A new report presents five lessons to support the long-term use of telehealth services as a tool to deliver high-quality virtual care.
The use of telehealth services to support patient care has rapidly expanded due to the global COVID-19 pandemic. The volume of care provided virtually jumped drastically from approximately 2% prior to the pandemic to highs of 50% or more as the initial wave of COVID-19 swept the United States.
In response, PBGH’s California Quality Collaborative launched the CalHIVE Network, an improvement collaborative focused on maximizing the use of virtual care tools to enhance chronic disease management. Over two years, the seven participating provider organizations adopted and refined telehealth strategies to improve virtual care for more than 715,000 Californians. The lessons presented here are supported by the real-world experiences of providers who participated in the CalHIVE Network.
1. Invest in people and technology
There is not a single telehealth strategy that health care organizations should adopt. Instead, they should examine their overall strategic plan, patients’ clinical needs and projected environment and decide how telehealth can be an integrated part of the overall clinical experience. This requires targeted resource investments.
Desert Oasis Healthcare, a CalHIVE participant, discovered that the shift to telehealth did not equally serve all members of its community, and even created new barriers for some. A mobile health unit was used to expand access to care. The unit provides access to a care team on-site in the mobile unit, or if preferred, patients can speak directly to their physician via the unit’s virtual exam room.
2. Support seamless data exchange and integrated clinical systems
Technology should support a seamless experience for care teams and patients, but this is often not the case because of poor integration into other clinical systems and the overall care experience. One CalHIVE participating organization surveyed network providers and found more than thirty different telehealth platforms were being used across twelve Independent Physician Associations (IPA).
Provider organizations should consider how a virtual care platform integrates with the current technology used by most of their network’s providers and ensure they understand which products are being used in their networks. Organizations may consider peer groups or information and resource sharing based on the most utilized platforms.
Many telehealth technologies are focused on primary care, rather than specialty care. This creates a huge gap when aiming for care integration. Technology and associated resources should be tailored to support as many specialties as possible.
3. Redesign clinical workflows to support telehealth
Effective team-based care has been a key attribute of high-performing primary care delivery for many years. However, when it comes to telehealth, many organizations have not had the bandwidth to redesign their workflows or may not even be sure what needs to be redesigned.
Choice Medical Group used their morning huddles to gather feedback on virtual appointment workflows and to proactively engage staff in problem solving. That feedback supported improvements to training and adjustments to their telehealth platform and workflows.
4. Collect and integrate patient and care team feedback
Understanding how your providers are using telehealth is crucial to achieving high-value virtual care. Organizations should regularly ask providers, care teams and employees about their telehealth experience to determine if workflows, training and functionality can be improved.
In a networkwide survey, PrimeCare found that the majority of its providers were offering telehealth services but were struggling with challenges related to coding, reimbursement and patient education. By using the feedback collected, the organization was able to take action to improve the quality of their virtual care visits, which led to 80% of patients reporting a positive telehealth experience. Efforts to respond to the challenges identified included implementing several centralized support services for its network by developing telehealth best practice guides, educating providers and staff through individualized meetings and adding specific telehealth-focused questions to its annual provider survey.
5. Utilize data to address known health disparities associated with virtual services
To better understand if telehealth is meeting patients’ needs, health care organizations should examine utilization, access, experience and outcomes data by key patient demographic fields to identify improvement actions needed to ensure telehealth is effective for all patients.
In trying to understand why telehealth services were being used less by their non-English speaking patients, Golden Valley Health Centers discovered that their translation service was causing poor audio quality for non-English speaking patients using video visits. Updated workflows, including a new standard work around for the “language line” instructions, and additional training and education for frontline staff have been successful in supporting non-English speaking patients.
More information about each of these lessons and the experiences of CalHIVE participants can be found here. As health care organizations prepare for the future of telehealth, these learnings can inform their decision making and offer a road map to high-quality virtual care. They may also provide insights to other stakeholders, such as purchasers, health plans, technical assistance organizations and policy makers, as they seek to support telehealth moving forward.