How can we make sure telehealth processes are making a difference that matters? Having led virtual care for Kaiser Permanente Colorado, what matters most to me is that we are finding ways to make care less expensive and/or with better clinical outcomes.
We have some proof that telehealth improves clinical outcomes. Video visits significantly decrease no-shows for mental health care. Remote patient monitoring significantly increases patient engagement in managing chronic disease. Most trust that no-shows and patient engagement are good surrogates for improved outcomes. However, the evidence that telehealth processes lead to decreased cost and/or improved clinical outcomes is less clear.
I currently lead a committee of the American Telemedicine Association (ATA) (americantelemed.org), comprising clinicians and administrators, looking for metrics that will demonstrate to payors whether care by telehealth is worth it to them OR NOT! Our initial focus is on telemental healthcare. We are considering downstream effects (e.g., costs, outcomes) of no-show rates and medication non-adherence. Here are some ideas of specific metrics that likely will matter to payors:
- Outcomes: Do video visits/virtual care processes address clinical need, same as/better than/worse than in person? Impact on star ratings?
- Cost: How often do patients who have video visits interact with the healthcare system? Is this just an “add-on” or a replacement? Some patients are using all the care options! Historically, the use of secure email resulted in increased usage of all other services.
At the same time, I am leading a group of telehealth leaders in Colorado, specifically, as the Colorado liaison to the Southwest Telehealth Resource Center (southwesttrc.org) and as the Colorado ambassador to the online, peer-reviewed journal, Telehealth and Medicine Today (TelehealthandMedicineToday.com). Here is what I’ve learned is being measured by Colorado telehealth leaders:
- Volume of transfers as result of video consult
- Number of video visits resulting in a visit to the hospital, dollars generated from non-affiliated hospitals
- Number of video visits
- Number of video visit no shows
- Number of video visits rescheduled
- Number who do not check in ahead of time for a scheduled video visit
- How long it takes to get reimbursed for a video visit, by telehealth code?
- Acceptance of video visits by seniors, ever had a video visit before? Did you enjoy it?
- Number of failures, need to convert to phone
- On patient end, provider end, both?
- Video, video/audio, audio problem?
- Is it the platform?
- Venue management: number of patients directed to more appropriate venue for unwarranted Emergency Room/Urgent Care visits
- Patient satisfaction: satisfaction with technology? Would you do it again? Clinical needs addressed?
I cannot say I am surprised AND I think we have a problem. What major healthcare systems, with plenty of data, are measuring is completely unaligned with what my best guess is regarding what is meaningful to payors.
The desired outcomes by 12/31/20 for the ATA Demonstrating Telehealth Value Committee, as described above include:
- Identification of data that will convince payors to reimburse appropriately for telehealth care, starting with mental health.
- Survey 30 organizations who provide telemental health care to find out what they are measuring/how they define success.
- Have at least five organizations who provide telemental healthcare collecting data as identified in #1.
- Standardized layout in different organizations with the same format.
To say that your input is welcome by both me and the ATA committee is an understatement. Thoughts? Please reach out! janground@gmail.com
