Understanding the new gold standard for virtual care

Virtual care exploded over the past few years, evolving from an ancillary offering to a cornerstone of modern medicine. But here's the catch: with so many options popping up, how do you know what's actually good? It can feel like the Wild West, and quality can be opaque.

Consider this: Virtual care visits skyrocketed dramatically in recent years, now representing a significant portion of all outpatient visits nationally.

That's where the NCQA Virtual Care Accreditation steps in. Think of the NCQA (National Committee for Quality Assurance) as the standard for quality across all areas of healthcare. They saw virtual care explode and recognized a critical need for clear, safe standards.

And here at Firefly Health? We didn't just meet those standards. We helped write them.

For patients, employers, and health plans navigating the myriad of virtual care options available today, Firefly's Chief Medical Officer, Nisha, emphasizes the clarity this accreditation provides. Many solutions, she notes, "do not follow evidence-based protocols, conduct any form of care coordination, or address accessibility issues." That's a huge problem.

This accreditation is essentially a trusted seal of approval. It means an external, reputable organization has vetted Firefly’s processes. Nisha explains, "without a patient needing to know the 84 pages of standards, they can rest assured that an accredited organization will deliver the highest quality health care that they deserve."

How did Firefly get involved?

From its earliest days, Firefly Health's commitment to quality was deeply ingrained. Back in 2018, Patient-Centered Medical Home (PCMH) principles⁴ were fundamental to our vision. Nisha reflects that Firefly had been "quietly working toward" accreditation for four years. While the traditional PCMH framework didn't quite fit our virtual-first model, a pivotal opportunity arose a few years back. In 2022, the NCQA approached Firefly for a Virtual Care Pilot.

As Clinical Program & Quality Manager Avae says, Firefly was "ahead of the curve. We shared our built-in practices and innovative approaches, helping to create the national framework for virtual care.” And the result? Firefly Health is the first national primary care practice to earn this NCQA Virtual Care Accreditation.

What does the accreditation entail?

Beyond necessary documentation, the standards reveal what elevates some virtual care organizations from others.

A few examples:

1. 1.

   What happens after the virtual visit?

   It's not enough to just see a patient virtually once. NCQA wants to know what happens after each appointment. This includes ensuring educational materials are clear and accessible, and that there’s a system for general follow-up beyond the initial encounter to support continued patient progress.

2. 2.

   Is all the relevant information collected?

   Virtual care offers unique opportunities to understand a patient's real-world context. This means utilizing the virtual setting to gather information you might not see in a traditional clinic, "what’s in their fridge? If their home situation is overwhelming? etc.," explains Avae.
   
   This emphasis on holistic data aligns with growing evidence that up to 80% of an individual's health outcomes are shaped by social determinants of health. Trina, a RN at Firefly and key contributor to the process, adds that it is vital to collect data like race, ethnicity, and identity, and track the management of chronic conditions to ensure care is constantly evolving.

3. 3.

   Is the treatment plan truly personalized?

   This isn't just about a diagnosis. It's about demonstrating a real investment in the patient. As Avae explained, it means "making sure that we are not just a face behind a computer screen, it shows real investment to the patient and the appropriate delivery of care." It's about understanding if virtual care is even the right fit, ensuring translation services are available, and identifying resources beyond the virtual visit that will truly impact a patient’s outcomes.

4. 4.

   Is the referral process truly complete?

   Beyond just making a referral, NCQA's standards dive into the crucial closed-loop referral process. Nisha highlights this as an area where Firefly's operations significantly shaped national benchmarks. "Early on we recognized referrals as a type of transition of care," she explains, pointing out that such transitions are "an opportunity for delays and patient harm."

   At Firefly, when a clinician refers a patient for a service, the team doesn't stop there. We ensure awareness of whether the patient received the service, assist in addressing any barriers, obtain the necessary records, and follow up with the patient. Nisha states, "only when these steps are followed to completion in a referral, do we feel that we have done our jobs."

The unseen work

Avae shares, "organizations often create these great processes, but then don’t circle back and they deteriorate." We built the "muscle" of continuous improvement. This means constant, rigorous review, strategic tech integration, and an unwavering commitment to future re-accreditation processes. Achieving accreditation is a milestone, but maintaining excellence is an ongoing commitment.

Firefly meticulously crafted it's Standard Operating Procedures (SOPs)—across technology, clinical practice, and operations. As the company has scaled nationally, the SOPs weren't static documents; they evolved to embrace a diverse patient population. "What was once a policy that mostly applied to a population in Massachusetts now had to reflect our patient population across the country," Trina explained, citing the expansion of lab offerings to include in-home options for patients without transportation.

Another crucial element to meeting these standards, according to Nisha, is leadership buy-in and a robust culture of quality and safety. "We were fortunate to have both," she reflects. "Over the years we have been very deliberate in creating a culture of quality and safety amongst the entire company—our leadership team, operations, clinicians, engineers, marketing, analytics… truly every department." Nisha found it gratifying that throughout the process of collating documentation, colleagues often gained a deeper understanding of Firefly's existing practices.

The mark of quality

So, what does this accreditation actually mean for patients? And for the future of healthcare?

Simply put, the ambiguity surrounding virtual care is over.

It means that Firefly Health has been rigorously evaluated, and our standards of care delivery hold up to the highest national benchmarks. Trina explains,"It's like seeing that "FDIC insured" sticker at the bank—it brings a feeling of security."

Looking ahead

The annual re-accreditation process is already on Firefly's horizon. Nisha states, "as Firefly moves more into providing care for patients for which we are also the health plan, I am excited to strengthen our integrated care and case management programs over the next year."

This is the promise of Firefly Health: a health plan built on a profound commitment to quality. Firefly Health isn't just a virtual care provider; it's a clinically integrated health plan. This means seamless experience where the health plan and clinical team work in lockstep, all held to the highest national standards.