Digital health changed access. Why continuity is the next opportunity.
Healthcare already knows what success looks like.
Better outcomes. Lower costs. Improved consumer and clinician experience. Greater health equity. A deeper understanding of the social factors that influence health.
These goals are not new. What healthcare still struggles to do is follow a consumer across the places where care actually occurs.
That distinction matters. A consumer can receive excellent care from a primary care clinician, visit an independent emergency department three months later, receive treatment from a specialist in another health system, work with a behavioral health clinician, and participate in a condition-specific program. Each part of that care may be appropriate and each organization involved may measure its own performance well.
But no one necessarily has the whole picture.
That fragmentation limits far more than reporting. It affects the clinician’s ability to make informed decisions, the consumer’s ability to navigate care, our ability to coordinate the next step, and ultimately our ability to understand the consumer’s health over time.
The challenge is not that healthcare needs another outcomes framework. We need the clinical infrastructure that allows us to deliver and measure care longitudinally.
Access solved one important problem. It exposed another.
Digital health has materially changed access to care. Through virtual care, digital front doors, and increasingly connected healthcare experiences, consumers can now access care more conveniently than ever before, without geography always being the determining factor. That is real progress.
But expanding access has also created the potential for more fragmentation. Adding another way to receive care is useful only if that care remains connected to what came before it and what needs to happen next.
Access and continuity are not the same thing.
Consider someone who begins with a virtual urgent care visit. During that encounter, the clinician identifies a need for primary care follow-up and discovers that they are also overdue for preventive care. They may subsequently need behavioral health support or treatment from a specialist.
Our traditional measures can tell us that the urgent care visit occurred. The urgent care organization may even be able to report excellent quality outcomes for that encounter. But those measures cannot, by themselves, tell us whether the consumer actually received the next care they needed or what happened six months later in another part of the healthcare system.
Nothing is necessarily wrong with any individual encounter. The problem is that the encounters do not add up to a longitudinal view of the consumer.
This is why “better outcomes” is not enough
It is tempting to frame the next phase of digital health as a shift from access to outcomes. But that oversimplifies the problem.
Healthcare already measures outcomes across many settings and conditions. Health plans measure quality and gaps in care. Health systems measure clinical performance. Primary care practices manage populations. Specialists measure condition-specific results. Digital health companies increasingly demonstrate outcomes within defined populations and programs.
Yet those measurements often stop at organizational boundaries.
Even sophisticated clinical records largely reflect the care visible to the organization maintaining them. Yet consumers do not organize their healthcare that way. They move among health systems, independent emergency departments, specialty practices, behavioral health providers, allied health professionals, pharmacies, health plan programs, and, increasingly, digital care.
The consumer is longitudinal. The healthcare system is not.
That is the gap we need to solve.
The opportunity is an ecosystem, not a collection of programs
Health plans have assembled increasingly broad portfolios of services to address the needs of their members. The next challenge is not simply adding more programs. It’s connecting them.
That matters because consumers increasingly evaluate healthcare through the lens of experience. Nearly half say they would switch health insurers if their expectations were not met, while consumers are four times more likely to remain with health plans they trust (Accenture). Connected experiences help build that trust.
Primary care can play a critical role in that model because it’s inherently longitudinal. A primary care clinician does not treat hypertension, depression, preventive care, or a dermatologic problem as completely unrelated episodes. Those issues belong to one member, and understanding how they relate is fundamental to good medicine.
Imagine extending that organizing principle across a digital care ecosystem.
A member could access primary care, urgent care, mental health services, and clinical partners through a connected platform rather than a series of unrelated destinations. Clinicians could have access to relevant information from the member's broader care history, and care delivered through one service could inform what happens in another.
The primary care clinician can then serve as a clinical anchor rather than simply another point of access.
That changes the role of the platform. It is no longer simply a place where healthcare transactions occur. It becomes connective infrastructure around the member.
That is the model Amwell is advancing: a unified, technology-enabled care platform that connects primary care, urgent care, mental health professionals, and clinical partners so care delivered in different settings can become part of a more continuous clinical experience.
It does not eliminate fragmentation across the U.S. healthcare system. No single platform can.
But it can reduce fragmentation where consumers experience it most: between encounters, between clinicians, and between the decisions that shape their care over time.
That also changes what we can meaningfully measure
Once care becomes more connected, our measurement can become more clinically meaningful as well. Registrations, visits, utilization, and enrollment still matter, but they become starting points rather than endpoints.
We can ask whether:
- a recommended follow-up occurred
- a referral resulted in care
- an identified gap was addressed
- clinically relevant information was available to the next clinician
- a consumer remained connected when ongoing care was appropriate
- most importantly, health improved over time
Not every outcome belongs to every clinician or every program. That distinction is important. A dermatologist should not be accountable for every dimension of a consumer’s health, nor should the outcome of an urgent care encounter be judged by measures unrelated to the reason the consumer sought care.
Longitudinal care does not mean making every clinician responsible for everything. It means giving clinicians enough connected context to understand their part in the consumer’s broader care journey.
That is a much more achievable objective.
The consumer should not be the integration strategy
Today, consumers often perform much of this integration themselves:
- Explaining information from one clinician to another
- Providing medication histories that may be incomplete
- Navigating referrals across organizations
- Moving between portals and programs
- Determining which clinicians need information from prior encounters
Their participation will always be essential to healthcare, but the consumer should not have to function as the connective tissue between disconnected systems.
The technology already exists to do better than that.
The challenge is no longer creating more access points. It is connecting the clinical ecosystem around the consumer so that access, information, coordination, and outcomes work together instead of operating independently.
For digital health, that is a far more consequential objective than generating another encounter.
We have spent years making it easier for consumers to get into healthcare. The next step is making sure that, wherever they enter, the rest of their care does not disappear from view.
Navigate what comes next
Access is only the beginning. The harder challenge is connecting what happens next across programs and services so consumers are not left to navigate a fragmented system on their own. In our recent Amwell + DermatologistOnCall webinar, “You launched it. Why aren’t members using it?”, we discuss how health plans can move beyond simply offering more points of access toward creating a connected care experience that helps members continue to the care they need.