A Centralized Virtual Care Support Model for Improved Telehealth Operational Outcomes

As telehealth achieves a steady state in the post–Covid-19 pandemic health care landscape, health systems require operational models that can support clinicians across service lines. The authors describe a highly successful case study of a centralized telehealth support model, the Virtual Care Center (VCC), within Duke University Health System, a large academic health system. Duke developed a system for virtual visits that allows the clinician to focus on medical care rather than technical support, in which they offer wraparound visit services typically available in a brick-and-mortar clinic. Via dedicated staffing, fully virtual clinician half-day clinic sessions, and standardized processes spanning pre-, intra-, and postvisit activities, Duke aimed to improve operational outcomes compared with non–VCC-supported virtual care. The VCC intervention was associated with a higher rate of patients arriving on time (91.1% vs. 82.5%, P<0.001), a higher rate of on-time starts for appointments (83.8% vs. 31.5%, P<0.001), a higher rate of e-check-in (86.7% vs. 82.1%), and lower no-show rates (7.5% vs. 11.1%, P<0.001). Within each specialty, VCC-supported video visits are shorter than non–VCC virtual visits. By offloading technical support and pre- and postvisit tasks to dedicated rooming staff, clinicians can have shorter visits with their full focus on patients' medical issues. Clinician satisfaction surveys show equal to higher satisfaction, thus demonstrating that these shorter visits are as effective at achieving clinical goals. Although a VCC-type model requires upfront investment in staff, the improvements in visits running on time, electronic check-in (e-check-in), efficiency, and no-show rates quickly result in a positive return on investment. Telehealth is here to stay postpandemic. To make video visits work, a centralized support model facilitates the completion of high-quality, efficient video visits for both patients and clinicians.