Your future telehealth program

Optometry Times Journal, May digital edition 2021, Volume 13, Issue 5

Building a plan beyond the pandemic

For years, the health care industry has been trying to figure out how to get people to buy into telehealth services. Are users concerned about security? Is it too hard to use? Will patients who are older be comfortable seeing their doctor online? It turns out that a pandemic was the catalyst no one saw coming.

Telehealth care during the pandemic and beyond

The Centers for Disease Control and Prevention reports that telehealth usage increased 50% in the first quarter of 2020 compared with the first quarter of 2019. Plus, the start of the second quarter of 2020 showed a 154% increase from the prior year.1 Changes in the way telehealth visits were reimbursed helped make this change and encouraged vendors and health care providers to offer increased support for virtual health platforms.

But how could providers quickly pivot to provide the services their patients needed without seeing them in person? According to a Kaiser Family Foundation (KFF) report, many providers didn’t have the capacity to offer telehealth at the level the pandemic required at the beginning of 2020.2

Regulatory changes brought a new influx of cash to health care systems to create or upgrade telehealth systems. The KFF revealed that although 50 of America’s largest health systems already had telemedicine programs in place, only about 15% of physicians in those systems actually used the platform.

The explosion of demand for telehealth services and new financial support for this channel meant that many health care systems had to consider revising or replacing their platforms and offering support and education to providers and patients. Health care systems that didn’t have these channels already in place found out quickly that there is a lot more to telehealth than a virtual connection.

More than just video

When it comes to telehealth platforms, there is no such thing as a one-size-fits-all approach. Each patient and provider has specific needs, and there is a wide range of services offered in every health system. Organizations need a flexible vendor partner that can satisfy different preferences among both physicians and patients, says Dan Olson, senior vice president of provider and payer solutions at Amwell, a Boston, Massachussetts-based telemedicine company.

“We find that our customers have a wide range of needs, and many want an integrative solution,” Olson says. “But they also have providers that really want fast, easy, and simple.”

Early in the pandemic, some health care providers resorted to private systems like Zoom or Face-Time to see patients if their systems weren’t ready to meet their virtual patient care needs. But these platforms bring up privacy concerns, and there is no consistency throughout the health care system. The focus shouldn’t be to just see a patient over a video stream but should focus on providing them with a safe and secure space that will allow providers to integrate care with their electronic medical records (EMRs). It’s not enough just to put a screen between patients and providers.

What to look for in a telehealth vendor

Systems should be agile, integrated

According to Patrick Rainville, director of business development at Iron Bow Healthcare Solutions, a telehealth firm headquartered in Virginia, health care systems should be looking for enterprise platforms that don’t need to be developed from scratch. Software platforms that can be configured for individual workflows at the use level— not coded—are in high demand.

“A vendor should offer something that can scale from home use and wellness to ambulatory, skilled, acute care, and more,” he says.

Telehealth systems have to be agile and easy to use for both providers and patients while also offering a consistent experience. Blending flexibility and consistency can be difficult. A lot of practices launched telehealth solutions quickly to meet the demand presented by COVID-19. According to Rainville, one problem of hasty solutions was that many lacked integration to a health system’s electronic health record (EHR).

“Everyone ran out with COVID-19 and tried to do video visits,” says Rainville, “The market is kind of paused now as vendors look at enabling virtual health throughout the entire care continuum.”

EHR incorporation is essentially make or break.

“Usually companies that struggle don’t have an EHR integration,” says Chad Anguilm, vice president of in-practice technology services at the Michigan- based health care consulting firm Medical Advantage.

There also must be an understanding of clinical care and workflow. “It’s not enough to just offer a telephone number or link,” says Anguilm. “It’s about training and support for everyone involved. Everything from triage to ‘webside manner’ is completely different in telehealth, and you have to be trained properly from the front office to the clinical team.”

Look for a proven record, adaptability

A vendor must be able to evolve with customer needs and scale across an enterprise, too. A lot of technology solutions can connect people, but delivering care is a different animal. A vendor partner should have a record of success—and be able to prove it.

“You need a partner that has done its due diligence and vetting,” Olson says. “Experience matters when it comes to telehealth platforms.”

A good vendor will be able to demonstrate success with other clients and be willing to create workarounds and flexible solutions where customers need them. They should share where their gaps lie and what they are planning to be able to move forward. Telehealth isn’t a static platform.

Health care systems should ensure their vendor partner is prepared to stick around and help long after a contract is signed.

“Choosing a partner that has done this before or who has a customer base where they have demonstrated success is important,” Olson says. “A lot of people claim they can do things, but they might not be health care specific. It’s important to have experience in health care because workflows and all the different systems you work with are very different than turning on a web meeting. You need account management and support teams that will walk you through it and build trust.”

The biggest question, says telehealth expert Joseph Brennan of Moonshot Health Consulting in Grand Rapids, Michigan, is how the system and patients will be supported after the health system signs on.

“When implementing a technology in health care, [remember that] whoever is supporting you— the relationship is critical,” Brennan says. “So I would ask [the vendor], ‘What is your model for support and what do I get with what I’m buying?’”

According to Anguilm, it’s helpful to have a dedicated project manager or support team from start to finish. Sustainability is also key. If waivers and reimbursement change once the pandemic subsides, you shouldn’t need to find a new platform.

A good partner will have a full implementation plan laid out, detail how you will reach out to and educate patients, provide reimbursement information, and more. Avoid long-term contracts, he says, because there isn’t much information yet on what reimbursement for telehealth will look like a year from now.

“Simply put, a good vendor partner program should feel like an extension of ongoing operations,” says Roland Therriault, president and executive vice president of sales at InSync Healthcare Solutions, a Florida-based health care technology company. “Health care organizations looking for a strong partner for telehealth should expect a level of support that maximizes opportunity and minimizes headaches and interruptions to current workflows.”

“Vendor partners should take on the heavy lifting of implementations, technology adoption and optimal use of a telehealth solution,” Therriault says. “In addition, the best relationships ensure ongoing success by keeping providers apprised of evolving regulatory movements, ensuring infrastructures align with the most advanced security functionality, and ongoing support and oversight of end-user education. This way, providers are able to focus on patient care and other mission-critical activities.”

Red flags and warning signs

When it comes to telehealth, the big challenge seems to be on the technology end. But solutions that focus on technology alone aren’t enough. Telehealth platforms have to have a deep understanding of health care and the needs of both patients and providers. When searching for a telehealth platform, Olson says there are a number of things to watch for, including vendors that overpromise.

“That should raise a red flag, in my opinion,” Olson says. “A vendor saying it can do anything a customer wants is not practical in the real world.”

Olson suggests asking vendors for references from providers who use their system already. They should be willing to share success stories. Anguilm agrees. “Ask for 2 or 3 references in a similar specialty,” he says. “If it’s taking a long time to find those references, that should be a red flag.”

Anguilm also says that it’s also important to look for glitches and delays during demonstrations of the program. If it happens in a demo, it will happen live, he warns. Make sure the company can support the technology it promises.

Brennan suggests that part of the vendor partner selection process should include a discussion of failure and connection rates. Do users who sign on stay on for their appointments? Where are people dropping off, and what can the vendor do to help address this? Ongoing support and service should happen, too, with teams dedicated to addressing patient problems and support providers. “When you’re looking for a partner, look for someone who has been around and has a full-service offering,” says Kevin

Greene, director of health care sales at Iron Bow. According to him, it’s not enough for a vendor to supply a product. There needs to be operational and clinical support with an understanding of the outcomes users are trying to reach. The best vendors offer helpdesk services and ongoing support for clinical and technical support.

“If you are looking for a vendor, you get commodity offerings,” Greene says. “When you look for a partner, you get someone who will invest with you.

You need partners that want to have a shared-risk environment that will put skin in the game, like a per-click share to make sure the program is successful.”

Overall, Brennan says, the understanding that not every solution works for every system and that there is a big difference between technology and health care is essential. The key is finding someone who understands your goals and knows what it will take to get you there.

“It’s all the same thing. It’s videoconferencing bolted onto your EMR,” he says. “But if the person you’re talking tovdoesn’t have any health care references, that’s a big red flag.

They’re either brand new and you’re going to be their first customer, or it’s not going that great. Many tech people don’t understand how intricate every aspect of health care is. This isn’t a retail shopping experience; this is health care.”

References

1. Koonin LM, Hoots B, Tsang CA, et al. Erratum: Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January– March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(43):1595-1599. doi:10.15585/mmwr.mm6945a9

2. Weigel G, Ramaswamy A, Sobel L, Salganicoff A, Cubanski J, Freed F. Opportunities and barriers for telemedicine in the U.S. during the COVID-19 emergency and beyond. Kaiser Family Foundation. May 11, 2020. Accessed April 12, 2021. https:// www.kff.org/womens-health-policy/ issue-brief/opportunities-and-barriersfor- telemedicine-in-the-u-s-during-thecovid-19-emergency-and-beyond

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