Apr 07, 2020



Coronavirus Town Hall with the American Telemedicine Association – Q&A

By Healthgrades Staff

On Thursday, April 9, Healthgrades hosted a Coronavirus Town Hall for Health Systems featuring Ann Mond Johnson, CEO of the American Telemedicine Association, Joe Brennan, telehealth consultant at Moonshot Health Consulting, and Dr. Brad Bowman, chief medical officer at Healthgrades.

Experts from ATA provided insight on the rise of telehealth adoption amidst the CVOID-19 pandemic.

If you missed it, you can access the playback here. Below is the Q&A portion with Dr. Bowman, Ann Mond Johnson, and Joe Brennan.

Q: What are your views on telehealth today? 

Telehealth was an overnight success 20 years in the making because it made so much practical sense. There was no technology barrier, and it had the ability to improve the continuity of care. It creates new techniques to monitor patients remotely through periodic, digital check-ins. If a patient is not doing well, the technology can flag them and ask them to come in for a face-to-face visit. It has come to a point where bringing patients back for regular face-to-face visits seems wasteful.

Care navigators and case managers spend a lot of time collecting data. Telehealth technology can collect this data for them and present it through an organized dashboard for case managers. In turn, case managers now spend more time with patients who need care, as well as creating the additional capacity to run a larger case management organization.

Ultimately, this technology will reimagine care. Following COVID-19, we will not be going back. COVID-19 forced us to see what telehealth is and it’s going to be hard to take it away from people. Now that a lot of the myths, misunderstandings and even the bias against it have dissolved quickly, telehealth is here to stay.

Q: What are the steps to begin using this technology?

In response to COVID-19, this is now a must-have technology. There were practices, hospitals and health systems that didn’t have anything pre-COVID and they didn’t know where to start. There are various questions you need to assess.

  • What’s the appropriate technology? 
  • What clinical considerations must you address before you start? 
  • How do you let your patients, staff, and physicians know what you’re doing? 

Also, consider what this looks like when we get to the other side of COVID-19.What is your strategy for virtual care moving forward? Focus on both the short and long term.

For health systems that need more guidance, ATA has put together a QuickStart guide that will help you quickly implement telehealth services during the pandemic.

Keep in mind, although this technology needs to be implemented quickly, this does not mean sacrificing quality. You want to make sure things are done both quickly and correctly, ensuring that telehealth is vibrant and well post-COVID-19.

Q: What support do providers and health systems need to be successful?

Focus on both the patient and provider experience. You want to make it as easy as possible for the patient to connect and the provider to use the technology. If we’re going to sustain provider engagement long-term, it needs to be easy for them to use. They can’t be juggling multiple pieces of software while trying to document in the EHR. They need an experience that is not only easy to use but something they look forward to implementing and learning. If health systems are conscious of that and create something with both the patient and provider experience in mind, that’s where the sustainability will come from.

Following COVID-19, health systems are going to see the convenience that telehealth provides patients, but they will also see how convenient it is for providers and their office and workflow. Virtual care creates more efficiency and allows providers more time at home. Perhaps take can even dedicate one daya week where they do virtual follow-up visits in their own home office.

Q: What regulatory changes will have an impact on the growth of telemedicine, from a consumer and provider health system perspective? What will help it grow into a viable, scalable option? 

Reimbursement historically has been a barrier to the adoption of telehealth by both consumers and clinicians. With changes to reimbursement in response to the pandemic, there’s a certain level of parity that wasn’t there before. Waiving the restrictions on where the service is delivered or where the patient or the provider needs to be when the service is delivered are going to be difficult to take back and will only continue to promote the expanded use of telemedicine.

Regulations have finally caught up with technology. For example, Medicare and CMS have embraced telehealth as a resource during this time. Health systems are always using telehealth in ways people hadn’t imagined before. As the waivers and more robust reimbursement continue, ATA is uniquely poised to take advantage of this on behalf of the entire industry — delivery systems, payers, and solution providers — to create a clear case for why this shouldn’t be rolled back.

Q: Are there any compliance issues with telehealth and out-of-state patients if they need follow-up?

There are a lot of compliance issues. There is a nuance with licensure waivers. First, people get confused about what is the federal domain versus state domains,.While HIPAA has relaxed privacy issues and there’s this notion of discretionary enforcement, that doesn’t remove what is still being done at the state level. Second, even in states that report to have waived licensure restrictions and are allowing out-of-state clinician to practice, they’re tying it to a specific facility, and that puts a significant administrative burden on the clinician. It’s important to understand what is being done at the state level to make it as easy as possible for clinicians to practice.

Q: How do health systems and practitioners engage with consumers to make them aware of telehealth services?

Before COVID-19, the last great barrier was awareness. People didn’t know that their providers offered this service. A lot of work was focused on digitally engaging the consumer through social media, paid search, targeted emails, and precision marketing to get messages out. Awareness isn’t a concern anymore. Now that people know what telehealth is, how is your health system communicating to patients that telehealth is a service that you offer and something that they should consider? If there are a lot of people who don’t necessarily have a relationship with a health system or a specific practice, you can use tools like paid search to let people know that this is not only something that you’re participating in but it’s a primary care delivery tool that you’re using.

Q: What role do chatbots play in helping delivery systems scale?

The use of asynchronous tools as a way to help delivery systems scale is interesting. Keeping people out of the emergency room or out of physician offices and replacing that access with a technology that is one-to-one instead of one to man doesn’t necessarily allow you to deal with the surge.WMany organizations have created chat-first tools that helps people understand whether they might be at risk.

Some health systems are had added new questions related to the social determinants of health. For example, have you or someone in your household lost their job? Do you have enough food for your family to eat this week and next? This provides the necessary information for health systems to step in even faster and prioritize populations at risk. It’s really scaling the response of delivery systems unlike ever before, while providing a mechanism to triage and smooth demand.

Q: Is there a way to leverage telehealth to bring cases back through the door, and how it can complement in-person visits going forward?

With COVID-19, you ultimately have two options. Option A: cancel everything because you don’t want people to come into the office. Or if it’s completely necessary, screen them via phone to make sure they don’t have symptoms. Option B: replace that face-to-face visit with a virtual option, and enable schedulers and staff to proactively inform patients that appointments are switching it to this virtual platform and they will be shown how it works.

Those that have gone to Option B are having success, and they’re not losing all of the revenue for those follow-up visits. Looking ahead, people are still going to be apprehensiveabout interacting in clinical settings. We’re not going to wake up one day and feel completely comfortable going out into the world. As this plays out, you can still take care of your patients and see the revenue of those visits but do it in a way that’s safe for both provider and patient.

Q: What can practitioners and patients new to remote visits do to optimally deliver and receive care?

Providing resources similar to pre-visit toolkits based on the condition or the topic and a list of questions that will likely be asked during the visit allows patients to think their answers through ahead of time instead of on the spot. Also, practicing good patient interviewing techniques and explaining concepts to patients in a way that is easy for them to understand. Don’t be afraid to solicit questions back from the patients to make sure they understand what you said or even ask them to tell you what they heard. All of these practices help ease patients into the virtual care systems.

Q:  How can providers get out in front to differentiate themselves?

Once again, focus on the patient experience. How is the actual connection through video? What steps are you taking afterward and how are you communicating with that patient, whether it is asynchronous or synchronous follow-up? Map out the entire patient journey and make it as smooth and seamless as possible so that telehealth is easy to use and something that patients access when they need care or want to talk to someone. Your true differentiation is this: don’t just take this off the shelf and plug it in. Create it in a way that is consistent with your health system’s values and make it the easiest patient experience possible.