Though COVID-19 vaccines began their rollout to the public, 2021 was still a turbulent year for healthcare providers as they weathered new virus variants, staffing shortages and burnout. 

But the pandemic also created a new wave of interest in virtual care and telehealth. Many providers turned toward the modality to keep in contact with patients in 2020, but startups and other organizations are betting virtual or hybrid delivery may be the future of healthcare.

Going virtual

Telehealth and virtual care used to be more of a niche offering, but the pandemic spurred its use as patients and their providers tried to keep their distance. A report from HHS earlier this month found Medicare visits conducted via telehealth increased 63-fold, from approximately 840,000 in 2019 to 52.7 million in 2020. 

After that growth last year, digital health companies expanded their virtual-care offerings or launched them for the first time in 2021. Cue Health, best known for its at-home COVID-19 test, launched a virtual-care platform in November. Truepill, which also offers a digital pharmacy and other telehealth options, touted plans about a COVID-19-specific virtual offering earlier this month.

Major companies are getting in on the telehealth boom, too. In May, Walmart announced its plans to acquire telehealth company MeMD. The deal closed in June. Amazon has also been gradually expanding Amazon Care this year, recently announcing Hilton as its newest client. Additionally, insurer Cigna's health services business Evernorth scooped up telehealth provider MDLive. 

But there are concerns the growth of telehealth may leave some people behind, like those who live in rural areas or don’t have access to high-speed internet. There are also questions about telehealth's role after the pandemic subsides. Telehealth utilization fell nationwide at the beginning of the year and during a few months in the summer, according to FAIR Health's Monthly Telehealth Regional Tracker. But it's grown in August and September, the two most recent months for which data are available. 

Digital health leaders and others in the industry think the technology is here to stay. Zoom's Head of Healthcare Heidi West – whose company unveiled updates to its telehealth services this year – told MobiHealthNews in August that it's difficult to put the genie back in the bottle. 

"I think the other piece that gets lost a little bit is that there is no going back to the way healthcare used to be," she said.

Constant contact for chronic conditions

Managing chronic conditions is a big task for the healthcare system. The CDC reports that 6 in 10 adults in the U.S. have a chronic condition like heart disease, cancer, COPD or diabetes, making up the vast majority of the country's annual healthcare expenditures. 

More startups and provider organizations began offering digital tools to help their patients manage chronic conditions in 2021. One Medical, a membership-based primary care provider, launched a chronic care offering in October. One Drop, which initially focused on diabetes care, began its move into other clinical areas with a heart-disease-prevention tool. Cadence, a remote patient monitoring platform for patients with chronic conditions, recently raised $100 million in Series B financing. 

Hybrid provider Carbon Health stepped into the diabetes management space with the acquisition of Steady Health, rolling out its own program earlier this month to find patients at high risk of developing the disease. 

"Devices like CGMs [continuous glucose monitors] create an opportunity to connect a patient with their provider in a way not possible before, to drive better outcomes," Eren Bali, cofounder and CEO of Carbon Health, said in a statement when the Steady acquisition was announced.

"Diabetes is one of the most pervasive and expensive health conditions in the U.S., and we are excited to partner with Henrik Berggren and his team at Steady Health to help elevate the management of diabetes. The Steady Health care platform is also one that Carbon intends to leverage to expand into the management of other chronic conditions in the future," Bali said.

A focus on primary care

Though primary care access is associated with improved health outcomes on a population level, the workforce is shrinking and fewer people are going to primary care visits, according to a report by the National Academies of Sciences, Engineering and Medicine. 

A study from JAMA Internal Medicine found the number of Americans with a primary care provider fell from 77% in 2002 to 75% in 2015, and the drop was even starker for younger Americans. Only 64% of those in their 30s had a primary care provider in 2015, compared with 71% in 2002.

This year, plenty of digital health and health tech players pushed initiatives to expand access to primary care. In October, telehealth giant Teladoc Health announced its new primary care offering, Primary360, would be available for health plans, employers and other payers. 

Propeller Health vets Chris Hogg, Joe Slavinsky and David Hubanks launched Marley Medical, a virtual primary care company focused on people with chronic conditions. Hydrogen Health revealed its own take on virtual primary care earlier this month. 

23andMe, best known for its consumer genetics tests, acquired telehealth and online prescription platform Lemonaid Health as a step into the primary-care space. 

"Our current healthcare system is based on reactive care, but we have the opportunity to change the paradigm for customers," Anne Wojcicki, CEO and cofounder of 23andMe, said on a call with investors when the deal was announced. "Starting with genetics as the foundation of primary care gives individuals and healthcare providers greater knowledge of potential health risks."