In 2015, Avera Health, a fully integrated health system based in Sioux Falls, SD, launched its direct-to-consumer telehealth service, AveraNow. Over the first 12 weeks, AveraNow saw 372 of its 2,500 enrollees complete a telehealth visit, surpassing the health system’s goals
.How did Avera achieve these goals while simultaneously meeting all quality guidelines?
From a clinical perspective, many steps needed to be taken before, during and after the launch to ensure each telehealth visit delivered the highest quality of care to patients.
Here are a few critical elements of Avera’s clinical priorities, implementation plan and the AveraNow launch. For an in-depth look at how Avera was able to staff, manage and run a telehealth service, Ryan Vanden Bosch, director of Avera Medical Group, and Dr. Jason Knutson, lead physician for AveraNow, recently shared their insights during a webinar. You can watch it on demand here.
Training Physicians
One of the most important medical requirements for AveraNow was physician training. Avera already had a business-to-business telemedicine program in place, so many of its physicians were comfortable advising other clinicians via telehealth. Avera physicians, however, had not been involved in any direct-to-consumer telehealth, and required specific training to help guide them through a remote patient encounter. Part of the physician training centered on creating stronger primary care relationships within the Avera ecosystem. If a patient has no PCP attribution, AveraNow physicians are trained and guided to begin to build that relationship with Avera through AveraNow.
Staffing a Telehealth Service
Avera uses its physician network to staff AveraNow; however, these physicians are not practicing strictly online. To staff the telehealth service while still remaining active in a clinical setting, AveraNow uses a platform, powered by American Well, that allows them to set themselves as “available” or “on call” for telehealth visits as needed. Avera’s current workflow is not impacted, yet the physician team opens itself up to treat new patients when it can.
Gaining Physician Buy-In
Initially, there was a mixture of concern among some Avera physicians that AveraNow would take patients away from their brick-and-mortar practices. Avera engaged directly with its medical groups to define the AveraNow program and openly address these concerns. Avera held in-person meetings with each facility’s physicians, creating informative write-ups for each regional hospital internal newsletter, and delivering AveraNow updates in a reoccurring medical group update from Avera’s Chief Medical Officer. Avera also conducted a preliminary launch specifically for employees and physicians to foster internal support.
Creating Evidence-Based Protocols
Another important aspect of gaining physician support was the development of telehealth-specific clinical protocols. AveraNow’s telehealth clinical protocols came from several sources. Avera’s clinics had been developing evidence-based clinical protocols over many years, some of which had been adapted for telehealth. In addition, Avera clinicians conducted extensive research, particularly in areas that touched on antibiotic stewardship. American Well was also able to contribute an existing set of telehealth-specific clinical protocols from its affiliate, Online Care Group, as an additional point of reference for Avera’s clinicians. Results have shown that the focus on antibiotic stewardship has had an impact, with prescribing rates on par or below in-office prescribing rates.
To learn the specifics about how Avera gained physician buy-in for telehealth and their tips for developing telehealth evidence-based protocols, watch this on-demand webinar for more information.