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The Telehealth Connection...2019/05/17  · - Telehealth strategic p lan roadmap with customizations...

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  • The Telehealth Connection

    One Hospital’s Approach to Developing and Implementing a Pragmatic and Patient Centric Strategy

    Hoag Hospital Memorial PresbyterianAngie MarshallMay 22, 2019

  • Telehealth In Action…

  • Telehealth In Action…

    “Direct to Consumer”

    Remote Patient Monitoring & Employee Productivity?

  • Telehealth In Action…

    “Telehealth 2099…?”

  • What to Expect (and not) Today

    • Expect:

    - Telehealth strategic plan roadmap with customizations

    - Input map to help define and align a Telehealth strategy

    - Examples of Telehealth implementations & key learnings - pitfalls, successes, recommendations

    - Strategic implementation tools and templates

    • Do not expect:

    - Telehealth market, competitive or vendor assessment

    - Regulatory landscape changes / policies

    - Detailed implementation guide

    - ROI or Pro Forma “How To’s”

  • Laying Telehealth Strategy Groundwork• Telehealth adoption rates rising on many fronts

    • 69% of physicians said they would be willing to use Telehealth1

    • 77% of consumers willing to try a virtual visit2

    • 80% of patients report they’d switch providers for ‘convenience factors’ alone3

    • Top 5 consumer concerns with Telehealth: - Quality of care- Capability to diagnose/treat virtually- Security of health information- Lack of personal connection w/provider- Cost

    • Telehealth strategy maps are in abundance – key is adapting

    1Healthcare Innovation, Is Physician Adoption of Telehealth At an Inflection Point?, April 16, 2019; 2 Advisory Board, Telehealth Industry Trends, April 2019. 3NRC 2019 Healthcare Consumer Trends Report. April 29, 2019

    Consumerism in Healthcare

    Growth of Teleheatlh

    Desire for Convenience

  • *Advisory Board, Telemedicine Strategic Plan Template, Oct 2018.

    Current Performance


    Future Market Assessment

    Plan Design (Strategy)

    Plan Summary & Implementation

    1 2 3 4

    • Mission and Vision

    • Key IT-Enabled Accomplishments

    • Current Telehealth Enabled Initiatives

    • Patients

    • Payers

    • Payment Reform

    • Employers

    • Providers

    • Competitors

    • Regulatory Changes

    • Telehealth Technologies

    • Defining Telehealth

    • Defining Goals, Objectives, and Initiatives

    • Aligning Telehealth with Overall Business Strategy

    • Develop Use Case Chart

    • Strategy Overview

    • Platform Roadmap

    • Telehealth Initiative Description

    • Total Investment Summary (e.g. Pro Forma)

    • Resources Required

    • Staffing Required

    • Interdepartmental Support

    • Performance Scorecard

    • Communication Plan

    • Operationalize Pilots

    Telehealth Strategic Plan Roadmap

  • Defining & Aligning Defining Telehealth:

    ‘The interactive, electronic exchange of information for the purpose of diagnosis, intervention or ongoing care management between a patient and/or health care providers situated remotely.’ ~Advisory Board, 2019

    Telehealth Modalities: Patient - to - ProviderProvider - to - Provider

    Store and Forward

    Remote Pt Monitoring

    Live Consultation


    Asynchronous capture, storage and transmission of clinical data.Real-time transmission of patient physiological or biometric data.Remote synchronous services provided by live video conferencing.Communications and data or image transfer via mobile devices.

    Established Technologies

    Emerging Technologies

  • Defining & AligningAligning Telehealth strategy with organization, market and consumer needs.

    Telehealth Strategy

    Gap (s) in Services

    Market / Consumer Demand

    Partner / Affiliate Competitors

    Community Needs Health Assessment

    Interactive Marketing /

    Digital Strategy

    IT / EHR Strategy

    Organizational Goals (Start)

    Leadership Prioritization


    Organization FocusedConsumer/Patient Focused


    Organizational goals supporting strategy:

    Business Model Innovation: Establish new services and/or revenue channels; convenient care access. - E.g. On demand virtual visits for employees, new patients.

    Population Health Management: Trigger early intervention and decrease suboptimal utilization. - E.g. Scheduled virtual visits & RPM.

    Channel Access: Create new and manage existing entry points to acquire and retain patients.- E.g. Minimize outmigration; attract new patients; extend primary care service area (E.g. On demand/scheduled virtual visits for millennials and at risk existing patients.

    Care Continuity: Facilitate streamlined throughput and transitional care. Activate patients for effective self-management. - E.g. Scheduled virtual visits, RPM.

  • Telehealth Use Case Library (Example)

  • Example: 6-12 mos

    Telehealth Pilot Prioritization

  • Telehealth Platform Roadmap - 2019 / 2020

  • Executive Summary 1-Pgr Example

  • Post Acute Care PilotPilot Length: 3 monthsVendor/Partner: Providence Express Care Virtual / American WellPatient Population: High risk inpatients requiring care coordinationProviders: Hoag LCSW Care Navigators

    Objective:• Evaluate impact to patient engagement of video vs. phone follow-up care

    Key Learnings:• Population too ill & did not want to be seen (e.g. hospice)• Patients saw no added value in face to face for ‘care coordination / social support’• Patients not tech savvy (preferred text / audio)• Language barrier (required interpreter line integration)• Implement tracking PRIOR to launch for patient response and reason if not interested in using

  • Gestational Diabetes Pilot Pilot Length: 12 monthsVendor/Partner: Providence Express Care Virtual / American Well Patient Population: Gestational Diabetes outpatientsProviders: Diabetes RN, RD and LCSW

    Objectives:• Pilot scheduled video visits with 30 Sweet Success patients• Improve GDM-related knowledge and self-management for optimal pregnancy outcomes• Document a randomized controlled trial for scientific validity and Center visibility externally

    Key Learnings:• Patient education re: Telehealth protocols critical (E.g. multi-tasking, public places)• Providers must be enthusiastic & resilient; overcome technology failures• Payers positioned as competitors; reimbursement dependent upon negotiated contracts• Don’t underestimate resources needed to schedule/reschedule/’virtually room patient’/etc.• Disparate glucometer compatibility w/EHRs requires manual processes and time

  • LifeWIngs Executive Steering Committee

    Urgent Care Pilot (Direct to Consumer) Pilot Length: 9 monthsVendor/Partner: Providence Express Care Virtual / American WellPatient Population: Existing & new patients seeking urgent careProviders: Providence Express Care Virtual NP’s

    Objectives:• Offer convenient access to Hoag Urgent Care services for existing patients (prevent outmigration)• Capture new patients and increase managed care lives in HMG through referrals• Pilot virtual visits cost efficiently to enable key learnings about Orange County consumers

    Key Learnings:• Growth strategies are long term investments - start w/employees• Marketing and end to end white labeling significantly impact outcomes• Clearly define referral and follow-up care processes, close care continuum loop• Employees on high deductible plan cannot pay a reduced visit rate due to tax issues • Large Telehealth vendor platforms less flexible and unlikely to customize

  • Remote Patient Monitoring (RPM)

    LifeWIngs Executive Steering Committee

    Pilot Length: 12 monthsVendor/Partner: Care InnovationsPatient Population: COPD / Diabetes inpatients & HMG outpatients

    Providers: Diabetes & COPD Care NavigatorsObjectives:• Reduce high risk patient admissions and readmissions• Recruit/convert new MA HMG patients• Increase patient understanding and self-management of their chronic disease

    Key Learnings:• Select vendor ‘partner’; negotiate shared risk outcomes, 12 mos & EHR integration• Physician buy in and referral is critical to patient engagement/participation• Requires ‘dedicated’ administrative (sales) & clinical resources; complex workflows• Inpatient populations not as interested in RPM• Overall patient satisfaction w/RPM is high

  • Top 10 Pitfalls and Recommendations

    LifeWIngs Executive Steering Committee

    1. Patients want choice. Meet patients where they want to be met.

    2. Resist implementing new technology ‘just because’ – validate need.

    3. Matrix manage & pilot to minimize cost - test, iterate, measure.

    4. Get comfortable with ambiguity - best practices, policies, precedence, validation.

    5. Do your research! Partners, vendors, competitors, research orgs, blogs, lobbyists. Learn from others.

    6. You’re the expert! Competition, reimbursement, technology, contracting, operations, etc.

    7. Engage, educate and communicate successes often (providers & leadership). Be your own advocate!

    8. Develop solid performance indicators, goals, metrics, RFP templates. Revisit & communicate often.

    9. Do not expect a traditionally quantifiable ROI.• Ex: When applied to financial risk pools, value add equates to reduced visits at “bricks and mortar” sites,

    increased patient panels, and decreased numbers of high-cost events.

    10. Encourage a culture that embraces change.

  • Telehealth Use Case Library

    Telehealth Platform Roadmap (6-12 mos)

    Telehealth Pilot/Program Executive Summary (1 Pgr)

    Appendix: Operational Tools

  • Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Appendix: Operational ToolsSlide Number 21

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The Telehealth Connection One Hospital’s Approach to Developing and Implementing a Pragmatic and Patient Centric Strategy Hoag Hospital Memorial Presbyterian Angie Marshall May 22, 2019
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