10 lessons learned for successful telehealth integration

Having facilitated more than 1 million e-visits, telehealth provider Teladoc has learned some lessons in what works and what doesn't when implementing virtual healthcare visits.

Teladoc has been operational since 2005, and in the past decade, it has built its network to include more than 2,650 board-certified physicians and behavioral health providers. While the company reached its 1 million milestone in October 2015, Teladoc expects to have facilitated a total of 2 million e-visits by the end of 2016.

Teladoc shared 10 of its learned telehealth insights in a Feb. 24 webinar hosted by Becker's Hospital Review.

1. Telehealth is safe and effective. "The most appropriate first lesson has to be on a subject of patient safety," said Henry DePhillips, MD, CMO of Teladoc. "The key to any telehealth program is that patient safety comes first and foremost."

To ensure care provided through Teladoc remains safe and effective, the company reviews 100 percent of consults for new physicians, and conducts 10 percent of chart review for all physicians in the network every month.

Additionally, Teladoc has a series of proprietary clinical guidelines, produced from research on global medical literature on diagnosis and treatment of common and complicated medical problems.

Another quality marker Teladoc presented was the need for a follow-up visit after an e-visit. Dr. DePhillips cited an independent RAND Corporation study examining follow-up visits in a 300,000-member population in California that shared the same diagnosis. According to the study, 6 percent of telemedicine encounters required a follow-up appointment, compared to 13 percent of face-to-face encounters and 20 percent of emergency room encounters. 

2. Patients want choice. As healthcare becomes less provider-centric and more patient-centric, individuals are calling the shots on how they want care delivered, and the healthcare industry is responding.

"With telehealth, we actually are able to reach out to patients and render care through smartphones, mobile applications, web browsers, video, telephone, whatever modality of technology is appropriate for the need," Dr. DePhillips said. "We're meeting patients where they want to be met on their terms and they're able now to consume healthcare, at least for common and uncomplicated medical problems, in a way that is convenient for them."

3. The typical patient is a 36-year old female, often with comorbidity. Using data analytics on approximately 382,000 visits, Teladoc determined the average user of its telehealth services is 36 years old, which makes sense since much of Teladoc's client base consists of working age people. The analysis also found 63 percent of users are female, which Alan Roga, MD, senior vice president and general manager of the provider market, said reflects the finding from a study by the Department of Labor that women make up 80 percent of the healthcare decisions for their families.

That 44 percent of users have at least one comorbidity indicates the breadth of use cases for telehealth. "What it's telling us is, we are not just taking care of college-aged kids with pink eye," Dr. Roga says.

4. Patients have a great experience and would use telehealth again. Dr. Roga said the patient satisfaction rate for Teladoc services exceeds the industry standard, at 95 percent and 82 percent, respectively. The same goes for access to care, with 86 percent of Teladoc users reporting telehealth made it easier to get care, while 64 percent is the industry standard.

Nine out of 10 telehealth users said they would use the service again, and Dr. Roga said the main reason accounting for patient dissatisfaction has more to do with an unmet expectation than the service received. He said, for example, if a patient was looking for an antibiotic but the physician deemed the patient to have a virus and the antibiotic was not appropriate, that may lead to reports of dissatisfaction.

5. Patient utilization is highest during weekdays and morning hours. Teladoc finds peak utilization times for telehealth mirror those of traditional in-person visits. On a day-to-day basis, visits peak in the morning, between 9 and 11 a.m.. When looking on a month-to-month basis, Teladoc visits increased in November and December, which Dr. Roga again said reflects trends in acute care settings.

Since these visit patterns for telehealth and in-person settings are so similar, Dr. Roga said they negate the thought that telehealth services can lead to overutilization of healthcare services.

6. Telehealth saves money. Teladoc serves more than 6,000 clients, including Fortune 1,000 companies, health plans and health systems. A study of one of Teladoc's national clients — an employer with presence in all 50 states — found it achieved $673 in overall medical cost savings per telehealth e-visit. Multiplying that individual cost saving by the 575,000 e-visits Teladoc facilitated in 2015 equals $387 million in medical cost savings — not including productivity costs — that clients were able to achieve.

Dr. DePhillips said the majority of these cost savings come from appropriate diversions from the emergency room.

7. Prescribing patterns are similar to an office visit. "There are those out there who think about telemedicine or telehealth and they say, 'Well isn't it really a teleprescription program?' and the answer is no," Dr. DePhillips said.

Teladoc's analysis found 77 percent of e-visits resulted in a prescription. They compared with the most recent CDC data on prescribing patterns in office visits, which says 82 percent of visits result in a prescription. At the very least, the two percentages are on par with one another, Dr. DePhillips said.

8. The regulatory environment has significantly improved. While telehealth has historically been subject to substantial regulation, more states are passing legislation and state medical boards are supporting regulation that fosters telehealth use and expansion — 20 states in the past 18 months to be exact, according to Dr. DePhillips.

"There's clearly a tidal wave of support. The state legislators and regulators are starting to realize how much businesses really like to have a telemedicine benefit within the state. It helps them be competitive by moderating their medical costs," Dr. DePhillips said. "Consumers in these states like to have access to care available to handle these common and complicated medical problems, especially in remote areas, or even in cities where there's a shortage of primary care physicians."

9. A direct-to-consumer program is a long-term investment. Dr. Roga said telehealth should be seen as a strategic asset and a service line to provider organizations. He outlined three use cases for why provider organizations are considering telehealth programs: finances, market share and care coordination.

In the financial arena, Dr. Roga said organizations are looking to prepare for population health management and deliver care in the most cost-effective manner. When looking at market share, organizations are concerned with growth strategy, devising ways to acquire new patients, retain existing patients and respond to competitive forces. For coordinated care, organizations seek to grow provider capacity and the system's reach.

"Growth strategies are appealing, but they need to be looked at as a long-term investments," he said. "There's no direct ROI that's quantifiable. But when applying telehealth to financial risk pools, they can produce immediate and demonstrable savings."

10. Don't get stuck in the parking lot. Healthcare's technology needs to be adaptable to carry organizations into the future, according to Dr. Roga. He said the telehealth market is at a transitory point, where its offerings match what the healthcare market needs: user experience, mobile expansion, EMR integration and subspecialty care, among others.

"For provider organizations to have long-term success, your rate of change is so fast right now that a company must have technology that can adapt to your needs to go into the future together," Dr. Roga said. Otherwise, organizations will get stuck in this proverbial parking lot, where organizations know what they want and where they want to go, but don't have the means to get there.

To view the webinar presentation, click here

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