A Waste of Telehealth: Are You Leaving Patients Behind and Money on the Table?

Hyperbole by a telehealth enthusiast? Maybe. But then again I am also convinced that the future is already here — just not evenly distributed. Meaning, that in many clinics there are clinicians in all kinds of medical specialties who are taking full advantage of all that telehealth has to offer. There are primary care clinicians, psychologists, psychiatrists, dermatologists, cardiologists, and others who are seeing the majority of their patients virtually.

Patients are ready, the technology is ready, there is reimbursement, the clinical benefits have been proven and every physician’s excuse over the past 20 years not to embrace telehealth has been dispelled.

But let me stop lamenting and instead shift into what I prefer doing in this column: offer pragmatic advice on what you can do in your organization to create more value out of telehealth, especially for the sake of your patients.

A Quick Rundown of Telehealth’s Key Benefits

While the first part of the list focuses on video visits, the latter partner also considers other telehealth modalities including secure messaging and remote physiological monitoring (RPM).

1. Telehealth provides access to care for patients who otherwise couldn’t or wouldn’t make the appointment. Transportation and time are two big impediments that telehealth solves.
2. Telehealth can be used to significantly reduce in-person (and video visit) no-shows and also convert many same-day cancellations into billable visits.
3. Telehealth improves the continuity of care leading to increased patient engagement and better outcomes.
4. Telehealth offers flexibility and variety for clinicians that can strategically be used to reduce clinician burnout.
5. In today’s highly competitive recruiting environment, telehealth has become table stakes as professionals are seeking exposure to the future of care delivery as well as work structure flexibility.
6. Many smaller clinics and hospitals cannot afford full time access to specialists or even nurses and virtual clinicians and nurses offer proven alternatives.
7. In value-based care environments patient engagement is critical to reduce utilization and telehealth’s various modalities (including secure messaging and RPM) offer easy and frequently touch points to keep patients’ health on track.
8. Chronic care conditions cannot be managed by monthly or even weekly visits alone and telehealth provides plenty of opportunities to engage with patients more frequently.

In short, telehealth provides patients with better access to care, improves health outcomes, improves clinician retention and recruitment, helps with staffing shortages, and improves the bottom line through higher productivity and billable services.

Three Main Indicators of an underperforming Telehealth Program

In many organizations, telehealth is still falling way short of its potential with utilization across many outpatient medical services hovering back in the single-digit percentages of overall volume.

Through our work with many healthcare organizations, we have identified these key three most common characteristics of telehealth services that are underperforming.

1. Low Physician Satisfaction and Engagement
2. Low Patient Acceptance and Patient Satisfaction
3. Poor Financial Performance

Low Physician Satisfaction, if not formally measured, often manifests through a reluctance to fully engage in leveraging telehealth to provide patients with access to care. Excuses range from a lack of acceptance by patients, technical and connectivity challenges on the patient end, or the notion that “telehealth is simply not clinically appropriate” for care.

Low Patient Acceptance and Patient Satisfaction in most organizations goes hand in hand with a low adoption of telehealth by the clinicians. While rarely measured formally, the lore is, anecdotally, that “patients are just not comfortable with telehealth”.

While, especially in rural areas or in organizations serving populations with a low socio-economic status, access to technology or the availability of reliable (and affordable) internet connectivity can be a real barrier, the vast majority of patients do enjoy the convenience and lower cost that telehealth affords and will find ways to get connected. Most of the time patient satisfaction with their physician also takes a dramatic hit when the clinician is reluctant to fully use telehealth, most often feeling not as confident with telehealth as with the in-person care setting.

Poor Financial Performance is the final of the three most common indicators of underperformance. As referred to above, organizations who are not taking full advantage of telehealth are leaving money on the table when they do not use this modality to convert no-shows and same-day cancellations into telehealth visits. An additional component is also that some video-reticent clinicians will bill audio-only visits that are reimbursed at a much lower rate.

Three Most Common Root Causes of Mediocre Telehealth

While the characteristics of underperforming telehealth described above are quite common across a multitude of organizations, the root causes can vary widely. Many performance challenges can be explained by the lack of openness to change of the organization, the demographics and socio-economic status of the patient population, the experience and maturity of the leadership team, and the lack of an innovative clinical and/or operational cheerleader.

For the purpose of this article, we will focus on three concrete root causes that, if turned on their head, can serve as guidance to quickly improve the performance of telehealth:

1. Inadequate Performance Management
2. Inefficient & Ineffective Workflows
3. Persistent Technology Challenges

1. Inadequate Performance Management means that the organization’s leadership team, including the CEO, the COO, the CFO, the CMO and the CIO are pretty much unaware of the performance of their suite of telehealth services, aside from anecdotal evidence. Is the performance good? Is it improving or worsening? Without the systematic collection of key performance indicators and in the absence of setting targets for each metric, telehealth services are pretty much just limping along. As the adage goes, you can’t manage what you don’t measure, thus a common root cause for poor performance is that the leadership does not even know they have a problem.

For guidance on how to address this challenge, see this collection of articles on measuring telehealth success.

2. Inefficient and Ineffective Workflows account for the second-most important root cause for mediocre performance. The delivery of care is ALL about workflows and poorly defined workflows are at the root of most satisfaction problems for both, clinicians and patients. E.g., very few organizations have well-defined “TeleRooming” or “Post-Visit” processes and the lack of a formal workflow leads to expensive (and frustrating) variability and missed steps or duplication of efforts.

For guidance on redesigning your workflows, here are four articles on a proven recipe for workflow design, smooth workflows, the seven most common telehealth workflows and the Happy Day Scenario technique.

3. Persistent Technology Challenges represents the third largest root cause of telehealth services that are not living up to the expectations. While there are some bad (or inappropriate) telehealth technologies out there, for the most part many technologies can be easily adapted to provide a smooth physician and patient experience. The secret to success here lies in proper training and support for clinicians and patients, as well as appropriately defined workflows that are optimized around the capabilities of the technology.

When selecting a new telehealth technology, it is crucially important to solicit input from the clinicians and patients and design the workflow first so as to avoid putting the horse behind the cart.

Improving Telehealth Service Performance

So how can an organization improve its telehealth performance?

The process is straight forward:

1. Commit your Executive and Senior Leadership team to take full advantage of all that telehealth has to offer.
2. Establish a Telehealth Performance Dashboard and start collecting — and acting on — the data.
3. Create a basic telehealth strategy and lay out a roadmap of initiatives to optimize and expand your telehealth services.
4. Work on the optimization of your telehealth services to first and foremost re-engage your clinicians.

Finally, building on your optimized program, expand your telehealth offerings to take full advantage of all that telehealth has to offer to your patients and to your bottom line.

Telehealth is undoubtedly here to stay and if your organization is not serving your patients via telehealth, someone else will. The choice is yours.

Are you curious to explore what this could mean for your organization? Then schedule a complimentary 40 minute conversation with me and your senior leadership team.