6 Smart Moves to Optimize Telehealth

The 5 Domains of Telehealth Performance

To understand the moves required to optimize telehealth, we can look to the five core domains of telehealth performance: operational, strategic, clinical, financial, and technical.

At the core of a telehealth services’ performance are the operational measures which include the common metrics of number of services performed as well as satisfaction scores. Next are performance measures around the strategic alignment of the telehealth services. Highly important are also the clinical outcome measures as well as the financial performance of a telehealth service. Both of the latter performance measures are key for a sustainable telehealth. Lastly the technical performance, often measured in helpdesk calls and recorded issues, can be evaluated.

1. Optimizing the Clinical Performance

Ultimately nothing matters more than ensuring that the clinical care provided and received creates the desired clinical outcomes. With telehealth still relatively new to many clinical teams (especially in family medicine and some specialties), the clinicians’ experience with how to best leverage the technology is limited.

The most effective and relatively easy to implement optimization is to bring all clinicians together to develop their own clinical telehealth guidelines. These can include decision trees for which conditions or symptoms certain modalities (in-person, video visit, telephone) are clinically appropriate and how to conduct and document virtual exams.

2. Optimizing Financial Performance

When it comes to the improvement of telehealth performance, a close second is ensuring that organizations get paid appropriately for the care delivered. Given the changing nature of regulations (especially as we are nearing another extension of the public health emergency), a best practice that has emerged is the periodic review of all telehealth charges and to track denials or payments that are lower than expected. While Medicaid and Medicare changes are widely publicized and discussed, private insurers, managed care plans, and medicare advantage programs often change reimbursement rules, sometimes in conflict with the state legislation, without much notice.

3. Optimizing Operational Performance

Based on our experience of implementing dozens of telemedicine services, the keystone to a successful telemedicine service is the engagement of the clinicians (read: satisfaction) with well-designed workflows, appropriately-selected technology, and knowledgeable, timely support. Secondary to that is the proper definition of all workflows from scheduling, pre-appointment TechChecks, and TeleRooming to post-visit activities and billing.

In our work with clinics and health centers we therefore focus on ensuring that clinicians are adequately trained and supported and to initiate the implementation of proven approaches to achieve high physician satisfaction (see: “Making Telemedicine Enjoyable for Physicians”).

4. Patient Engagement & Marketing

“Build it and they will come” may have worked at the height of the Covid-19 health crisis, but since many other healthcare providers are now offering telehealth services, it is important to make sure that your patients are having a great experience and that they also know about the services your organization is offering.

We therefore recommend that you study and develop the telehealth engagement of your primarily targeted patient population, starting with the systematic identification of barriers to engagement. These oftentimes include: a bad telehealth experience in the past, privacy concerns or technophobia (see: “Telehealth visits are more secure, offer more privacy”), as well as connectivity or digital literacy challenges. The best recipe for high patient engagement is training clinicians on webside manners and conducting pre-visit Telehealth TechChecks.

The best strategy to market telehealth to your patients is actually the direct offer by a clinician to conduct the next visit via telehealth, followed by schedulers and front office staff making the same recommendation. Obviously the availability of telehealth as a new way to access to care should be equally promoted in all of the organization’s marketing materials from the website and online ads to print materials.

5. Quality Improvement with Telehealth

The “Q-word” is thrown around in healthcare a lot and it definitely has its rightful place in telehealth, too.

Two quality optimization approaches come to mind: First, you want to leverage typical clinical quality metrics, such as Press-Ganey and HCAHPS scores, in addition to condition-specific health outcomes, such as post-surgical wound healing, A1C for diabetics, medication compliance, etc.

The second approach is to adopt a mindset of continuous quality improvement of the telehealth service. The basis for continuous improvement is to first put the proper measurement systems in place so that improvements can easily be measured. The common first steps include to establish a telehealth service performance dashboard; set targets for the key performance indicators; conduct root cause analysis on missed targets; design and implement interventions; and how to strategically leverage telehealth to improve the organization’s overall quality scores.

6. Expand into Remote Patient Monitoring (RPM)

This is not an optimization of a telehealth service, but really an optimization of your overall telehealth program. Many health systems have already launched large-scale remote physiological monitoring programs, oftentimes enrolling thousands of patients.

Whether it is for the management of patients with multiple chronic conditions, preventing readmissions, or extending critical care into the home — the applications and uses for RPM are manifold and the potential for big ROIs is high.

To get started in RPM, though, first create your for each service and define with the clinical teams the desired workflow. before evaluation and selecting a vendor.

Smart Moves to Optimize Telehealth

Telehealth is undoubtedly here to stay and we are definitely on the road to increased “virtual first” outpatient visits, eventually leading to “virtual, mostly”. Making an investment into telehealth optimization is a good use of resources, given the multitude of benefits that telehealth creates. It’s time to make your move.

What optimization have you completed to get the operational, financial, clinical, technical, and strategic performance of your telehealth services in line with the potential and/or expectations? Let me know, I’d love to compare…