Adding Virtual Care to the Chronic Disease Management Toolkit

By Danna Chung, MD

As widely reported, virtual care offerings have proliferated in response to COVID-19 challenges. When we look beyond the obvious use cases, we can see the bigger picture. Factors such as poor distribution of healthcare services and staffing shortages have impacted healthcare, resulting in treatment disruptions for chronic ailments such as hypertension, diabetes, and cardiovascular disease. Virtual care “done right” has had the opportunity to rise to the occasion to ensure care continuity and enhance patient engagement.

A recent article noted that patients with chronic conditions are 35% more likely to adopt telehealth than patients without chronic conditions. Twenty three percent reported their telehealth visits were for regularly scheduled chronic care appointments, while 9% turned to telehealth for “ad hoc” appointments to manage concerns.

These statistics shine a light on what providers of virtual care services already know: Virtual care extends far beyond triage or urgent care episodes to enable continuous, technology-enabled connections with our most vulnerable, at-risk populations. As we consider the comprehensive and longitudinal nature of care across settings, virtual care is critical to the management of chronic disease. Further, as we seek to move away from sick care to improve health and wellbeing, we understand that patient engagement in longitudinal relationships will make all the difference in how we’re leveraging virtual care for success.

Models of chronic disease management 

Traditional approaches to managing chronic disease are built on intermittent and transactional care episodes. After diagnosis, a series of routine, in-person follow-up office visits typically are scheduled for every three to six months, a “one-size-fits-all” strategy that has proven ineffective for a complex pool of patients with varying health needs. This mismanagement is costly, says the CDC: 90% of our $4.1. trillion in annual healthcare expenditures goes toward treatment of people with chronic conditions. Heart disease alone costs $216 billion annually. Preventing chronic diseases, or managing symptoms when prevention is not possible, can reduce costs and improve outcomes for patients. 

Virtual care offers unique and recurrent means for chronic care patients to connect with their care team and vice versa. From asynchronous secure messaging to live virtual visits, ongoing support that fits the patient’s preferences is optimal for achieving maintainable, optimal wellbeing vs. combating repeated episodes of acute sickness.

Effective chronic disease management requires providing patient support outside the four walls of a clinician’s office through more real-time medication and symptom management, and other remote monitoring capabilities to integrate important lifestyle modifications relating to exercise, stress reduction, and healthy eating. Wellness isn’t built on band-aids; we need to think about engaging patients—meeting them where they are—to make a genuine impact on health. 

Evidence supporting the positive impact of virtual care on chronic disease management continues to grow. A recent study published in the Annals of Internal Medicine assessed the benefits and harms of video-based telemedicine for the treatment of chronic diseases, with results demonstrating it was as safe and effective as in-person care. As a provider, I’d add that while safety and efficacy are paramount, the benefits of convenience and flexibility complement and compound these outcomes to improve appointment adherence. An NIH study reported that while in-office missed appointments occurred at a rate of about 36%, telehealth visit no-show rates were only 7.5%.  

A recent systemic review and meta-analysis of telemedicine application in patients with chronic disease—diabetes, hypertension, and rheumatoid arthritis—found that telemedicine had a positive effect on disease management. Virtual care improved blood pressure in hypertensive patients, reduced negative emotions, and enhanced medication adherence in rheumatoid arthritis patients. According to original Crossover Health data, members with diabetes who sought virtual care appointments as supplementary to in-person visits were 30% more likely to achieve glucose control than those who received in-person care alone.

Extending virtual care applications 

Virtual care usage will only grow in the management of chronic conditions, and it will do so as part of a comprehensive care model built on trusted connections across numerous specialties and touchpoints virtually and in person. We will see it play a significant role in primary care settings for disease prevention efforts as patients become more engaged and invested in their own wellbeing both during and in between visits. The NIH reported just how effective virtual care is for this purpose summarizing various studies, with highlights including:

• 97% of patients were satisfied with their telehealth experience.
• 87% of patients felt they were able to express themselves as effectively for virtual visits as in-person visits and believed that telemedicine visits had the same reliability as in-person visits.
• A significant positive association was found between the degree of patients’ trust in their physician and telemedicine visit satisfaction.
• No statistically significant difference was found in the care provider domain between virtual vs in person visits. 

The effectiveness of virtual care for managing chronic conditions is clear and compelling. As fragmentation threatens to limit healthcare’s reach and impact on overall care, I’d suggest that we need to rely on the use of virtual care to close care gaps and deliver an efficient, coordinated care experience for all. Beyond chronic disease management—and extending into mental health, physical medicine, health coaching, and numerous specialties—virtual care enables a connected patient care journey where optimal health outcomes are not only achievable, but commonplace. 

Danna Chung, MD, is the Virtual Medical Director at Crossover Health. She is board certified in internal medicine, allergy/immunology, and integrative/holistic medicine. Prior to launching virtual care for Crossover Health, she was employed by a number of telemedicine companies and the US Department of Health and Human Services.

Be sure to look for Crossover Health, co-sponsor of the ATA2023 Welcome Reception!