Demystifying Clinical Appropriateness in Virtual Care and What Is Ahead for Pay Parity: Proceedings of the 3rd Annual Mass General Brigham Virtual Care Symposium.

Although virtual care delivery has existed in some form for over two decades, the COVID-19 pandemic thrust it into the national spotlight. Each year since 2020, a national group of experts in virtual care have gathered to address the most pressing topics of the day (see https://www.virtualcareconsensus.com for recordings of prior symposia). These experts were selected for their long history of virtual care and deep implementation experience within academic health systems across the country, experience that enabled them to lead the way forward nationally in the adoption and refinement of virtual care delivery throughout the massive COVID-19-driven expansion. We began by rethinking curriculum, competency, and culture in the virtual care era in 2020, including defining a framework for assessing competency for training in virtual care, and addressing challenges, workflows, strategies, and best practices in virtual care-enabled education. We then pivoted in 2021 to assessing the frameworks for measuring and ensuring quality in virtual care delivery, defining the guiding principles necessary for the future of virtual care measurement, best practices deployed to measure the quality of virtual care and how they compare and align with in-person frameworks. Particularly important was how rapidly increased adoption of virtual care impacted patient access and experience, and provide examples of challenges, pitfalls, and actual frameworks that have been put into place. This year’s symposium focused on the postexpansion phase of sustainability, namely looking at how best to define clinical appropriateness within virtual care delivery, and how the payment system will play a critical role in the future of virtual care. The accompanying articles underscore the importance of considering virtual care within the broader context of digital patient experience, with a critical emphasis on digital health equity. COVID-19 highlighted the stark contrasts in access to care, mortality, and despair that was disproportionately experienced by people of color, those with limited English or digital proficiency, and other unfavorable social determinants of health. The continued and expanding mental health crisis that has followed in the wake of the COVID-19