“Who Moved My Cheese?” uses the analogy of two mice in a box with a maze and a cheese reward. The mice (Sniff and Scurry) are introduced to the box and they quickly find the cheese. They become very good at going to the same places and doing the same things to find the cheese. But when the cheese is moved, they become frustrated and stressed. They continue doing the same things and going to the same places even if the cheese is no longer there. In the end, if they do not go outside the box to find the cheese, they starve.

The analogy applies to healthcare where providers have spent decades building the “box” and doctors have learned how to find and care for patients inside it. But patients must “go to the box” to receive healthcare. In today’s consumer-centric world, however, more patients are moving outside the box and healthcare leaders are struggling to adapt. Once patients require care outside the box, no amount of changing the box will help you find them. You have to think outside the box.

The healthcare box is more than hospital and medical office facilities. It is the strategic model of bringing “patients to doctors” (P2D) in order to optimize physician productivity. If the new model is bringing “doctors to patients” (D2P, virtually), many of the old assumptions, methods and technology will only keep you trapped in the box. If the cheese has moved outside the box, you can no longer stay in the box to find the cheese – you have to break free of old conventions.

Virtual Care is a new model of delivering care outside the box that is challenging many fundamental methods and assumptions of traditional healthcare models. Providers who are stuck inside the old box (P2D) are hobbling new “doctor to patient” (D2P) virtual models with old practices, overhead and tools that are unnecessary, burdensome and costly. Clearly there are patient safety requirements, but new methods can simplify and streamline the approach to make it more productive with better outcomes outside the box.

An example of this new D2P virtual care delivery model is happening in long-term care. At The Carpenter Health Network, Dr Jim Ratliff needed to find a new way to take care of more nursing home patients across numerous locations without hiring more providers. Typically, one medical director can manage two nursing homes by driving for two visits per week to each location, resulting in days of delay in caring for patients. But hiring 3-4 medical directors to provide for the patients across six nursing homes is too expensive and not responsive to high-risk patient needs, resulting in too many patient transports to emergency rooms. To improve patient outcomes and physician productivity, Dr Ratliff developed a new D2P model using a virtual care solution, changing the practices, roles and tools to create an “out of the box” care delivery model that reduces costs and improves quality, service and satisfaction. Working remotely to direct nurses, who are wearing virtual reality headsets, the remote physician can now cover all six facilities within minutes (not days) of patient needs. Patient admission assessments and care plans are completed within a few hours of admission, not days or weeks. Patient symptoms are assessed in real time with immediate treatment and adjustments that reduce escalation and hospital trips. And, remote nurses can use the headsets to guide nursing assistants to support patient care needs. One doctor can now provide the same coverage as three physicians with corresponding increases in productivity and volume.

This new model of virtual care is more than adding new tools. Much of recent telehealth models are an extension of the practices and roles from our current box – only the tools have changed with some minor adaptations. Yet, telehealth is failing as a model to drive care delivery change. The number of care transactions using telehealth has steadily declined since the COVID peak, falling to less than 6%. 

Extending virtual care to a wider range of high-risk patients requires new care team roles and practices to provide remote physicians support from local caregivers for hands-on assessment and treatment.  New virtual roles and teams are developing new virtual care practices that enable remote physicians to confidently assess, order, treat and train patients. New virtual tools and technologies give physicians a more in-depth “you see what I see” experience, using virtual reality headsets and remote diagnostic instruments (e.g., stethoscope, otoscope, and ultrasound). 

This new virtual care team can extend a physician across multiple local patient care sites (e.g., nursing homes, clinics, urgent care and homes). Specialists can now consult live with ER physicians and hospitalists in rural hospitals and clinics. And Advanced Practice Providers (NP, PA, RN, Therapist, etc.) can provide virtual guidance and support with care assistants in distant homes, clinics and long-term care facilities. Importantly, they now work as a team through collaborative care that upskills the workforce. Physicians can learn and bond by working together in a professionally satisfying way – the way that they were trained. “Treat and Train” becomes a constant reality.

Rural healthcare can benefit the most from this new virtual care model. Virtual care can extend remote specialists directly into rural hospitals and clinics to consult with hospitalists, ER physicians and family practitioners to provide immediate specialty assessment, orders, treatment and training. This allows patients to stay in local hospitals and/or recover locally after regional specialty intervention. For community care, rural provider teams can collaborate with traveling medical assistants to reach into patient homes, long-term care facilities and clinics to support population health. Remote nurses can also support both hospital and community-based caregivers, providing direct patient care and proctoring.  Finally, remote faculty can train GME residents in rural health programs with individual and group proctoring of patient care. This virtual care approach overcomes many of the staffing and access barriers that constrain rural healthcare today.

Virtual care does not replace Acute Care models, but augments them by allowing remote physicians to guide distant patient care. Virtual Care is a new “out of the box” approach, not simply an adaptation of the traditional healthcare delivery model. Those that continue trying to implement telehealth as an extension of current practices are looking “inside the box” for the missing cheese and will not find a workable answer. Only by stepping back and developing a next-generation virtual care team and model that fits the new situation, environment, practices and tools will we succeed in delivering the promise of extending health systems and care delivery into the community for effective population health.

So, Who Moved My Patient? The patients are moving themselves, demanding better care on their own terms. And, they will end up going to providers with a better care model that serves them in their own locations on their own terms. Those who respond by developing new models of virtual care will succeed in moving their patients to improved satisfaction, service, access, affordability and care outcomes.

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Tom Fee is VP of North America, Hippo Technologies, Inc.