Lee Horner, CEO, Synzi

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Virtual care could improve access to care — and much more. Image has been altered. Licensed from Andy Dean - Fotolia.

The Centers for Medicare & Medicaid Services (CMS) made recent updates to improve access and expand reimbursement for telehealth and virtual care services. The measures will help drive healthcare organizations to deliver better patient care from a timing and quality standpoint. CMS proposed expanded benefits for Medicare Advantage to provide beneficiaries with more convenient access to healthcare via virtual care and telehealth services. CMS’s 2019 Physician Fee Schedule is also intended to drive more access and adoption as Medicare will pay providers for these kinds of services, including quick check-ins between patients and providers.

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With this expanded access to virtual care and telehealth services, more providers and home health organizations will be working to implement this technology to reap the multitude of benefits that virtual care platforms can offer — from increasing patient satisfaction and staff efficiency to improving health outcomes while avoiding excess costs.

According to AARP, 87 percent of adults age 65 and older want to stay in their current home and community as they age. The Centers for Disease Control and Prevention defines aging in place as “the ability to live in one’s own home and community safely, independently and comfortably, regardless of age, income or ability level.”

Virtual care can help older populations remain engaged and active in managing their health while keeping them at home as long as possible. The hospital-at-home type of care ensures that patients understand how to self-manage their conditions on a daily basis. Leveraging virtual care technology, providers’ video calls, emails, secure messaging and text messages can facilitate deeper patient engagement by regularly emphasizing the treatment plan, reminding a patient of upcoming appointments, addressing questions about medication reconciliation and recommending changes to improve one’s overall health and well-being. Access to home health staff (and even clinicians, specialists and pharmacists) is now at the fingertips of these patients. And remote family members and informal caregivers can also be included in the communications and virtual appointments to drive greater understanding of the patient’s care plan.

With the increase in the aging population, more patients will face a turning point in their care, especially if they are living with one or more chronic conditions.

Virtual care technology can optimize visiting nurses’ productivity by enabling nurses, specialists and related specialists (e.g., pharmacists, nutritionists, etc.) to communicate via video in real-time. The real-time “live” interaction will limit disruption to existing workflows and reduce travel time and costs for all care team members, while improving alignment on the patient’s progress and next steps in the care program. Patient wait times for serious interventions are minimized as clinicians can readily be included in the video-based virtual visit if the nurse is unable to answer the patient’s question or address the emerging concern. Staff members’ available time can be better used to deliver compassionate care to more patients versus driving to a handful of patient appointments each day.

Each key stakeholder involved in a patient’s care can benefit from increased access to and reimbursement of a virtual care platform.

As coordinating conversations across a patient’s care team is difficult with busy schedules and various locations, a virtual care communication platform enables providers to connect with each other, regardless of the various locations. Using video, a provider can ensure that clear, efficient and open communications take place among care team members and that the quality of care — and patient’s concerns, needs and wishes &mdash; are maintained throughout the care continuum. If a patient needs to be transferred from home, all stakeholders can discuss the best way to move the patient in so that it minimizes the patient’s wait time and maximizes the continuity of care. The expanded use of virtual care will help keep patient-centric care at the forefront for all providers and settings.

As providers have the ability to detect potential patient issues before immediate in-person consults are needed, preventive care can be conveniently delivered via video, and expensive in-person critical interventions (whether at the emergency department or at home) can be minimized. The Health Care Cost Institute estimates that the average cost of an emergency room visit is $1,917, while the Agency for Healthcare Research & Quality estimates that the average cost of a readmission for a patient is $13,800 (Medicare) or $12,300 (Medicaid). In this way, leveraging virtual care helps to avoid excess costs for all organizations across the care continuum.

Virtual care is an effective and efficient way to bring care to patients and help them remain comfortably and conveniently at home. By using technology to provide patients with better access to follow-up care, healthcare organizations can optimize their community’s physical and financial health while lowering costs for all stakeholders. The latest CMS developments help to drive better access and reimbursement, leading to better outcomes for all involved.

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The idea of virtual care is easy to grasp, and the benefits are quickly understood. But implementing virtual care technology can be challenging unless organizations are prepared to contend with (and triumph over) challenges, including:

Integration into an organization’s technological infrastructure

Addressing HIPAA compliance and other security considerations

These issues can become even more complex when healthcare organizations seek to implement virtual care that goes beyond traditional telehealth communication methods to engage patients. However, the challenges of including more robust functionality in a virtual care communication platform are offset by the expansion of patient access to more timely and higher quality care, in a more resource-effective manner.

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A virtual care communication platform uses a range of media — including video, text, secure messaging and email &mdash; to do more than just check up on patients. The platform is critical to engaging patients in their healthcare on a regular basis, while also enabling providers to access consults from offsite/remote colleagues on a timely basis. Virtual care can improve care delivery, optimize workflows and staff productivity and enhance patient engagement, avoiding excess costs along the way.

Although healthcare organizations may have concerns when considering virtual care, there are several strategies to overcome these issues.

Access to broadband — at a patient’s home or at a healthcare facility &mdash; can be restricted. In rural communities, limited access to adequate broadband may deter organizations from deploying virtual care technology.

In order to provide all populations better access to care, healthcare organizations should not be stymied by the limitations of today’s broadband situation. While the broadband infrastructure continues to be built throughout the U.S., healthcare organizations can overcome this hurdle by selecting a virtual care platform that can work on cellular and Wi-Fi connectivity. Using platforms designed to work on any level of connectivity, providers have increased flexibility for delivering timely consults via video, and rural patients have improved access to care via cellular or limited broadband connection, which is especially important if they are geographically isolated. Continued investments in broadband infrastructure and adoption should eventually extend virtual care to at-home patients, such as those in rural communities.

Challenge No. 2: Access Through a Range of Devices

Another concern is whether a healthcare organization needs to invest in specific equipment (carts, flat screens, etc.) to deliver virtual care at its facility, or whether the organization must consider absorbing the cost of these devices to allow patients to securely access care from the convenience and comfort of their home.

Fortunately, organizations may select a platform that works on any device — smartphone, tablet or computer &mdash; which most providers and patients already own. The flexibility of a platform that does not require specific hardware means that an organization can deploy a platform that is already future-proof (as large carts quickly become outdated and too large to move quickly around a facility) and considers individual preference for specific devices and operating systems. Virtual care fits into a patient’s lifestyle if they are already comfortable with using computers, smartphones or tablets.

Challenge No. 3: Integration into an Organization’s Technological Infrastructure

When and how should healthcare organizations involve IT in the decision-making and deployment process for virtual care technology?

Although providers will likely be the true champions (and users) of introducing a virtual care communication platform, IT leaders will need to understand the benefits of virtual care and how it can be part of near-term workstreams versus a future state. The IT department may be concerned by existing projects and other investments that are ready to deploy and might not understand how critical virtual care can be to the broader organization’s ability to deliver timely, quality and cost-effective care. An IT assessment should be completed early in the discussions about implementing virtual care technology. Providers can help ease IT’s anxieties by identifying the first use case(s) where it will be easiest to implement from a technological standpoint and/or most critical to deploy from the care delivery perspective. Instead of trying to deploy a platform throughout all facilities, departments and care settings, IT can optimize the initial rollout before expanding across the organization.

Challenge No. 4: Working with Existing Clinical Workflows

Given the complications of implementing electronic health record (EHR) solutions in recent years, many healthcare organizations are wary about how to integrate new technologies into their workflows.

In order to achieve seamless integration of a virtual care platform, healthcare organizations should work with their virtual care partner to conduct a workflow analysis to understand how the virtual care platform fits in with current clinical practices. Virtual care should be thought of as “just another method” of delivering healthcare, as opposed to a disruptive, new way to practice medicine. Virtual care protocols should be consistent with existing, in-person protocols. This will help providers feel more comfortable in adopting virtual care and delivering care using technology on a regular basis. Additional tips include:

Set expectations on implementation timelines, deliverables and milestones; identify potential obstacles to staying on track; and brainstorm solutions to either address these obstacles upfront or in the future.

Determine how the organization will monitor and evaluate the use of virtual care on a regular and ongoing basis. Metrics may include levels of usage, frequency of usage, comfort level by users, efficiencies realized and effects on satisfaction, quality and outcomes.

Assess performance regularly to identify trends, successes and areas for optimization to continue to improve effects and expand usage.

Challenge No. 5: Addressing HIPAA Compliance and Security

HIPAA compliance, along with platform reliability and security, are common apprehensions of providers and their IT colleagues. Some providers may even assume they can use existing communication platforms — such as Facetime or Skype &mdash; to communicate with colleagues and patients. It helps if all involved understand the need for (and value of) a safe and secure communication platform.

First, providers and patients likely already communicate in their personal lives via the cloud. However, all parties need to remember that healthcare communication is a serious matter and must be enacted in the most secure manner possible. Communication platforms that are HIPAA-compliant are table-stakes at this point. Now, healthcare organizations should also understand the need to have a HIPAA-compliant and HITRUST-certified platform to ensure security, privacy and compliance.

Exceeding the healthcare industry’s benchmarks and regulations is critical for healthcare organizations seeking to deliver virtual care that is safer than FaceTime and better than telehealth. Tech-based communication platforms can keep providers focused on caregiving by helping manage their time and effectiveness. The platform can keep patients engaged in their care by helping to facilitate convenient access to their providers. And the platform can ensure that IT departments and the broader healthcare organizations are optimizing the use of available resources while enhancing the overall outcomes for all stakeholders.

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Lee Horner, CEO, Synzi

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