How service lines can prepare for the future of telehealth

Telehealth is not a replacement for in-person care

Lockdowns across the country in the spring of 2020 meant that telehealth was the only way to provide even a minimal amount of care to many patients, as service lines moved to protect inpatient capacity and patients sought to avoid exposure to Covid-19. These circumstances incentivized systems to view telehealth as a replacement for in-person care.

While that may have been true in the short term, telehealth should not be considered a replacement for in-person care. However, many systems have failed to adjust their telehealth strategies accordingly. In some cases, this has meant converting as many patient appointments as possible to virtual visits, regardless of need or appropriateness. This volume-based approach can backfire as it is not efficient and could lead to overutilization or poor use of resources. Rather, service line leaders need to set telehealth utilization goals for the patient populations, disease states, and visit types that are most suitable for virtual care. 

When deployed strategically, telehealth has advantages that benefit the overall quality of care delivery. For instance, virtual visits may allow for more appropriately timed check-ins with providers during an episode of care than in-person appointments. Providers can use virtual visits to better integrate the patient's home life and family into care plans. And through remote patient monitoring, providers can offer continuous care to patients. 

Use goals to inform telehealth strategy and investments

Telehealth for telehealth's sake is not a strategy. Rather, an effective strategy will use telehealth to solve problems.

Your first step should be to consider service line and system goals and how the distinct advantages of virtual modalities can be leveraged to help meet those goals. We’ve listed several ways that telehealth can help achieve service line and system goals below.

Connecting telehealth to strategic goals will also simplify the investment decisions that are an inevitable part of potentially expensive virtual platforms and modalities. Considering the earlier example, if your primary goal is to increase market share, then the considerable investments associated with remote patient monitoring may not be necessary. Instead, you may want to focus on building a convenient and easy-to-use platform for first-time referrals or patient self-schedulers. Of course, no goal is mutually exclusive with any other goal, and robust telehealth strategies will be multi-pronged.

Service lines cannot rely on reimbursement potential alone to sustain their telehealth programs

At the beginning of the Covid-19 pandemic, CMS and private payers put in place measures to make telehealth more accessible for health care providers. One of the most important steps they took was to offer reimbursement parity between virtual visits and in-person visits. ​Granting reimbursement parity was a major driving factor in removing the opportunity cost that previously impeded telehealth adoption. 

While the future of reimbursement remains an open question as of early 2021, CMS and private payers have signaled that they will start moving toward a pre-pandemic posture toward telehealth reimbursement at some point soon.

Given this uncertainty, service line leaders need to prepare for a world in which reimbursements are not the primary driver of value for telehealth. The first step must include tracking relevant data to gauge the performance of your telehealth strategy. Not only will this help identify areas of improvement for telehealth at your program, it may also help make the case to payers that they should continue to reimburse such services. Payers won’t be willing to pay for something that does not have proven value; it is up to service line leaders to show telehealth’s benefits to the system. 

Track telehealth against pre-existing goals to show value

Service lines leaders should select and track metrics that will help prove the value of telehealth initiatives. This process is inextricably linked to the goals service line leaders are trying to use telehealth to achieve. After service line and system goals are set, systems should look at relevant performance indicators to determine the extent of success and opportunities for improvement. 

Some metrics that can be used to gauge success include: 

• Provider satisfaction
• Patient satisfaction
• Time to guided medical therapy
• Reduction in no-shows
• Reduction in ED visits
• Increased patient access
• Reaching lower socioeconomic status and at-risk patients

Tracking metrics related to the performance of your telehealth program is imperative. Choose metrics that are related to your chosen goals or strategy and that will give insight into the extent to which telehealth is advancing those goals. Service line leaders should continually revisit and adjust telehealth strategy if the data that is tracked shows that goals aren’t being met. 

Service line leaders need to understand how their patient populations access virtual care and keep that understanding at the center of telehealth implementation. Optimizing the patient virtual experience will require several distinct areas of intervention:

Address patient pre-visit needs

It is imperative that providers are clear on how a patient should prepare for a virtual visit and patients should what expect. Ensuring that patients feel fully supported in the pre-visit process helps provide a positive experience and facilitates a smoother telehealth encounter, making it a more effective use of your care team’s time.

Raise awareness and steer utilization

• Advertise virtual options prominently on your service line’s main webpage
• Reach out to patients to explain the benefits of telehealth
• Help obtain tablets or provide digital literacy education

Segment and prioritize patients

• Identify patients that would benefit the most from telehealth services
• Identify technologically literate patients or those with an active interest in telehealth
• Reserve in-person capacity for patients who most need it

Provide visit and technology support

• Bifurcate your pre-visit workflow for patients new to telehealth versus those who have already used it, focusing increased support on new patients
• Help the patient set up required technology and collect registration information
• Keep technology support on hand during the visit

Understand the digital divide in your region

Telehealth has the potential to expand access for many patients—though it can also expose inequities that prevent parts of your patient population from benefiting from these new tools. Although solving the “digital divide” cannot fall solely on service line leaders, it is important to ask how your service line can ensure equitable community equitable access to the virtual visits you’re offering.

Early efforts could focus on:

Improving access to telehealth for all patients

• Screen patients for access to technology, broadband internet, and digital literacy
• Equip staff with standardized outreach scripting to support patients

Mitigate digital literacy and technology barriers

• Develop training and educational materials to teach patients digital skills
• Consider leveraging latent staff capacity to help provide basic technology assistance to patients

Remove health system-created barriers

• Actively market telehealth offerings to raise community awareness
• Offer audio visits for patients who can’t access video visits
• Don’t require the use of patient portals to access visits; vulnerable populations are less likely to consistently use patient portals

Make telehealth a “value-add” service, rather than a stopgap

Virtual visits need to be more than just a lesser alternative to in-person visits; they need to be considered equally valuable care. For that shift in mindset, your patients need to have a strong, positive experience throughout. Opportunities for virtual services to provide a value-add include:

• High-demand support services
• Multidisciplinary services (or facilitation)
• Virtual community education sessions
• Information sessions or Q&A with your clinical staff

Part of the service line leader’s role must be engaging physicians to generate buy-in for virtual care. Physicians are going to have their own concerns about integrating virtual care into everyday operations. To secure their support, you need to both make sure they feel comfortable and confident with providing telehealth and be clear in communicating the extra value telehealth can provide by complimenting, not replacing, in-person care.

Make telehealth easy for providers to use

Consider several interventions to provide “quick wins” for providers using telehealth and to facilitate long-term adoption.

1. Technology training

Ongoing telehealth training could be service line-specific or partnered across the organization and should include technology education and keep providers up-to-speed on any technological or policy changes.

2. Block scheduling

Block schedule virtual visits for certain hours of the day to lessen providers’ burden from transferring between virtual and in-person care. Add in flexibility to virtual visit timing to allow for unexpected delays or technology malfunctions.

3. Provide visit and technology support

Give providers the tools to maintain positive virtual patient interactions. Prior to the visit, providers should feel comfortable with their technology and set the stage for a virtual conversation. During the visit, providers should feel supported in addressing any technology issues that could distract from the patient and practice patient-centered communication. After the visit, providers should send a follow-up note recapping the visit and proactively ask for feedback.

Involve providers in telehealth workflow decisions

Service line leaders should enfranchise their providers to be involved in telehealth workflow decisions. Those decisions may include questions such as:

• What visits can be offered virtually?
• How will virtual services be built into the existing workflow?
• Is there an escalation path in place if the physician needs to refer the patient to in-person care?

Involving your providers in these decisions will lend clinical credibility to telehealth decisions and give providers a greater sense of agency over virtual care.

Case example: Midwestern AMC

A large academic medical center in the Midwest convened a cross-service line, monthly telehealth forum at the start of the Covid-19 pandemic while scaling up virtual services. The telehealth forum is attended by their virtual care team and a virtual care champion from every service line—typically the chair from each clinical department.

Although the forum was initially convened to provide telehealth trainings and support and to communicate any policy updates, it became a driving force for initiating service line analyses of common diagnoses that could or should be conducted entirely virtually.

To conduct this analysis, each virtual care champion pulled their service line’s top 100-200 most common diagnoses. They then worked with physicians on their team to decide which diagnoses and visit types lend themselves best to virtual care.

Once a service line identifies a visit type as optimal for virtual care, their team inputs a flag into their scheduling system that tags that visit type as optimal for virtual care. Since the start of the pandemic, this AMC has converted about 15-20% of ambulatory activity to telehealth.

Although physician buy-in is crucial for sustainably integrating telehealth into service line care, your care team will shoulder most of the administrative work and patient coordination. Your care team must understand the strategic goals surrounding telehealth utilization, have clear expectations around what their new responsibilities may be for virtual visits, and feel supported as they schedule, facilitate, and document this new care modality.

Opportunities to empower your care teams in facilitating telehealth mirror those we’ve discussed to better support your physicians and patients. These opportunities are centered around being clear on how and when your care team needs to be involved in telehealth.

Areas to clarify care teams’ role in telehealth

1. Scheduling process

Covid-19 worsened many of the scheduling challenges already faced by care teams, especially the uncertainty around how long and what type of visit to schedule. Remove some of the guesswork by standardizing the scheduling process for virtual visits and setting clear expectations for when and what visits should be virtual.

Tactics to consider

• Standardize scheduling process for virtual visits
• Standardize templates for telehealth visits to match in-person templates
• Create blocks of time where staff know they can schedule virtual visits
• Incorporate automatic flags for what visits could be scheduled virtually

2. Care team roles

Telehealth changes the traditional team roles in patient care but lacks an obvious solution for delineating pre- and post-visit responsibilities. Many organizations have moved away from using APPs or physicians for pre- and post-visit support, and instead tap into MA or IT analyst bandwidth. Revisit your patients’ care paths to pinpoint areas needing increased staff support and identify who is best equipped to own that step of the process.

Tactics to consider

• Determine what staff role is responsible for patient pre-visit support
• Delineate how many pre-visit touchpoints each care team member should expect to provide per patient
• Consider assigning post-visit follow-up to someone on your care team

3. Visit operations

Support your care team by streamlining telehealth operations—integrating tasks and functionalities so that telehealth feels like an extension of your care team’s toolbox, rather than an additional burden. Some components of telehealth integration may require ongoing support from your telehealth or IT department but help give your care team clear marching orders for visit operations.

Tactics to consider

• Integrate your telehealth platform with your EHR
• Develop standard operating procedures for staff during virtual visits
• Program automatic triggers for patients who may need follow-up support