Telesitting, remote maternity care: Where telehealth is going next at Kaiser Permanente

Oakland, Calif.-based Kaiser Permanente is creating a "hybrid" or "fluid" model of healthcare, mixing video visits, remote monitoring and "telesitting" — along with in-person treatment — to give patients care where and how they need it, said Edward Lee, MD, executive vice president of IT and CIO of the Permanente Federation.

Dr. Lee shared with Becker's how the health system is taking the lessons it learned from telehealth's skyrocketing use during the pandemic to shape its care now — and where he sees the technology going next.

Note: His responses have been lightly edited for length and clarity.

Question: What specialties does telehealth remain popular for as the pandemic has waned?

Dr. Edward Lee: As of October 2022, 34 percent of Kaiser Permanente's ambulatory care visits are being conducted by a scheduled video or phone call. That compares to an industrywide range of 13-17 percent of care being delivered via telehealth across all specialties — a level that has largely stabilized since the pandemic's onset.

A significant amount of our specialty care has continued to be delivered via phone and video visits in 2022, including nearly 70 percent of visits with infectious disease specialists, and about 69 percent of visits with allergists and endocrinologists.

One specialty that retains particularly high telehealth usage is our mental healthcare. During the pandemic, we shifted nearly all our mental health services to telehealth to ensure our members continued to receive high-quality mental healthcare without risking exposure to COVID-19. In April 2019, 16 percent of mental health encounters were virtual, compared with 99 percent by April 2020.

Demand for virtual mental health services has remained high across the healthcare industry. Throughout 2021, we continued to conduct nearly all (94 percent) of mental health visits by phone or video and have seen similarly high levels of telehealth utilization (around 90 percent of visits) thus far in 2022.

Q: Do you expect telehealth's utilization to rise or fall in the future?

EL: Our telehealth utilization rates have been largely stable since mid-2021.

The COVID-19 pandemic accelerated the use of telehealth options and improved many patients' receptiveness to try them. As care facilities reopened, patients have continued to embrace telehealth as an integral part of their care experience but not a replacement for in-person care in every setting.

This has spurred the creation of hybrid or fluid models of care, in which patients and care teams can work together to determine which modality of care (in-person, video, phone, or other) best meets the clinical need and patient preference. Kaiser Permanente has been uniquely well-positioned to embrace these hybrid models of care because of our integrated model and EHR that captures all patient care interactions across care delivery modalities.

Q: Where do you see telehealth going in the future?

EL: Patients increasingly want and expect telehealth options, but also — now that the most acute phase of the pandemic has passed — want to know they have the option to see our clinicians in person as desired. With this in mind, we anticipate the continued growth and refinement of hybrid models of care that increase care delivery options to respond to member expectations and preferences.

Remote patient monitoring is one area that shows tremendous promise for implementation in a range of areas. For example, we are working to expand our home-based remote cardiac rehab program nationally and have begun enrolling pregnant patients in hybrid maternity care programs that include some video-based appointments and self-monitoring to track metrics such as blood pressure, weight and fetal heart rate.

Most people equate telehealth with outpatient services delivered outside of a traditional care setting. However, we are also embracing telehealth in the hospital setting too by implementing telecritical care, telesitting, virtual caregiver support and expanding options for specialty video visits.

Q: What differentiates Kaiser Permanente's telehealth offerings?

EL: Kaiser Permanente has been a pioneer in using telehealth, starting in the late 1990s. We have continued to enhance our telehealth capabilities and introduce new ways to deliver convenient, high-quality care as a standard and seamless part of care delivery, not as an add-on service.

Because of our early adoption of and investment in telehealth, our established infrastructure was able to rapidly scale to meet the sharp rise in demand at the outset of the pandemic. 

Outside Kaiser Permanente, telehealth is often delivered by third-party providers and treated as a separate, one-off product. Quality, cost, and availability of services can vary significantly, creating a confusing and frustrating experience for patients.

Q: What have been the pros and cons of the great telehealth expansion?

EL: Member feedback affirms our belief that telehealth increases safety, convenience and cost savings for members by avoiding unnecessary in-person visits that require travel and time away from work or family. Telehealth services also empower patients to prioritize their health and help prevent delays in seeking and obtaining care. It also improves access for members who live in remote areas or those who cannot easily leave their homes.

  • Evidence shows telehealth also improves adherence to care regimens. A 2019 study found that more than 80 percent of the patients who joined Kaiser Permanente's home-based cardiac rehabilitation program completed it, compared to the national average of less than 50 percent completion. That program combines wearable technology with support from an assigned healthcare team.  
  • Since launching in September 2021, Kaiser Permanente has conducted more than 440,000 phone and video visits through its 24/7 virtual urgent care option, Get Care Now.
  • Telehealth also enables our clinicians to connect with each other to better serve our members. Physicians who are physically based in different hospitals or medical offices are able to consult with each other by phone, video, or through secure text messaging.

By broadening access to care and expanding clinician reach to underserved communities, we've also seen how telehealth can help bridge gaps for vulnerable populations.

  • We offer real-time interpreter services in 40 languages during phone and video visits.
  • Since 2020, we have seen significant growth in telehealth among many racial and ethnic demographics and historically hard-to-reach populations. A 2021 Kaiser Permanente study found that Latino and low-income patients (295.5 percent and 313.5 percent, respectively) in Southern California had the largest percentage increase use of telehealth in 2020.

While our experience offering and delivering telehealth has been overwhelmingly positive, we have also identified learnings along the way that others may benefit from. Our learnings include:

  • We must adequately support both members and clinicians with their technology to create a positive user experience that does not distract from the visit. Technological difficulties during phone and video visits can result in lower satisfaction scores.
  • As we continue to expand the ways members connect with their care teams, our task now is to help guide the member to the most clinically appropriate channel that aligns with their preferences.
  • Some members or clinicians may prefer face-to-face visits, and we know that telehealth is not the most clinically appropriate option in all circumstances — therefore, we must continue to make in-person care available for our members.

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