Telehealth: An Essential Element of Practice Transformation

January 12, 2018 1:44 pm

Delivering high-quality care as cost-effectively possible is a goal of nearly every healthcare organization. For medical groups, in particular, fulfilling this goal requires two primary areas of focus: expanding care access to underserved populations to improve clinical outcomes, and reducing emergency department visits and avoidable hospital admissions that occur because patients have not received preventive care or have failed to adhere to their treatment plans.

Telehealth is gaining traction as a method to deliver care in a manner that is cost-effective for both the patient and the provider. A telehealth system, however, is not a one-size-fits-all proposition. Medical practices—whether they are stand-alone or integrated within a health system—need to determine the most efficient telehealth workflow for their specialty and size, and they must check their state regulations and health plan contract rules to determine how to charge for the visits.

Implementing Telehealth: Initial Steps

Implementing a telehealth program requires due diligence and planning while securing practicewide buy-in. Some steps to consider include the following.

Develop the payment forecast. Ensuring the telehealth services are financially viable is a critical concern. The first step in implementing telehealth should be to determine the potential payment for online care from commercial health plans and government payers, which will vary widely depending on practice specialty and payer mix. As of July, 34 states and the District of Columbia had telehealth payment parity laws for commercial insurers and eight others had similar laws in the works. These state laws vary as much as commercial-payer contract policies concerning telehealth, so it is important for practices to work with their health plans to determine the terms of coverage.

Identify clinician and administrative champions. At least one physician or front-office staff member in the practice should be a leading proponent of telehealth and the benefits it can bring to patients and the practice. The efforts of such champions are crucial to helping secure buy-in from the rest of the clinical and administrative staff. A champion can best encourage further adoption by delivering a presentation to the practice outlining the potential positive clinical and financial outcomes of implementing telehealth.

Establish policies and procedures. Telehealth is focused on care that can be delivered through nontactile observation and patient discussion. Although this approach limits the types of acute conditions that can be treated, telehealth can be highly appropriate for numerous chronic condition maintenance check-ups or follow ups after in-person visits. Practice leaders should establish policies concerning the types of care that will be delivered through telehealth and the protocols that should be followed when clinicians determine that satisfactory care cannot be delivered online.

Determine an implementation timeline. Once buy-in is secure, the practice should outline an implementation timeline in conjunction with all its locations and IT staff, if applicable. Smaller practices typically will have shorter timelines, but with a cloud-based telehealth platform, technical implementation should be quite rapid, regardless of the organization’s size.

Train staff and clinicians. Administrative staff should understand how the telehealth platform works and the types of care that will be delivered on it so they can answer patient questions. Clinicians require training on how to conduct telehealth encounters safely and effectively based on the practice’s new policies and procedures. Training on the telehealth platform is essential to ensure that online visits are free from technical glitches and clinicians aren’t distracted by the technology.

Communicate new services to patients. Before the telehealth program launches, it needs to be marketed to patients and the community using numerous methods. Notices posted at facilities can be effective, but practices may want to begin by contacting patients most inclined to access the service. For example, patients who have demonstrated receptivity to electronic communications, such as emails, text messages, or secure messages delivered through the patient portal, would be ideal first targets. Frequent users of the patient portal may be among the most likely be receptive to telehealth because the portal is likely where access to online care will occur.

Determining the Right Workflow

To maximize efficiency of telehealth services, medical practices must determine the best telehealth staffing techniques and workflow. For some practices, the best approach may be to schedule a nurse practitioner or physician assistant to focus exclusively on web visits during peak patient-volume days or times of year, whereas for other groups, the best approach may be simply to have available staff treat patients online as needed.

Depending on a practice’s specialty and patient volume, it may need to experiment with staffing configurations to find the most cost-effective workflow. Regardless, patients are likely to be highly receptive to telehealth visits, and their satisfaction will reward the practice with a steady demand for those services.

Tom Toperczer is director of product management for Brother, Bridgewater, NJ. 


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