Consumers have come to appreciate virtual visits conducted over their computers, tablets, or smartphones. Insurers and providers are warming to them. Now comes the hard part.
Following a path taken by many other provider organizations, Beacon Health System, a two-hospital system serving northern Indiana and southern Michigan, introduced real-time outpatient video visits at the beginning of this year. The organization was late to the virtual-visit movement—until last year, Indiana law placed onerous restrictions on telehealth—but was more than ready to jump in.
Beacon Connected Care allows patients to connect with physicians online via smartphones, tablets, or computers. Consumers appreciate the convenient service, says Lori Turner, chief marketing, experience and innovation officer. And she expects it will lower the cost of delivering care, improve patient outcomes, and boost physician satisfaction with their jobs.
“The opportunities for this kind of platform really can alter the trajectory of how you run your business,” she says. “We’re not just looking at it for incremental improvements.”
For several years, some Beacon patients have benefited from telehealth’s most obvious attribute: expanded access to care. The system has offered tele-stroke consults in its emergency departments, dramatically improving the care available to stroke patients; and tele-psychiatry, providing hard-to-find counseling services to patients who come to a medical office for video appointments with remote physicians.
In January, Beacon introduced virtual urgent-care visits directly to consumers and employers, allowing minor symptoms to be checked out via an online session that, on average, lasts just over six minutes.
“We actually offer it to our 7,000 Beacon Health employees as part of their benefit program,” Turner says. “And we’ve had high levels of early adoption.”
But Turner is more excited about what she foresees as a new way of caring for patients with chronic conditions. To test the waters, a group of 10 physicians is beginning to schedule follow-up visits via telehealth.
That makes life easier for patients who don’t have to travel and improves a practice’s efficiency. “Every time you room a patient, it takes staff to do that,” Turner says. “This will save time and cost, and we are looking at it as an opportunity to do a better job serving our chronic care patients.”
Beyond that, Turner believes telehealth will be the technology that finally makes physicians’ work lives easier. While the implementation of electronic health record technology has decreased physician productivity, technology that supports virtual visits allows physicians to see more patients in less time. Physicians’ reception to technology-supported visits was mixed initially, but enthusiasm is building as they learn how much patients like it.
“We’re getting great feedback from our customers,” Turner says, referring to the 5-star rating system embedded into the virtual care platform. “We’re running at 4.8 stars in terms of how they rate the experience and the provider.”
Beacon Health is ramping up to offer inpatient dermatology and psychiatric consults via telehealth—and encouraging physicians to take the lead on how virtual care evolves. Some physicians want to offer telehealth appointments on Saturdays to reduce the crush of patients clogging the waiting room on Monday mornings. Others want to use it to connect with nursing home patients.
“In terms of clinical delivery and when it’s appropriate to use it, that’s a physician-led conversation,” Turner says. “This has huge ability to be transformative to our entire organization in terms of how we think about care delivery.”
Change Brings Challenges
Beacon Health’s enthusiasm about the potential of outpatient care delivered via virtual visits is widely shared. Although such services are becoming commonplace, however, challenges remain, says Joseph Kvedar, MD, vice president of Connected Health at Partners HealthCare in Boston.
While virtual care has been in limited use for many years, its broad adoption is still new, and best practices have not yet been determined. Among the issues to be sorted out:
Payment. For years, payers’ refusal to pay for most types of telehealth visits limited the service’s growth. That is changing as employers demand access to virtual care for workers and their dependents.
“And since the insurance industry feels this is needed, they are of course compensating for it,” Kvedar says.
But that compensation has caveats. Many insurers have their own relationships with virtual care companies, and payment is available only to providers that are affiliated with those companies. For example, Cigna includes two companies—American Well and MD Live—as in-network providers. Physicians who provide telehealth access but are not affiliated with one of those companies are considered out-of-network for coverage purposes, according to Cigna spokesman Joe Mondy.
Fragmentation of care. Most provider organizations that offer virtual visits are affiliated with a company that provides the technology platform, and coverage when the organization’s clinicians are not available. While some virtual visit programs create seamless records, that is not a universal practice. Rather, when patients are seen by one of the vendor’s providers, as opposed to their regular provider or a colleague within the health system, records of the visit may not flow to their primary care physician.
“They might remember to get you a copy for your primary care doc, but they may not,” Kvedar says. “That sets up a completely parallel record system, and it is a challenge.”
Quality of care. As health systems seek to standardize care, the use of virtual-care clinicians employed by telehealth companies may introduce a complicating factor. When researchers compared the performance of Teladoc and physician offices on Healthcare Effectiveness Data and Information Set (HEDIS) measures, they found the Teladoc providers were less likely to order appropriate diagnostic tests and had poorer performance on antibiotic prescribing for bronchitis. a
Separately, a study using fake patients to assess direct-to-consumer tele-dermatology websites identified problems including incorrect diagnoses, treatment recommendations that contradicted guidelines, and prescriptions made without disclosing possible adverse risks. b
Utilization patterns. When researchers reviewed claims data for enrollees in an HMO who sought telehealth treatment for acute respiratory infections, they found that net annual spending on those conditions increased by $45 per user. While 12 percent of the telehealth visits replaced visits to other providers, 88 percent represented new utilization. c
Despite the challenges, the benefits of virtual care are expected to support its continued growth, Kvedar says. As risk-oriented payer contracts gain traction, provider organizations need to improve patients’ access to care so that they stay healthy, and focus on efficiency to keep care delivery costs as low as possible.
At Massachusetts General Hospital, where Kvedar practices dermatology, about 25 percent of patient service revenue flows through risk-based contracts, prompting considerable investment in population health strategies that include video visits.
“Mass General did several thousand of these various electronic interactions last year, and it is felt that there was efficiency gained and a real avoidance of high-cost care in certain areas,” he says.
“This is clearly the tip of a spear of innovation where you start to see care that is only in-person when it really needs to be.”
Lola Butcher writes about healthcare business and policy topics for several HFMA publications.
Interviewed for this article:
Joseph Kvedar, MD, vice president of Connected Health, Partners HealthCare, Boston; Lori Turner is chief marketing, experience and innovation officer, Beacon Health System, South Bend, Ind.
a. Uscher-Pines, L., Mulcahy, A., Cowling, D., et al., “Access and Quality of Care in Direct-to-Consumer Telemedicine,” Telemedicine and e-Health, April 2016.
b. Resneck Jr., J.S., Abrouk, M., and Steuer, M., “Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease,” JAMA Dermatology,July 2016.
c. Ashwood, J.S., Mehrotra, A., Cowling, D., et al., “Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending,” Health Affairs, March 2017.