Palmetto Health, a six-hospital system headquartered in Columbia, South Carolina, has been working to push its telehealth efforts. As some care seems to be moving away from hospitals directly and into retail clinics and telehealth apps on smart devices, forward-thinking organizations are beginning to experiment with new modes of care delivery. With experimentation and change comes uncertainty, but some like Tripp Jennings, chief value and informatics officer at the health system, believe that organizations need to work through the uncertainty to stay relevant in today's landscape of changing healthcare expectations.
"In healthcare, we need to recognize we can't implement new technologies and tools like telehealth with the same mindset that we did with new service offerings in a fee-for-service world," Jennings told Healthcare Dive at the Pop Health Forum in Boston last week. He stated you can't adopt a telehealth strategy overnight (maybe not even in two to three years) and providers shouldn't wait until they switch to value-based care to look into such efforts because by then, they'll already be behind the curve. "You've got to start changing mindsets now because when you get to that magic tipping point from fee-for-service to value-based care, you better have solutions like telehealth which can significantly reduce your operating costs as well as grow your system to scale."
Making innovations routine
At the conference, one of the main themes was "innovation." This isn't particularly different from most other health IT conferences as they tend to attract early-adopters, but another key theme in tandem was "buy-in," both from executive and clinical stakeholders. Dr. Leora Horwitz, director of the Center for Healthcare Innovation and Delivery Science at New York University Langone Medical Center, shared five guidelines during a keynote address to help make innovations endure:
- Choose and implement an intervention - Identify an issue and explore how it can be solved.
- Find a champion - A dedicated champion can help motivate groups around new ideas.
- Keep the champion - However, that may not do any good if the champion leaves the organization. An innovative project could fall flat thereafter
- Understand the value-add - Not all solutions are equal. Some may even be unpopular. It's helpful to identify and promote the value-add to end-users to move from a culture disrupted to a culture that thinks of the disruption as "just something we do."
- Tailor the approach - As not all solutions are equal, nor are all change management efforts. Think of your organization and its members when developing a change management plan.
"When we're looking at developing a strategic plan, a lot of it is around education," Amelia Bischoff, telehealth manager at Palmetto Health, told Healthcare Dive during the conference. That includes educating executives and providers on telehealth. "Buy in from the top is incredibly important and executives really need to be link between the top all the way down to those who have their boots on the ground to understand telehealth and how it can fit into our strategy. That's incredibly important as far as alignment both with people and processes."
Why the efforts matter
Future growth for hospitals doesn't look rosy. Hospital utilization and the number of beds are decreasing while expenses are rising. In addition, some physicians are opting to leave hospital employment to join less stressful job opportunities, whether it be joining telehealth care or consulting. While decreasing utilization and rising expenses directly relates to a hospital's bottom line, athenahealth's CEO and President Jonathan Bush shows why physicians leaving practices may negatively affect hospitals. "One, they don't amortize [a large] IT investment over as many people, transactions, doctors, activities, earning power," Bush told Healthcare Dive at HIMSS17 in February. "Two, their ability to keep admissions rate up is eroded. They may actually lose admissions or diagnostics."
Hospitals need to be forward-thinking and consider how to control or cut costs while looking to expand its active customer base. In fact, a recent Advisory Board Company survey found 183 hospital executives' primary concerns are improving patient access to outpatient settings and expense reduction. This is no easy task and the looming uncertainty over the future of the individual insurance market could constrain that base just a little bit more for hospitals and health systems.
At Palmetto Health, Jennings and Bischoff are working to cut spending and give patients the care they need by looking where telehealth can be a care delivery service without over-extending physicians, services. Bischoff shared that the 35 to 44-year-old age bracket uses telehealth the most at Palmetto. "When you look at the whole spectrum of care, a lot of it can be done virtually," Bischoff said.
The bottom line: If implementing new strategies can't be done overnight, decisions need to be made sooner rather than later to set an organization up for leaner times. Telehealth could be one prong in a financial strategy moving forward.
With wins come challenges
Jennings shared that while the system is making progress in telehealth (he views this as a win), he and Bischoff identified some challenges to their telehealth effort. In part, some challenges include the need to educate. "There's this misperception that telehealth investments are separate from our traditional care delivery models and our service lines when really they fit hand in hand," Bischoff said.
One of the biggest used areas for telehealth at Palmetto is stroke care, which has been established for about six years, Bischoff shared, adding it's timely, efficient care with quality metrics and ROI associated with the service. "It's very established and embedded into the service line. That's the approach we want to take with other service lines," she said.
Though the efforts are continuing, Palmetto has found some obstacles with its telehealth efforts, including:
- Marketing - Not every solution is a Field of Dreams "If you build it, they will come" scenario. For telehealth, without proper marketing, the service could go unnoticed or largely rely on word of mouth. At Palmetto, marketing budgets were cut, which clipped some telehealth marketing efforts. Jennings and Bischoff learned to push for marketing efforts to be linked to future tools and efforts. For telehealth, "We're scrapping together some things to make sure it continues to have success but it's certainly not the volumes we could be getting because marketing has only been internal," Jennings shared.
- Reimbursement - This is always a problem, Jennings said. Palmetto doesn't push for reimbursement parity as much unless the service ties into a value-based model because FFS under telehealth can be a challenge. "We'd rather just say 'Pay for the care of this population and let us use telehealth to decrease costs,'" Jennings said. "If we get paid to do something, we'll do that so it's a good situation [but] the challenges is how do you get an effort started."
- Politics - There's a fair amount of politics regarding providers who feel protective over their patients and that can trickle into telehealth efforts. For example, are pediatric patients taken care of by pediatric specialists or family medicine practitioners? There can also be squabbling over physicians associated or affiliated with the hospital but not part of the medical group who may feel in some instances telehealth steals patients who could be coming into their practices.
- Tech approach - With telehealth efforts, providers face the decision of buying a third party tool and potentially experiencing buyer's remorse or building a home-grown tool.
- Pace - "We're trying to go faster and faster and get technology deployed. At the same time, everybody else is trying to get other technologies deployed and keep up," Jennings said.
While these challenges haven't magically disappeared altogether, Jennings and Bischoff are continuing to champion telehealth and the benefits it could afford patients and their health system. "We're going to start to see a huge push toward direct-to-consumer solutions," Bischoff said. For Palmetto, that will include looking to enhance the connection between providers and patients through mobile devices and video as well as branching into subspecialty care such as psychiatry and obstetrics for DTC telehealth opportunities. "That's the trend we're seeing and we need to market it," she said.