Table 3.

Goal for Future Virtual Services: Optimizing Primary Care

Rationale for virtual approach	Quote
Treatment of Minor Acute Illnesses
Allow faster access to primary care with the goals of preventing unnecessary emergency department visits or avoiding care outside of the health system (e.g., a visit to an independent urgent care). Designated clinicians for after-hours reduces the need for all clinicians to be on call. Asynchronous services (e-visits) use algorithm-derived questionnaires to assess patient concerns and can be converted to video visits, as needed.	“so for pink eye it's a structured questionnaire that kind of you know describe your eye, describe the discharge, and it gives you options. You know any other symptoms and so you fill out this questionnaire, you can take a picture of your eyes and then send it […] then goes to the nurse practitioner who reviews it […] is able to then determine what the treatment would be so in the case of pink eye, if it's clearly pink eye, then you know, being able to just provide that antibiotic prescription through e-prescribing and then close the loop with the patient to go pick up the medication at the pharmacy always kind of the purpose that that patient did not have to talk to anybody to get their care taken care of.”
Behavioral Health
Process mirrors in-person, just conducted via virtual modality which means there are no observed clinical downsides. Does not require touching the patient. Patient may feel more comfortable.	“Our [behavioral health] therapists are doing 100% virtual care, right now, still now and they report that it's a very successful, you know, tool for them.”
Care Coordination
Increase interactions between primary care and specialist clinicians. Facilitates data sharing across care settings. Provides a financial incentive for collaboration. Examples included: (1) e-consults (EHR-based tool) which may reduce need for specialist visits, (2) one clinician attended patients' video visits with specialists.	“On a zoom call with the consultant, and the patient in the room and, you know, often the patient will go to the [specialist] visit and they'll tell you something and then you know you might get a note and you might have questions, and you know being on the call and getting paid to be on the call for what you're doing. You know, encourages you to do that stuff and you know you get much better patient care when you're actually collaborating together rather than through letters or emails or things like that.”
Care Management
Provide the same care management services as previously, but via video. Allows care management staff to visually assess patients' homes.	“I also think that some of our support and ancillary services will use telehealth also as another way to connect with their patients are in care coordination”
Follow-up Visits
Alternating in-person and virtual follow up for patients with chronic illnesses can reduce travel. Virtual visits may make the patient more likely to attend visits due to convenience.	“My plan in the future is to do, alternating telehealth and in person visits, so that that yeah and because of the distance to travel and things like that in a rural community patients really you know they like that not having to drive in and wait and make up ground and do this it's a much too much shorter quick a visit for them.”
Annual Wellness Visits
Virtual Medicare annual wellness visits ensures the visit is focused on preventive care rather than diagnostic services (which can be addressed in a subsequent visit). Allows clinicians to assess risks within the home.	“they [Medicare wellness visits] really lend themselves to telehealth because one they can be done with a nurse practitioner, and that allows the nurse practitioner […] because they can't lay hands on the patient into because it's really focused on preventive. And wellness questions to ensure that their visit does not convert to a diagnostic visit, which is so easy to do when you're talking to patients with co-morbidities.”

Abbreviations: EHR, Electronic health record.