Transforming Health
Care Delivery Through
Virtual Care
Transforming Health Care Delivery Through Virtual Care | 2
Executive Summary
For well over a decade, Charlotte, North Carolina-based Atrium Health, now part
of Advocate Health, has been using the tools of technology to streamline patient
access to care, reduce wait times and improve the patient experience. As the
COVID-19 pandemic emerged, Atrium Health built on its pioneering foundation in
virtual care to, in a matter of weeks, create and implement innovative programs
to bring care directly into patients’ homes, free up hospital beds and limited
supplies, and increase eiciencies within the clinical setting.
Those programs now have expanded throughout the medical system to hospitals,
schools, community clinics, in-home and on-demand services, as well as urgent
and primary care settings.
By taking advantage of advances in medical technology, paired with the expertise
of its clinicians, Atrium Health has spearheaded virtual care initiatives throughout
the Carolinas, Georgia, Alabama and beyond that oer cost-eective and eicient
solutions to industry-wide problems, including clinical sta shortages and
burnout. More importantly, it is delivering convenient access to care for the most
vulnerable members of the communities it serves – addressing the medical needs
and social determinants of health that influence well-being and quality of life for
those who are underprivileged or who have a generational or cultural distrust
of institutional health systems. Through these eorts, Atrium Health is achieving
better health outcomes and measurable increases in satisfaction among patients
and sta.
Integrating virtual health care services into traditional care oers a model for the
future of health care in America and a strategy that points the way toward the
holy grail of health care: delivering the best medical care eiciently, resulting in
improved health and lower costs.
From primary care to hospital at home, virtual nursing, behavioral health and rural
health, through innovation and adaptation, Atrium Health – as part of Advocate
Health – is helping reshape the future of how and where care is delivered.
Transforming Health Care Delivery Through Virtual Care | 3
Atrium Health Virtual Care by the Numbers:
More than
virtual programs
30 facilities with
eICU services
15
More than
school- and community-based virtual visits
20,000
More than
Behavioral health integration visits annually and another
13,700 such visits in emergency departments
125,000
COVID-19 patients
served on “observation
wing” of virtual hospital
at home
57,000
emergency departments with telestroke services
47
More than
acute care patients served via
hospital at home, saving over
30,000 bed days.
8,400
Transforming Health Care Delivery Through Virtual Care | 4
With what it calls its “for all” mission, Atrium
Health has assumed a leading role in tackling
some of these pressing health care challenges,
with special focus on how to reach and care for
underserved and marginalized populations and
eliminate disparities in care, especially among
people of color. An integrated, non-profit health
system with more than 70,000 employees (called
teammates) serving patients at 40 hospitals
and hundreds of care locations, Atrium Health
is extending its reach and its ability to improve
health, elevate hope and advance healing for all
through its advances in virtual care.
Virtual health care at Atrium Health is “part of a
larger, transformative shift of the entire care model
that we would not be able to make without the
virtual component and the ability to deliver health
care and related services through technology,”
said Katie Kriener, senior vice president of virtual
health for Advocate Health and its Southeast region
medical group operations, which comprise the
entirety of the Atrium Health footprint. It involves
“looking at the whole person and creating technical
connectivity between providers, between
patients and clinicians, improving patient
activation with greater, more timely access” and
compiling data that measures outcomes.
The need is growing across the country, and
particularly in the Southeast, Kriener said, due to
high rates of chronic disease, an aging population
“and the need to lower the cost of care, because
we are in an unsustainable health care cost
growth system.”
Atrium Health’s virtual health strategy is
multipronged and embedded in planning
throughout the system at a scale that is
groundbreaking.
“Our vision, both within Atrium Health
and throughout the larger Advocate Health
enterprise, is to be a national leader in
operationalizing a highly coordinated and
connected virtual health program that’s driving
the values and the measure of success that we’ve
set for ourselves,” Kreiner said. She hopes it will
be a model “that others want to follow, and that
would then allow patients to connect to anyone,
anywhere, anytime, when clinically appropriate.”
McKinsey & Company estimates 20% of
Medicare, Medicaid and commercial outpatient,
emergency department and home health
spending could be virtually enabled, providing an
opportunity to increase access and convenience
while improving both cost and outcomes.
2
“For us, our virtual capabilities are one way we
have been able to set ourselves apart as a best
place to receive care, as well as the best place to
provide care,” Kreiner added. “We are redefining
how, when and where care is delivered to help
people live well.”
Introduction
Spending on health care in the United States far exceeds that of other
countries but, when it comes to health outcomes – such as disparities
in access to primary and hospital care, administrative barriers related
to insurance, high rates of chronic disease such as diabetes, suicide
prevention and mental health-related illness and mortality – the U.S. ranks
at or near the bottom compared to other countries.
1
For us, our virtual capabilities are
one way we have been able to set
ourselves apart as a best place to
receive care, as well as the best
place to provide care.
– Katie Kriener, Senior Vice
President, Virtual Health for
Advocate Health
Transforming Health Care Delivery Through Virtual Care | 5
Atrium Health
Hospital at Home
Atrium Health’s signature virtual platform is
the Atrium Health hospital at home program.
It has been widely heralded in medical journals
and media for its innovation, practicality and
simplicity. In just three years, it went from the
drawing board to being what is believed to be the
largest hospital at home program in the nation.
At the start of the COVID-19 pandemic, Atrium
Health recognized the urgent and unprecedented
need for medical services at a level that would
swamp hospital systems and strain providers
across the country and the world. It responded
swiftly and eectively by ramping up virtual
health care initiatives on site and expanding into
the community.
Atrium Health was well-positioned to meet
the challenge.
“We had developed significant competencies
in virtual health care going back 10 years,”
said Colleen Hole, vice president of clinical
integration for Atrium Health, chief nurse
executive for the Atrium Health medical group
and also the administrator of the Atrium Health
hospital at home program.
That experience included virtual patient visits
and physician consults at bedside, as well as
transition care combining virtual interaction
with in-person visits by community paramedic
teams for discharged patients who were unable
Around 20% of all Medicare, Medicaid and commercial
outpatient, emergency department and home health spending
could be virtually enabled.
Near-virtual oce visits are services that require lab tests or diagnostics, with a portion of the visit requiring in-person
interaction (for example, a blood draw), but the consultation with the physician or the review of the lab test results is virtual.
2
Total Outpatient
(OP), emergency
department (ED) and
home health spending
could be virtually
enabled
billion
opportunity
Nonvirtualized
$1 Trillion
$247 20%
126B 35B
35B
39B
12
Tech-enabled
home medication
administration
Virtual
oice visits
Virtual home
health services
Near-virtual
oice visits
Virtual
urgent care
Share of OP, ED or home health services that could be virtually enabled, %
20%
9% 24% 35% 2%
B
Transforming Health Care Delivery Through Virtual Care | 6
to manage their care on their own at home.
“In March of 2020, we were watching what was
happening in Italy and New York,” she said, “and
we saw the numbers in hospitals going up in a
scary way.”
The hospital at home program was initially
developed to provide services to COVID patients
who did not require hospital care. Most patients
were monitored by a team of virtual registered
nurses who provided education, support and
care escalation, as needed. Other patients needed
hospital-level care, but were stable enough
to be cared for in the home with virtual nurse
monitoring, virtual visits with a provider and a
daily visit in the home by a trained paramedic to
take vital signs, deliver treatments and ease the
anxiety of isolation. Services of a chaplain, social
worker and physical therapist could also be made
available, if needed.
At a time when there were critical shortages
of personal protective equipment (PPE),
visiting paramedics needed only two changes,
per patient, each day, rather than multiple
changes needed by hospital sta going in and
out of patient rooms. Treating less-severely
aected patients in their homes also limited
exposure of clinical sta in the hospitals and, by
keeping contagious patients away from others,
helped avoid further spread of the virus within
the community.
“It was a crisis move,” said Hole. “In normal
times it would have taken us a couple of years”
to implement such a program. With resources
pulled from all parts of the system serving as
many as 130 patients at the peak of the pandemic,
she said, “it was like having another hospital.”
In Atrium Health’s program, the home-based
patient is treated and discharged like an inpatient.
“This is hospital-level care,” she said. “It’s not
home health on steroids, it is a completely
dierent model, leveraging our capabilities
across the board.”
Now, the program has expanded, from 10 to 40
community paramedics who work together with
14 nurses dedicated to hospital at home, and six
providers – such as physicians and
advanced practice providers (nurse practitioners
or physician assistants) – who provide care at
home, treating conditions from acute, to chronic
condition exacerbation and even post-surgical.
By directly observing patients in the home, the
paramedics can also assess additional needs,
such as food insecurity or social challenges that
may aect overall health, and connect them with
the appropriate resources.
“It’s a three-legged stool of physicians, nurses and
paramedics who are undergirded by a team of
social workers, therapists and others,” Hole said.
Hole believes the virtual model, integrated
within the overall system, is here to stay. With a
typical daily census of approximately 35 patients
during the summer of 2023, the system intends
This is hospital-level care. It’s
not home health on steroids, it is
a completely dierent model,
leveraging our capabilities across
the board.
– Colleen Hole
Vice president of clinical
integration and administrator
of hospital at home program
for Atrium Health.
Transforming Health Care Delivery Through Virtual Care | 7
to be able to care for 200 patients daily in the
hospital at home model by 2025, she said, “which
is like having an additional hospital you don’t
have to build.”
“Our patients strongly prefer this model, by 10
points in surveys,” she added.
As the population grows and ages, Hole expects
virtual health care services will be in greater
demand. It is being embraced by people of all ages
because of the convenience, the ability to access
care on demand and the chance to avoid sitting
near sick people in a physician’s waiting room.
Additionally, as the cost of delivering care in
this format can be as much as 25% lower than
in a bricks-and-mortar hospital, widespread
acceptance and use of the model also has the
potential to slow the inflationary growth of health
care costs for consumers, over time.
The advantages of virtual options for medical
services are clear and Hole expects investments
in this area will grow. Inpatient hospital care will
always be needed, she said, but if home-based
care is appropriate, it reduces the risks of falls,
hospital acquired infections and other concerns.
“If you can avoid hospitalization, in particular for
an older, fragile population, it makes much more
sense in every way,” she said.
Working with Payors
Payment models include private and public
insurers, as well as grant funding. The Centers
for Medicare and Medicaid Services (CMS), in
November 2020, granted waivers for telehealth
flexibilities and emergency waivers for hospital at
home care. Since then, recognizing that such care
is safe, eective and helpful for many patients,
CMS extended the telehealth waivers and its
Acute Care at Home waiver, which is funded
through the end of 2024.
At the state level, however, embracing a payment
model is coming much more slowly. Only nine state
Medicaid programs extend coverage to hospital at
home programs, including North Carolina, which
began coverage in November 2023.
Regulatory oversight and working with payors
are evolving processes as cost-savings, patient
and care team enthusiasm, and eectiveness of
virtual care become more recognized, said Molly
McColl, Advocate Health’s vice president for
virtual and global health care.
A positive byproduct of the devastating pandemic
was the “consistency from a federal, state and
commercial perspective that virtual health was
going to be covered” in the same way that a brick-
and-mortar medical visit would be covered,
she said.
Hospital at Home
Scope of Services
Remote Patient Monitoring
2-way audio/video connectivity
24/7 Virtual RN
Assessment & Monitoring
Twice daily in-home
Community Paramedic or
RN Visit
Daily Virtual Visit
with Provider
IV Infusion/Meds, Oxygen,
Resp Care & other therapies
EKG
Labs
Transforming Health Care Delivery Through Virtual Care | 8
That allows virtual care to be deployed where it
makes the most clinical sense and gives patients
the benefit of knowing their virtual medical visit
would be covered, as if they had driven to the
doctor’s oce for an in-person visit.
While exponentially expanding the services of
virtual health overall, Atrium Health has been
gathering critical data that will tell the story of
the cost savings, health impacts and quality of
life improvements that have been achieved.
“We knew it was going to be important, and we
knew we had to take advantage of the volume
we were seeing, to be able to make sure we were
deploying it eectively,” McColl said.
Atrium Health has a comprehensive virtual
health dashboard that tracks growth metrics,
payer metrics and utilization, working with
population health experts to think through
strategies and assure that quality outcomes
are tracked.
“We have robust reporting around, for example,
antibiotic prescribing,” she said, “because it was
a concern that, through the use of virtual health,
we would see an increase in antibiotic use. We
continue to monitor these trends and have not
seen any dierence in patterns between virtual
and in-person care.
School- and
Community-based
Virtual Health Care
A program that preceded Atrium Health’s hospital
at home program established a new standard
for the system’s goals of breaking down barriers
to improve access as well as connecting more
people to the convenience of receiving care how,
when and where they want it. Its school- and
community-based virtual health care oerings
started with a pilot program in a single rural
school in 2017. With generous support from
philanthropic partners
3
, Atrium Health has since
expanded to oer on-site virtual care in more than
150 schools, colleges and community sites, serving
more than 20,000 adults and children.
What drove the initiative was the urgent need
for student access to health care, said Atrium
Health pediatrician Dr. Patty Grinton, who
founded the school clinic program. Children
were missing school days, health problems were
prolonged by delays in care and parents, unable
to leave work during the day, frequently brought
children to an emergency room at night for care
that could have been better accomplished in a
primary care setting.
After reviewing the outcomes,
we proved our hypothesis that by
seeing children during the day at
school, we could reduce the impact
on our emergency departments. It
also resulted in more class time for
the students and less missed work
for parents.
– Dr. Lyn Nuse
Pediatric Primary Care Medical
Director, Atrium Health Levine
Children’s Hospital
Transforming Health Care Delivery Through Virtual Care | 9
Grinton said the idea for school-based care came to
her one day during the spring of 2016, during high
pollen season. She received a call from a school
nurse inquiring about a student with swollen eyes.
A swollen, injected eye can be due to infectious
pink eye, which would require the student to be
dismissed from school early. However, during the
spring, swollen eyes are more often attributed
to allergies.
Grinton recalls thinking to herself “if I could
video connect with the school nurse and see
the student, I could determine whether the eye
swelling was due to infection versus allergies.
If it was allergies, the student would not be
contagious – she could remain in school and
avoid an early dismissal.”
The introduction of video for virtual care,
along with digital diagnostics and high-resolution
camera images, brought that wish to reality and led
the way to a comprehensive virtual care program
that addresses parental needs, overcomes access
barriers and supports school sta.
School nurses often are responsible for several
schools in a region, and many schools have
no nurse at all, so Atrium Health employs
telepresenters who are trained through a
partnership with a local community college.
When a child is sick at school, the nurse or
other designated school employee contacts a
parent or guardian for permission, then calls
for a nearby telepresenter who travels to the
school with the equipment needed to conduct an
exam and connect virtually to a pediatric health
care provider. The pediatrician can do an exam
remotely and parents can observe remotely,
without having to leave their jobs. Decisions are
made about medication, either administered on
the spot or ordered for pickup from a pharmacy,
and when the child can return to class.
“In addition to improving access, one of the
primary objectives of the school-based virtual
care program was addressing ‘avoidable’ visits
to the emergency rooms,” said Dr. Lyn Nuse,
pediatric primary care medical director for
Atrium Health Levine Children’s. “Our initial
pilot took place in a rural district where we saw
the highest rate of emergency department use for
conditions that could easily be managed within a
primary care oce. However, children were being
brought to the ER in the evenings instead.
“After reviewing the outcomes, we proved our
hypothesis that by seeing children during the
day at school, we could reduce the impact on our
emergency departments. It also resulted in more
class time for the students and less missed work
for parents,” Nuse said.
The program has been a boon to children, their
parents, local health systems and the schools,
leading to a 32% reduction in preventable
emergency department visits, a 50% return-to-
classroom rate since schools reopened after COVID
shutdowns and an average, estimated financial
benefit to parents of $352 per remote patient
visit, due to avoiding lost wages, emergency room
copayments, travel costs and other expenses.
4
Grinton said teachers and other school sta
began asking to have access to the same in-school
virtual health care being oered to students.
Then parents expressed interest, too.
Following a successful pilot with Charlotte-
Mecklenburg Schools (CMS), Atrium Health
Levine Children’s launched school-based virtual
care
5
in 20 CMS elementary schools during
the 2022-23 school year. Ten middle and high
schools received behavioral health teletherapy
services through the program. Within three
years, Atrium Health expects to oer virtual
care at 50 CMS schools and behavioral health
telemedicine at 31 of the district’s schools, one of
seven North Carolina school districts the school-
based virtual care program serves.
Transforming Health Care Delivery Through Virtual Care | 10
To meet the needs in both rural and urban
communities, Atrium Health has also expanded
the program beyond schools into community
colleges, community centers, faith-based facilities,
a YMCA – and even an apartment complex, as well
as elsewhere throughout the Atrium Health service
territory. Partnering with community groups, such
as the Latin American coalition and respected
religious and community leaders, increases the
level of trust and acceptance of care, even among
people who have never had regular medical care.
Recognizing the growing behavioral health needs
among young people, Atrium Health has also
built a successful school-based virtual therapy
program, building on nearly three decades of
history delivering in-person, school-based therapy.
Launched in 2020, it is now available in 133 schools
in North Carolina and South Carolina. By making
tele-therapy easily accessible, Atrium Health has
seen a rise in parents consenting to therapy for
their children and increased participation in family
therapy with their students.
The idea is that “we want to be in your backyard,
so that if you need care, accessing it is not the
challenge,” said Grinton.
Primary Care
Settings
Atrium Health’s integration of virtual care services
in primary care is based on a philosophy that, for
consumers, it should be simple and easy to see a
primary care provider, said Dr. Matt Anderson,
senior vice president and virtual health medical
director for Advocate Health and Atrium Health’s
senior medical director for primary care. Primary
care should be available when needed and in the
manner that is most acceptable to patients, he said.
“We want to provide frictionless access in the most
personalized way, and that is where virtual really
comes in,” Anderson said. “By oering the option
of an in-person oce visit or a virtual visit via a
video device at home, patients can choose what
works best for them and their specific needs. If
it’s a three-month follow-up for monitoring blood
sugar, for instance, or for a prescription refill, the
video option is convenient and timesaving.”
We want to provide frictionless
access in the most personalized way,
and that is where virtual really comes
in. By oering the option of an in-
person oice visit or a virtual visit
via a video device at home, patients
can choose what works best for
them and their specific needs.
– Dr. Matt Anderson, Senior Vice
President and Virtual Health
Medical Director, Advocate Health;
Senior Medical Director For Primary
Care, Atrium Health
Transforming Health Care Delivery Through Virtual Care | 11
Another option is an e-visit, in which patients log into
an online portal, answer basic questions to describe
the problem and the information is sent to a provider
who can make an assessment, call in a prescription
or recommend an in-person visit if one is needed.
E-visits can be particularly useful when the patient’s
schedule doesn’t align with the provider’s availability.
Instead of having to rearrange schedules, the ability
for patients to receive care asynchronously helps
make sure they get what they need with as little
friction as possible.
“We want to give patients options and let them
decide,” Anderson said.
Virtual visits aren’t for everyone, and there are some
conditions that require hands-on care, he said. In the
fall of 2023, Atrium Health was seeing 5% to 7% of
its monthly primary care visits virtually. For urgent
care visits, 12% of patients utilize the virtual options,
with around-the-clock, on-demand availability that
counted more than 50,000 visits in 2022.
As an example, if a patient wakes up with a fever
in the middle of the night, instead of going to an
emergency room, that patient can log on and see a
health care provider in a two-way interaction and,
where appropriate, have a prescription called into a
24-hour pharmacy.
Virtual access enables greater flexibility for primary
care physicians to tap into the expertise of a
specialist, when needed, through virtual electronic
consultation, or e-consults. This gives the primary
care physician, who is trained as a generalist to treat
a wide range of illnesses, the expertise and guidance
of a medical specialist. This enables patients to
receive the best care on-the-spot, rather than facing
delays in getting an appointment with a specialist
and potentially having to travel some distance,
especially in rural areas where the availability of
specialty care may be limited.
Traditionally, the health care model has been one-
size-fits-all, Anderson said.
“As I see patients get more comfortable with virtual
care, and as payment (from insurers) becomes stable,
I think we’ll see an increasing percentage of visits in
primary care practices occurring virtually, perhaps
10% to 20%, or more,” he said.
Anderson noted that will be even more likely as
home test kits, such as those for flu and COVID,
become available to detect a wider range of
respiratory viruses and other infections.
In September 2023, Atrium Health began oering
24/7 virtual primary care visits. It allows patients
to schedule an appointment with a family medicine
physician and establish a virtual primary care
relationship, allowing ongoing care from a dedicated
physician who is familiar with the individual and
their personal medical history.
6
For clinicians, the opportunity to treat more
patients in settings of their choosing and achieve
greater control over their own time may help
reduce the kind of exhaustion that was reported
in a 2022 American Medical Association survey,
which found that half of 11,000 physicians and other
clinicians reported feeling stressed and burned
out. In primary care, 70% of physicians and 89% of
residents reported burnout.
7
At Atrium Health, a survey of providers’ experiences
with e-consults told a dierent story. Dr. Robert
Levy, a family practice physician with Atrium Health
Primary Care Cabarrus Family Medicine, wrote:
“This is by far the most helpful addition to clinical
medicine that has been implemented since I started
practicing 15 years ago. Every day in primary care,
dozens if not hundreds of clinical questions come up
that may require specialty expertise, but this may
often be limited by extensive waiting time, therefore
leaving the primary care provider to try to manage
or workup medical problems that are outside the
broad scope of training. Since starting to utilize
e-consults, I can say my patients are getting better,
more cost-eective care, fewer unnecessary tests
and treatments and are VERY satisfied that so much
more can be done in their medical home. I practice
full scope family medicine (inpatient, outpatient,
newborns through geriatrics, and obstetrics) and
tend to manage a lot on my own, but now feel like the
level of care I am delivering has risen to a new level
of excellence. Thank you so much!!”
The additional freedom created by Atrium Health’s
virtual oerings is being further enhanced by its
continued investments into the latest technologies,
with a special emphasis in being the “best place
Transforming Health Care Delivery Through Virtual Care | 12
to care” for its providers, as well as to receive
care for its patients. In 2023, Atrium Health
became the first health system in the nation to
implement a new artificial intelligence tool which
securely captures the conversations between the
provider and the patient during both in-person
and telehealth visits.
8
The tool then transcribes
the clinically relevant content, which can be
loaded into a patient’s electronic medical record.
This increases the accuracy of the clinician’s
notetaking and saves them considerable time,
allowing them to better focus on spending more
time with patients and less time on paperwork.
Virtual Health Care
in Rural Settings
The on-demand advantages of virtual care provide
a huge convenience to patients in receiving care
close to home or in the home. Perhaps nowhere
is that more evident than in rural America. It is
especially pronounced in Southern states where,
between 2007 and 2018, approximately 10% of
rural counties lost one or more hospitals to a
closure – leaving those counties without a hospital
nearly half the time, resulting in longer travel
times to seek hospital care.
9
As such, the medical technology underpinning
virtual health care is especially needed in rural
areas, where hospitalization in a far-o location
makes it harder for families to visit, where
resources are scarcer and isolation may delay
in-person care. Video, digital wearables and other
equipment enable smaller hospitals and clinics
to oer sophisticated services locally, in schools,
hospitals and community centers that reduce
costs and provide access to comprehensive health
care in areas where poverty, workforce shortages
or geography require creative solutions.
Atrium Health is creating programs that extend
the reach of its clinical excellence to more sites
of service, increasing access and eciency. One
such example is at Atrium Health Anson, a 15-
bed hospital in Wadesboro, North Carolina.
“What makes this approach to care dierent is that
we have primary care embedded in the physical
footprint of the hospital,” said Seth Goldwire,
vice president and facility executive for Atrium
Health Anson and nearby Atrium Health Union
West. “As specifically related to telehealth, we have
established several partnerships with schools to
provide primary care services and mental health
services for students. We also oer additional
telehealth services for substance abuse and virtual
cardiology, from the outpatient standpoint, and
have expanded it to oer cardiology coverage in
the inpatient unit,” employing digital monitors
and home-based devices to manage hypertension,
heart failure and more.
Within the hospital, patients who are likely to get
out of bed or are otherwise at risk of falling can
be observed remotely using “virtual sitters,” who
Virtual health care is going to grow, both in the hospital setting and in
the home. Rural counties don’t necessarily have the volume (of patients) to
support hiring a large sta of physicians, but we need those services. Virtual
care models aord us the ability to provide the services needed.
– Dr. Paul D’Amico, Chief Medical Oicer, Atrium Health Anson, Atrium Health Union
and Atrium Health Union West
Transforming Health Care Delivery Through Virtual Care | 13
can alert a nurse, if needed, said Teresa Cochran,
director of nursing at Atrium Health Anson.
Acceptance of virtual health care is growing,
said Cochran. Patients who initially resisted
home-based monitoring have embraced it, she
said, and as internet connectivity in rural areas
improves and reimbursement for services from
insurers and government-sponsored programs
becomes more seamless, virtual care will be more
widely available.
“Virtual health care is going to grow, both in the
hospital setting and in the home,” said Dr. Paul
D’Amico, chief medical ocer for Atrium Health
Anson, Atrium Health Union and Atrium Health
Union West. “Rural counties don’t necessarily
have the volume (of patients) to support hiring
a large sta of physicians, but we need those
services. Virtual care models aord us the ability
to provide the services needed.”
Technology-enhanced virtual care oerings at
Atrium Health Anson include virtual cardiology.
The leaders there are also working toward
establishment of virtual oncology care, in which a
patient can receive a chemotherapy infusion locally
under the care of a remote oncologist, without
having an hour or more drive into Charlotte.
“As we grow the services,” D’Amico said, “we’re
growing the technology and growing the impact
we can have.”
Behavioral Health
Care
Atrium Health maintains an intentional focus
on virtual health deployment and organizational
commitment, as well as investment into its
virtual health team. Within its bricks-and-
mortar operations, Atrium Health incurs
losses of roughly $90 million per year in
uncompensated or undercompensated
behavioral health care. Yet, because of its “for
all” mission to provide care for vulnerable
populations, it has continued to invest into
behavioral health in the virtual space as well.
Caring for the whole patient means addressing the
mental health needs of patients through all stages
of life. During the pandemic, the need for such care
became more urgent as prolonged isolation, work
and social instability, school closings, domestic
stress and other factors aected more people.
Seeing the need, Atrium Health immediately
ramped up its virtual behavioral health programs
in all care areas, including hospital, home, school,
community and primary care settings.
In 12 acute care hospitals in the system’s
Charlotte market, consult teams are available,
oering care that is not only ecient, but also
is available in rural hospitals where there is no
psychiatrist on sta. A virtual patient navigation
and transition care program allows patients who
have been treated in the emergency department
to be followed up with at home. A virtual
navigator checks in with the patient up to 45 days
after discharge, oering the kind of support that
can prevent self-harm and the need for return to
emergency care.
Reaching outside the hospital, Atrium Health’s
virtual integration into its primary care program
is serving patients in 74 primary care practices
in Macon, Georgia, and Charlotte, North
Carolina, supporting more than 400 primary
care providers. With virtual behavioral health
consultations available on demand in primary
care practices, combined with its other virtual
behavioral health programs, it is believed that
Atrium Health is now the largest provider of such
services in the nation.
It is estimated that up to 40% of adults have
symptoms or a diagnosed mental health issue,
said Dr. Wayne Sparks, a psychiatrist and Atrium
Health’s senior medical director for behavioral
health services. Atrium Health’s virtual
behavioral health program, with more than 100
psychiatrists and 35 advanced practice providers,
allows treatment of far more individuals than
could be seen in an oce setting.
“A patient in a primary care practice may already
be on medications,” said Sparks, noting that
many primary care physicians prescribe
Transforming Health Care Delivery Through Virtual Care | 14
medicine to manage depression and anxiety. But
when “a primary care provider lacks the training
or comfort to go higher on medications, they
would often refer the patient to a psychiatrist
and be frustrated because of the wait times.”
That’s where a virtual consult team can help.
A clinical team, which includes a psychiatrist,
guides and provides back-up to the primary care
doctor in treatment and can recognize when a
patient’s needs reach a level where in-person
psychiatric care is called for. Patients who have a
long-standing relationship with a primary
care doctor often feel more comfortable
receiving behavioral health care within
that setting, rather than having to go to a
psychiatrist’s oce, Sparks said.
“Within our outpatient virtual behavioral health
care, we’ve had great outcomes with this,” said
Sparks, including dramatically reducing no-show
rates, especially for those with chronic, severe
mental illness. “They are able to maintain care
virtually and, when they need medication, they
come in to get it.”
Atrium Health’s tele-consults for behavioral
health have resulted in positive outcomes for
its patients. Fifty-six percent of these patients
had at least a 50% reduction in their PHQ-9
scores, which is tied to a depression assessment,
during the first six months of 2023, and 40%
met the definition of remission. Similarly, 43%
of patients saw at least a 50% reduction in
their GAD-7 scores, which measures anxiety.
Among patients who expressed suicidal ideation
when enrolling into Atrium Health’s virtual
behavioral health program, 80% no longer
had such ideations at the conclusion of their
individualized program.
Atrium Health plans to continue expanding
these services.
Addressing substance abuse
“During the pandemic, addiction problems
worsened,” said Sparks. “We’re seeing that the need
for addiction treatment and psychiatric treatment
has not leveled o – if anything, it has intensified.
We had a mental health crisis way before the
pandemic, and the pandemic brought it out.”
An addictions team, including a psychiatrist
and an internal medicine doctor with an
addiction fellowship, is available to treat
psychosocial aspects of substance abuse as well
as the associated physical health problems,
such as hepatitis, gastrointestinal issues or
cardiovascular problems. Atrium Health
oers addiction consultations with acute care
hospitals virtually, enabling care in rural areas,
where a doctor might be an hour away from the
hospital but can have equipment in the oce for
evaluations and referrals, as needed. In-person
appointments are scheduled for patients at
We are here locally; we know the
resources; we know next steps
needed for our patients and how to
get them there. Most of our providers
do some virtual and some in-person.
We are still “boots on the ground,”
and we use virtual care as an
extension.
– Dr. Wayne Sparks
Senior Medical Director, Behavioral
Health Services, Atrium Health
Transforming Health Care Delivery Through Virtual Care | 15
least twice a year but, increasingly, patients and
practitioners are growing more comfortable with
virtual visits, Sparks said.
One strength of Atrium Health programs,
according to Sparks, is that the system is focused
on the region it serves, rather than being spread
out among dozens of virtual start-ups across
the country.
“We are here locally; we know the resources;
we know next steps needed for our patients and
how to get them there,” he said. “Most of our
providers do some virtual and some in-person.
We are still ‘boots on the ground,’ and we use
virtual care as an extension.”
Advantages of
Virtual Nursing for
Sta and Patients
During what has been called the “great
resignation,” an estimated 30% of the nation’s
nurses quit, citing inflexible work hours, stress,
understang and burnout.
10
Atrium Health’s
virtual nursing program, which began as a way
to monitor and care for COVID-19 patients, has
become a permanent part of the health system,
relieving burnout and winning praise from
patients and nurses alike, said Patricia Mook,
senior vice president for enterprise nursing
operations and professional development at
Advocate Health.
Virtual nurses work remotely from home or
in a designated room, called a bunker, and
observe patient rooms via video monitors. Each
virtual nurse watches over about 10 patients
and can monitor vital signs, conduct admission
assessment and discharge instructions, teach
family members about what will be needed at
home and summon a nurse or doctor to the room
if needed. They serve as patient safety monitors,
assist with pain assessment and charting and
provide emotional support. The program has
resulted in higher patient satisfaction scores, less
overtime, fewer hospital-acquired infections and
a decrease in response time to call bells.
“It’s a collaborative partnership between a
bedside health care team and a virtual nurse in
two-way conversation,” Mook said.
The system makes it possible for nurses nearing
retirement or who are physically unable to work
on the floor at bedside to share their expertise
and extend their working life.
“Our virtual nursing allowed us to get to the
level of nurse-patient ratio that we needed,
by retaining nurses who couldn’t work at the
bedside, but could do this work virtually,” Mook
said. “We are able to mentor new graduate
nurses or new hires with an experienced nurse
behind the camera. Our new nurses are excited
about this innovation and we are using it as both
a recruitment tool and a retention tool.”
In its original form, a rolling cart was equipped
with a video camera, screen, speakers and some
necessary accessories. The cart was rolled into the
patient room near the bedside, so the patient could
be seen by and converse with the nurse. In recent
construction projects, Atrium Health has been
equipping new patient rooms with the wiring and
other infrastructure needed to expand the program
broadly, making it a fixture in the rooms.
Our virtual nursing allowed us to
get to the level of nurse-patient
ratio that we needed, by retaining
nurses who couldn’t work at the
bedside, but could do this work
virtually. We are able to mentor new
graduate nurses or new hires with
an experienced nurse behind the
camera. Our new nurses are excited
about this innovation and we are
using it as both a recruitment tool and
a retention tool.
– Patricia Mook
Senior Vice President, Enterprise
Nursing Operations and
Professional Development,
Advocate Health
Transforming Health Care Delivery Through Virtual Care | 16
While virtual nursing is a tremendous tool for the
nurses, the concept has also proven popular with
patients and their family members. With in-room
video capabilities, it’s possible for a family member
to take part in a consultation with the attending
physician during a hospital stay. It has also been
shown to reduce the number of falls by patients
who attempt to get out of bed, as the virtual nurse
can quickly intervene verbally and summon help.
One of the most fulfilling aspects of the virtual
nursing program was quickly realized during the
pilot program, early in the pandemic. It was a
time when no visitors were allowed into patient
rooms and hospital sta were often covered
head-to-toe in face masks and other personal
protective equipment.
“We had patients tell us how much they
appreciated the virtual nurse,” recalled Mook.
“Often times, they were scared and they were
lonely, so what they truly appreciated was being
able to see the face of their nurse on the other
end of the connection. It was the only face they
would see and the only time they were able to see
someone smile.”
Transforming Health Care Delivery Through Virtual Care | 17
Conclusion
The future of health care in America will require better health outcomes,
cost containment and enhanced patient and provider experiences. Virtual
health care, seamlessly woven into the overall health care system, enables
Atrium Health – and Advocate Health, as a broader enterprise – to provide
the best possible care to the greatest number of patients in a way that is
eicient, sustainable and places the patient’s needs first.
“Care is care,” said Kriener, the senior vice president of virtual health for Advocate Health. “Delivering
care through technology or virtually is a tactic we’re successfully using to care for our patients and
reach underserved populations and communities. It allows us to do more, be better and go faster to help
more people live well.”
“We deliver options,” said McColl, Advocate Health’s vice president for virtual and global health care.
“We want consumers to be able to engage with their care team in the way in which they desire and is
clinically appropriate.
“At the same time, we want to ensure our virtual capabilities are a core competency throughout our
footprint,” she added. “This speaks volumes to patients who are choosing a provider. It is a strength in
recruiting the best physicians, nurses and other talent into our system. It is truly a dierentiator that
sets Atrium Health, Advocate Health and Wake Forest University School of Medicine – our academic
core – on the leading edge of care delivery and life-science technology, today and for decades to come.”
Atrium Health’s long-term investment and vision is bringing excellent care to patients in their homes
and communities, supporting the health system’s mission to improve health, elevate hope and advance
healing – for all – by creating a new model of health care for the future others are working to emulate.
“The biggest priority for us, moving forward, is integrating virtual care into every aspect of care that
strategically makes sense and is financially sustainable,” McColl said. “That is foundational to our success.”
Patient-Centered Virtual Care Continuum
Primary & Specialty Care
Virtual Behavioral Health
Virtual Visit
Phone Visit
eVisit
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Patient
Access &
Continuity
of Care
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Patient’s Home
Patient Portal
Healthbot
Virtual Visit
eVisit
Care Connection Center
Hospital At Home
Post Acute
Virtual Patient Observation
Virtual Nursing
TeleHospitalist
Virtual Post Op visits
Inpatient
TeleHospitalist
TelePsychiatry Teleneurology
Virtual Critical Care
TeleID
Emergency
TeleStroke
TelePsychiatry
Community
School Clinics
Community Clinics
Employer Clinics
Remote Management & Monitoring
Transforming Health Care Delivery Through Virtual Care | 18
References
1
https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-
reflecting-poorly
2
https://www.mckinsey.com/industries/healthcare/our-insights/the-next-frontier-of-care-delivery-
in-healthcarenote
3
https://atriumhealth.org/community/health/accesstocare/shelbychildrens
4
Improving Health Access with School-Based Virtual Care, Atrium Health Levine Children’s
Hospital research
5
https://atriumhealth.org/about-us/newsroom/news/2022/transformational-gift-from-bank-of-
america-supports-program-aimed-at-reducing-health-disparities
6
https://atriumhealth.org/about-us/newsroom/news/atrium-health-now-oering-24-hour-virtual-
primary-care
7
https://www.cbsnews.com/news/doctor-burnout-primary-care-medical-workforce-mental-health/
8
https://atriumhealth.org/about-us/newsroom/news/atrium-health-ai-solution-improved-
documentation-experience
9
https://sph.unc.edu/sph-news/nearly-10-of-rural-counties-in-the-south-are-losing-hospitals/
10
https://www.forbes.com/sites/debgordon/2022/05/17/amid-healthcares-great-resignation-burned-
out-workers-are-pursuing-flexibility-and-passion/?sh=792038177fda
Transforming Health Care Delivery Through Virtual Care | 19
