'Virtual care is here to stay': Valleywise Health execs talk telemedicine transformation and what's in store post pandemic 

In response to the pandemic, Phoenix-based Valleywise Health built a telemedicine program from the ground up, facilitating more than 20,000 virtual visits and spurring benefits that will pave the way for future expansion.

Kelly Summers, CIO, and Anthony Dunnigan, MD, chief medical information officer, helped lead Valleywise Health's telemedicine transformation in March, equipping the safety net hospital with a Doxy.me virtual communication platform and training providers how to conduct visits. Since its launch, the telemedicine program has completed more than 20,000 visits, equating to $13 million dollars in billable charges, Mr. Summers told Becker's Hospital Review.

As self-proclaimed telehealth advocates, Mr. Summers said he and Dr. Dunnigan had been trying to launch a telehealth program at Valleywise Health before the pandemic. In recent years, the hospital had invested $40 million in its Enterprise Strengthening the Foundation program, helping re-architect its information networks, re-platform the EHR system and set a firm technology foundation. It is these investments that allowed Valleywise Health to launch a telemedicine program so rapidly once the pandemic hit, Mr. Summers said. 

Here, Mr. Summers and Dr. Dunnigan explain their strategy behind the telemedicine rollout as well as their expectations for CMS and other regulators to support permanent virtual care access post pandemic.

Editor's note: Responses have been lightly edited for clarity and length.

Question: How are you planning to continue telehealth expansion post-pandemic? Valleywise Health implemented Doxy.me to help quickly scale telehealth – do you plan to keep using this platform once regulations go back in place?

Dr. Anthony Dunnigan: When this pandemic hit, we were under the gun. We were following the regulation changes very closely, and it was apparent very early on, even within the first week, that there was obviously going to be openness to doing virtual visits either in an interactive video platform or by phone. We had been trying to percolate telehealth along for years and suddenly from a business and regulatory point of view, it was all possible. With the regulation changes, providers were able to use a wide array of video chat apps to conduct patient encounters, such as FaceTime or Facebook Messenger.

Mr. Summers and I did a very quick assessment, and there were some on the list that were specifically healthcare certified and better built for telehealth. Zoom and Doxy.me were both on the list. I really liked Doxy.me because of how light weight and intuitive it is. If you can click on a link and you can put your name in, in most cases you're up and running and talking to somebody. 

Kelly Summers: That was one of our paramount decisions. One of the criteria that we had was something that could be deployed with a very small footprint. We purposely chose something that we could stand up very quickly and was very intuitive, to Dr. Dunnigan's point. We made the conscious decision to not pursue tight integration within our EMR. We wanted to facilitate the virtual visit, understanding that we weren't going to use that piece of the application for clinical documentation. We have our Epic EMR for that. I think that was really one of our pivotal reasons for this acceleration was that we quickly took a solution that was very lightweight. We initially used the free version of it to kind of dip our toe in the water, and we then purchased the enterprise version of it, which allowed us to do some branding with it and things like that.

Q: Valleywise Health went from zero visits to 14,000 telehealth visits in a seven-week time frame. How were you able to accelerate the adoption curve? 

KS: Let's be candid. There's two pieces to it. The first is to ensure that we're able to engage with our patient population. We've got folks that need clinical care. How can we do it? How do we keep well people from coming into the hospital if we can avoid that? The answer is by doing a telemedicine visit or other virtual care. All of that is focused on the patient. But then also, in that same timeline with that curve we're now at about $13 million of gross billable charges, which, again, helps us recoup some lost revenue.

AD: The other key piece when you look at that crazy adoption curve is we didn't really end up touching the Epic experience at all. Mr. Summers mentioned our point of decision not to stress about integration, so essentially, if you picture a provider, they're interacting via the video platform. Then they've got a second screen on Epic, and their Epic world is business as usual. They're using their same note templates. They're doing their same documentation. The coding and billing pieces are the same, and it is because of the video experience and how to facilitate that connection with the patient. We literally got this in people's hands and by the end of the day they were doing 30 percent to 40 percent of their visits virtually.

Q: What has the provider adoption process been like?

KS: It's one thing that the technology works, but then it's also about the adoption of the providers and their ease of use and experience as well as the experience of the patients. We solicited all our providers to survey, and the data is showing that about 80 percent are having an above average or outstanding experience using the solution. In my experience having been deploying IT solutions for a number of years, those are pretty phenomenal acceptance numbers. Further, we asked the question: 'Post COVID-19, would you still want to use telehealth for care?' Eighty-six percent of our providers said yes.

Patients also expressed similar levels of support for telehealth. Looking at both the provider and the consumer, when you're well above 80 percent to 90 percent satisfaction that shows you have a pretty good solution and process. As the technology guy, it's all about people, process and technology. We got the technology right, but what Dr. Dunnigan has done with his colleagues has gotten the process right, or how we engage the patient.

Q: What are your thoughts for telehealth in the post-pandemic world?  

AD: Virtual care is here to stay. I think the ability to do full visits over the telephone will probably go away, but we will have interactive audio and video chat visits going forward. Our patients expect that we'll have it and our providers certainly aren't going to let it go. They've become very much experts at this. I think Mr. Summers and I look for the next three to six months that we'll still be in a somewhat tactical place. We're working through that cultural journey. I think we know that the day of an ambulatory provider probably never looks the same again. You're going to have some in-person business, you're going to have a pretty big book of virtual business, and then there are other components like helping care coordinators and other population health elements that equate to kind of a new day.

Q: What do you think is in store for telehealth and HIPAA regulations after the pandemic? Do you think CMS will keep these relaxed?

KS: I think physicians are going to refer to this idea that "the genie is not going back into the bottle entirely." Pre-pandemic, telehealth was already there. There was already CPT codes and regulations that allowed for telehealth. There was some loosening of the regulations as it relates to 'HIPAA compliant tools'. I don't think there will be a ton of restructuring with that. If you really want to look in the macro of how do we start to take cost out of healthcare, and how do you increase the quality of healthcare? If we talk about triple or quadruple aim, I think what we're going to end up having here for the next three months is this very specific empirical data set that says, 'Have we been able to improve healthcare?' I think that's going to be in the affirmative. 'Have we been able to see as an industry how to do it in a more cost effective manner?' I think that's also going to be in the affirmative. That will be the pressure point for CMS to look at and say 'how do we tailor this appropriately within the regulations to continue to encourage the use of telehealth in a clinically appropriate HIPAA-compliant way?' Those are the factors we don't want to compromise on, of course, but I don't see us going back and I think the government is going to see it the same way.

AD: I think that's spot on. We will certainly have a virtual visit element to chronic care coordination. We've been moving in this direction for years, toward value-based care and population health care coordination. Telehealth helps push us farther down that road, and virtual tools help enhance that. Now suddenly we're conducting virtual visits with the ability to have a blood pressure cuff in the home or a scale. Bringing digital devices into the home in ways that flow into the EMR, that becomes glaringly obvious.

We've been able to connect some dots very quickly that we had been trying to connect for literally years. When I try and look in the crystal ball for what CMS is going to do, and our state Medicaid and the carriers, this is going to lead to high quality, less expensive care because they don't require the same heavy weight inputs and visitation that we had to do without all these things in play. But I think it is win-win. I have a very glass-half-full outlook on the future. 

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