics, ongoing optimization, strategic change management, and ensuring seamless integration and sustainable business transformation.
ProNexus knows that how you measure is as important as what you measure. We emphasize the importance of thoughtful, deliberate action—ensuring that decisions to invest in virtual care are strategic and well-informed. This perspective enables organizations to have confidence in making data-informed decisions to unlock the full potential of virtual care.
Growth in the availability of remote care delivery technologies in tandem with rising costs of care and workforce capacity challenges highlights the urgency for healthcare organizations to strategically invest and integrate virtual care delivery and reimbursement. ProNexus is your trusted partner in navigating this complex landscape. Together, we can ensure that technology-enabled care can deliver expected financial, clinical, and operational outcomes.
About the Author
Lisa M. Schaffner, Ph.D. is an experienced healthcare strategist, data and analytics executive, and health services researcher. She helps organizations get immediate and sustained value from their investments in data, analytics, and AI. Lisa has over twenty years of expertise and experience with integrating insights into healthcare delivery and financing. Her ability to seamlessly translate between the business of healthcare and technology improves the adoption of new solutions and ensures that assets are used pragmatically to optimize the Quintuple Aim.
