How telehealth has enhanced Cleveland Clinic's value-based care strategy

Interest in the telehealth industry has grown rapidly in recent years, with 78.5 percent of healthcare consumers reporting they would be comfortable interacting with a physician via online video or online chat, according to a 2016 report out of the Aloft Group — even if almost half of respondents were still not familiar with the term "telemedicine."

As reimbursement models uphold outcomes over volume of services rendered, hospitals are tasked to improve the health of the populations they serve both within and outside of their walls. Given its capacity to reach patients in their homes, provide early intervention and care for minor conditions and alleviate overutilization of hospitals' emergency rooms, telemedicine has become an integral part of many hospitals' core patient access strategy.

In a webinar sponsored by American Well and hosted by Becker's Hospital Review, Matt Stanton, senior director of distance health at Cleveland Clinic, and Danielle Russella, president of customer solutions at American Well, discussed how Cleveland Clinic incorporated telehealth into its spectrum of care and services.

In September 2014, Cleveland Clinic partnered with American Well to deliver urgent care via telehealth. The partnership set out to increase patient access to care, support Cleveland Clinic's transition to value-based care, improve efficiency and expand the system's reach to new patients.

"Part of this is about expanding our access and our reach, around the world, without having to build buildings all the time," Mr. Stanton said. "We recognize that's not a long-term sustainable strategy, to keep building hospitals."

How to determine where to implement telemedicine
Although Cleveland Clinic's partnership with American Well began with urgent care, it has since expanded to cover a range of services, from specialty follow-up care to remote second opinions.

"We've seen that the real value of telehealth goes well beyond urgent care," Ms. Russella said of the services American Well offers, which include patient-to-provider and provider-to-provider interaction. "We've watched and influenced how our clients have taken our infrastructure to market. In the early days, it was specifically with urgent care. Today, it's with all kinds of care."

Postoperative follow-up care, home care, chronic care and behavioral healthcare are all areas ripe for remote intervention. For chronic care, in particular, Cleveland Clinic has seen success with a few different initiatives.

The hospital is nearing the end of a six-month hypertension pilot project, during which roughly 100 patients would track data from remote monitoring devices at home. That data was integrated with Cleveland Clinic's telehealth platform. Providers could then view these vital signs, such as blood pressure, during scheduled virtual visits, to help patients manage their care.

"I do think urgent care is a good place to get started," Mr. Stanton said, "but in thinking about where you would go outside of urgent care, I think this is where telemedicine really becomes part of the fabric of healthcare."

Telemedicine helps health systems foster innovation
Incorporating telemedicine into a health system's strategy presents opportunity to create innovative tools to support population health management. For example, Cleveland Clinic is working to develop an app for patients with chronic back pain. Once complete, the app will be introduced to patients who come to the ER with low back pain. Instead of immediately referring such patients to specialists, they can use the app to learn exercises that can help relieve their pain and also track any improvements in their pain level over time. With such tools, patients are empowered to address their condition at home.

"I think this is where providers need to be thinking about using telemedicine, if we really want to make a difference in our patients' lives," Mr. Stanton said of Cleveland Clinic's expansion into experimental modes of remote care.

3 factors for a successful telehealth program

1. Staff engagement. To build a shared understanding of the role and value of telehealth with the clinical team, Mr. Stanton suggested reaching out to medical staff directly.

"We do have make sure everybody on the team understands why we're doing this, why it's good for patients and what exactly the process is going to be," he explained. "There is no staff meeting that is too early in the morning or too late at night to show up at and present the concept."

Along with staff outreach, Mr. Stanton highlighted how Cleveland Clinic's CEO has been a strong proponent of virtual healthcare, and has been strongly encouraging department chairs to integrate it into their services.

"In my opinion, it really comes down to the physician, nurse and administrator," Mr. Stanton said. "Without any one of these three people being excited about doing this, invariably it becomes very difficult to get it launched."

2. EMR integration. When Cleveland Clinic first launched its telehealth program, physicians scheduled e-visits without EMR integration. This posed an issue for physicians who were looking to bring information from the virtual visits into their patient notes.

Today, Cleveland Clinic's EMR supports scheduling on the telehealth platform, and automatically inputs data into patients' medical records based on information they provide online. The EMR has also integrated revenue cycle management capabilities, to help streamline patient payments.

"Once we got our scheduled integration done with our EMR, it enormously increased our ability to get departments launched and eliminated all sorts of training we had to do for front desk personnel," Mr. Stanton explained.

3. Patient awareness. One of the main drivers of growth for the telehealth program also took the form of increasing patient awareness of virtual healthcare services — which often fell under the purview of marketing.

"I wouldn't underestimate the amount of awareness that you have to build on the patient side," Mr. Stanton said. "There's a fair amount of talking to them about why this is appropriate for them and that we're only using this in situations where we feel that it's clinically appropriate, but I think all of that is going to evolve as this becomes a more visible part of the healthcare system."

To drive patient awareness, Cleveland Clinic launched a few different marketing campaigns, including email outreach. Outside of more traditional marketing attempts, Cleveland Clinic also debuted a telehealth-focused advertisement during this past February's Super Bowl LI, which Mr. Stanton said led to a spike in traffic on the hospital's website and app.

Through developing innovative remote services and building awareness among providers and patients, hospitals like Cleveland Clinic are able to deploy and establish successful telehealth programs. As outcomes continue to determine an increasing share of reimbursement under value-based payment models, a comprehensive telehealth strategy will continue to help healthcare organizations stay competitive.

Listen to the webinar recording here.

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