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

Analysis

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

mHealth

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

(End)

Organization FocusedConsumer/Patient Focused

Defining & Aligning (Example)

TELEHEALTH STRATEGY: IMPROVED ACCESS & CARE CONTINUITY

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