Virtual-First Care Shouldn’t Spark an “A-Ha” Moment Anymore

A year ago, coming out of ViVE in Nashville, I wrote about virtual-first care as the next logical evolution of virtual health – one that could expand access to care without sacrificing quality, continuity, or the trust health systems have spent decades earning.

I still believe that. But I want to be more direct about something I experience all the time and have seen over the last several days while at Stanford’s Consumer Health Conference and at ViVE: even now, I’m often greeted with an “A-ha” moment – real surprise – that virtual-first can exist in a way that is truly connected to a health system and still feels radically easy for patients. Moreover, the notion that primary or urgent care providers could collaborate in real time with a behavioral health team about your overall health is mind-blowing. When I say virtual-first, it’s not that it’s a gatekeeper model; it’s a model that is focused on honoring that patients first and foremost want their care to be delivered virtually. They want to leverage digital tools to own their health and their relationship with their care team.

The “A-ha” problem

This reaction is telling. It means the benefits of virtual-first care are real, but the market still hasn’t internalized what “good” looks like. We’re not just building the next care model, we’re simultaneously evangelizing the idea that it’s possible.

Virtual-first care has immense benefits. It can improve access, reduce friction, widen the top of the funnel for preventive and longitudinal care, and create more intelligent pathways to in-person escalation when needed. For patients who need or prefer care in-person, we’re creating capacity for them with actual increases in overall volume for our customers, not cannibalization or competition.

And yet, too often, decision-makers still carry an outdated mental model: that virtual care is either a disconnected or one-off third-party service, a transactional video visit, or a shiny digital front door that doesn’t actually connect to the clinical engine underneath – something that can be an invaluable option in achieving population health goals and being successful in value-based contracts.

So when they see virtual-first done well – fully integrated with the EHR, aligned with health system clinical and quality governance, capable of warm handoffs, and simple enough that patients don’t need instructions – it creates genuine surprise.

That surprise is the opportunity and the problem.

It’s the opportunity because it confirms the model has differentiated value when executed correctly. It’s the problem because it tells us the industry still underestimates what is required to make virtual care trustworthy at scale. Virtual care ultimately should be synonymous with virtual-first, requiring deep operational integration, clinical accountability, and a relentless focus on making the right thing the easy thing for patient and provider alike.

In other words, the next chapter for virtual-first care isn’t just scaling the care model. It’s updating the collective imagination of what care can and should look like.

Once you name that gap, it becomes clear what “what’s next” really means: virtual-first must graduate from a novelty to an expectation. And that only happens when we stop selling it as a channel and start operationalizing it as just simply being part of the care model we operate in – measurable, safe, longitudinal, and connected.

Virtual-first care has to become the default operating posture for access and continuity. I am hearing that from my customers, but it’s a massive mindset shift.

So we should be honest: getting there will require more hard work and evangelizing than most people want to admit, because the industry is still carrying old assumptions about what virtual care is and isn’t.

The bar is not, “can we do a virtual visit?” The bar is, “can we make care feel connected and easy at the same time – without breaking trust, fragmenting your record, or outsourcing accountability?” 

I’ve heard so many times at ViVE and at Stanford that much of what is done today by your provider can be performed by AI, or very soon will be. AI augments care teams, but it doesn’t replace them. It can’t replace the relationship, the trust, and most importantly, the accountability that is created; it provides insights, not a relationship where both parties are invested in your health.

When virtual-first becomes so normal that it no longer produces an “A-ha” moment, we’ll know we’ve actually changed the system.

Photo: sdecoret, Getty Images

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