How 3 leading pediatric health systems are harnessing telehealth to transform care

As hospitals and health systems leverage technology to improve patient care, particularly for rural populations with limited provider access, three leading pediatric health systems partnered with American Well, the nation's largest telehealth operator, to transform pediatric care delivery.

In an April 18 webinar sponsored by American Well and hosted by Becker's Hospital Review, Ali Hyatt, vice president of marketing at American Well, joined leaders from Children's Health of Dallas, Children's Hospital & Medical Center of Omaha (Neb.) and Florida-based provider group Pediatric Associates to discuss how their organizations are revamping pediatric care practices through American Well's telehealth service.

American Well's mobile and web service connects patients with physicians for real-time, on-demand video visits and works with a variety of different markets, from health plans such as Anthem and UnitedHealthcare, to some of the nation's leading health systems, including Cleveland Clinic and Salt Lake City-based Intermountain Healthcare.

Leaders from Children's Health of Dallas, Children's Hospital & Medical Center of Omaha, and Pediatric Associates discussed how their partnership with American Well is revolutionizing care for their unique patient populations, including using telehealth as a vehicle for viewing patients as consumers, the transition to telehealth and why their organization chose to implement telehealth.

Telehealth as a vehicle for patient consumerism

For Children's Health of Dallas, telehealth provides care access to both rural and urban patients, particularly for patients who have to take several bus rides or spend entire days traveling to one medical appointment, said Tamara Perry, director of virtual health operations at the health system.

Additionally, nearly one in five Dallas County children are uninsured, prompting a number of patients to seek care in the health system's emergency rooms. "Quite a few of our telemedicine programs were started due to the high level of ER visits we receive," Ms. Perry said.

"We noticed there was a lack of access to care for both rural and urban patient populations," Ms. Perry explained. "We had to begin shifting focus from patient care to consumer care and look at our model in terms of population health, and technology is one of the easiest ways to reach our patients."

Children's Health of Dallas, which began its venture into virtual health in 2013, now provides telehealth across numerous service lines, from blood disorders to school telehealth. The school telehealth system is implemented across more than 100 schools across Texas and is the largest school-based telehealth program in the country, Ms. Perry said. Telemedicine units are housed in the school clinic, where trained nurses help patients connect to virtual care providers.

"In using telemedicine, we transitioned our care process to bringing healthcare to the patient and not the patient having to come to brick and mortar for that," Ms. Perry said.

For patients who lack a primary care provider or live in areas with few pediatricians, virtual medical appointments and education programs serve as a way for Children's Health of Dallas to reroute ER traffic and let patients stay in their communities. "The goal of using telemedicine is to keep the child in their hometown, in their hospital, with their family and not have to transport them," Ms. Perry said. "We're aiming toward having a hub model of telemedicine."

Now, Children's Health of Dallas is furthering their push toward direct-to-consumer care by expanding the reach of virtual visits through health kiosks, which allow patients to video conference with providers from locations such as local pharmacies and community residential sites. The health system partnered with Dallas-based Dougherty's Pharmacy to provide the telehealth kiosks, with the first kiosk launching in 2016.

In addition to offering patients real-time access to health providers through a video call, the visit kiosks record patients' vital signals as well as other basic health measurements. A telehealth presenter is on site to help patients who require assistance when using the technology. After patients complete their first visit, they can schedule future appointments on their mobile device.

"The addition of these kiosks allows patients with socioeconomic concerns to access healthcare where they live, when they need it," said Victoria Rodino, manager of virtual health and innovation at Children's Health of Dallas.

Making the plunge into telehealth

Children's Hospital & Medical Center of Omaha, which cares for 250,000-plus children annually, is harnessing telehealth to address the limited access to pediatric psychiatric care in Nebraska.

"When we started thinking about telehealth about three years ago, our new CEO, who was an advocate for telehealth, guided us toward recruiting Dr. Jennifer McWilliams to lead as our physician champion for psychiatry," said Michael Vance, PhD, director of behavioral health services at Children's Hospital & Medical Center of Omaha.

Recruiting physicians who are on-board with telehealth is critical to the initiative's success, Dr. Vance said. "Find that physician who is willing to put up with all of its hiccups and challenges and is passionate about [telehealth], because it can be a big challenge up front," Dr. Vance added.

From a financial perspective, choosing a telehealth company can be a significant commitment for a hospital or health system, Dr. Vance said. "We landed on American Well because they had extensive experience in the use cases we wanted to go to and they were willing to be innovative to go to new use cases we planned to do," Dr. Vance said.

For Jennifer McWilliams, MD, a child and adolescent psychiatrist in Children's of Omaha's department of behavioral health, telehealth serves as a tool to more easily connect patients to providers rather than entirely altering how providers deliver care.

The hospital's virtual visits for psychiatry have significantly increased, with 600-plus telepsychiatry visits conducted since the program's launch. "I provide care via telehealth about half the time but could easily begin providing care via telehealth 100 percent of the time," Dr. McWilliams said.

"With telehealth services, I'm providing pediatric psychiatry service just the same as I would be if someone came to my office in person," Dr. McWilliams said. "When I'm talking to other providers, I really emphasize that telemedicine is simply a tool. There are some aspects of evaluation that are more challenging when evaluating certain conditions via telehealth, but on the flipside, when dealing with patients who have experienced trauma or anxiety, they feel more comfortable seeing a provider virtually." Additionally, since its inception, the telehealth program helped reduce Children's of Omaha's follow-up no-show rates by 50 percent, according to a case study conducted by American Well.

The hospital recently recruited a nurse practitioner who lives outside of Omaha but can see patients in rural sites from her home, Dr. McWilliams said. "We're also addressing workforce issues that are so prominent for mental health workers in Nebraska. And by seeing families in our primary care offices, we're able to reduce the stigma for patients seeking out mental healthcare," Dr. McWilliams added. "It puts children at ease and makes it far less difficult to provide mental healthcare."

Overcoming telehealth implementation challenges

Pediatric Associates, which cares for approximately 500,000 active patients, implemented telehealth services to triage patients and help with ER diversion. Pediatric Associates providers staff the group's telehealth system and created triage protocol to determine the best site of care for each patient and curb unnecessary ER visits.

Amy Verlsteffen, director of the patient contact center for Pediatric Associates, discussed barriers the provider group addressed before implementing telehealth, including physician buy-in, concerns over whether it would detract patient volume from offices, reimbursement policies and malpractice issues.

To address these issues and develop a secure platform for implementing video telehealth, Pediatric Associates partnered with American Well in 2017. "All of our appointments made through telehealth are triage-based, and patients can continue to be scheduled through our existing phone system," Ms. Verlsteffen said.

The group has four full-time telehealth physicians available from 7 a.m. to 11 p.m. on weekdays and 3 p.m. to 11 p.m. on weekends. Since the program's implementation in July 2017, monthly telehealth visit volume increased from 100 visits to 1,000-plus visits as of March 2018.

"Our focus is on growth and embracing managed care and value-based care," said Scott Farr, COO of Pediatric Associates. "That's been the key for developing this initiative around telehealth — it allows us to care for our patients in the most efficient way and providing them the greatest ability to access care."

Ms. Verlsteffen shared one patient's story. A three-year-old's parents started a telehealth video visit after the child had a high fever and began vomiting after the office had closed. Per the advice of the physician, the parent called 911 and took the child to the ER, where physicians found the child was experiencing diabetic ketoacidosis. "It was one of those cool stories where despite our offices being closed, we were able to save this child, which would not have been possible without our telehealth services," Ms. Verlsteffen said.

To listen to the full webinar recording, click here.

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