Whether in rural Alaska or in an urban city, a telehealth program has the ability to add value to the way healthcare...
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organizations deliver care. Massachusetts General Hospital, a hospital and accountable care organization in Boston, has learned this first hand.
Mass General began its telehealth program in 2011. Since then, they have conducted more than 10,000 virtual visits across 12 different specialties, have seen a 10% reduction in re-admissions and outpatient appointments, and have noticed a 20% reduction in overall transportation costs for patients at Spaulding Rehabilitation Hospital in Boston, Sarah Sossong, director of telehealth at Massachusetts General Hospital, said during a presentation at the mHealth + Telehealth World Congress conference in Boston.
While the results of implementing a telehealth program have been positive for Mass General, creating and building such a program can be a challenge. Sossong and Marcy Simoni, senior program manager of telehealth at Massachusetts General Hospital, discussed the four tenets of success for building a telehealth program: identifying the target patient population, setting a goal, engaging stakeholders and partnering with other departments.
Identify the target patient population
Sossong explained that when evaluating which patients would be a good fit for telehealth, one criteria is departments with patients who visit frequently.
Sarah Sossongdirector of telehealth at Massachusetts General Hospital
For example, psychiatric patients or pediatric weight management patients participating in the hospital's cardiac care program usually visit the hospital or their doctor often.
"These patients are coming in monthly for visits with a multidisciplinary care team, and so that's also been a really good fit for patients," Sossong explained.
Another consideration when targeting patients is how often they use certain technologies -- such as mobile phones and tablets -- in their daily lives. However, Sossong said Mass General has patients ranging from early childhood to patients in their 80s using telehealth technologies with no problems.
Have a goal in mind
Sossong and her team spoke with a hand surgeon who was excited about using telehealth technologies, "but he wasn't really exactly sure why it was he wanted to do it," Sossong said. "If there's not a goal for why you're doing this, then it's not likely to be successful, and certainly won't be successful in helping achieve the goals for an accountable care program."
It's important to pinpoint exactly why telehealth technologies would be beneficial in a certain department within the hospital or health system. For example, in the emergency department, there is a need to better manage admissions and transfers to critical care floors or the post-acute rehab facility. Sossong believes telehealth is helping them to better manage these tasks and to eliminate unnecessary admissions.
"It's allowing us to get patients out of the ICU space sooner than we would have if we had not had [telehealth]," she said. Furthermore, "in the post-acute space … we've been able to provide additional specialist expertise, burns, ortho, plastics, urology are just a few examples, via these virtual visits."
Engage patients, providers and support staff
Engagement is crucial to the success of a telehealth program, Simoni said. And there are three stakeholders that need to be considered.
Patient feedback is key to improving a telehealth program, Simoni said, and so far, receiving patient feedback has helped Mass General modify staffing models and discover that patients are willing to pay for virtual visits.
"Through patient data and sometimes surveys, we saw that most patients would be willing to pay for virtual visits. So about a little over a year ago, we rolled out a fee for virtual visits to help demonstrate the value of the service to commercial payers," Simoni said. "This is just another helpful way that feedback has directly informed changes that we made in our program."
The telehealth team has also been working with Mass General's Patient and Family Advisory Council to get continuous, real-time patient feedback.
With all the competing demands that providers face today, provider engagement can be a challenge, Simoni said.
"Among other things, our telehealth program has been competing with things like our recent Epic implementation," she said. "So growing and maintaining provider adoption has been a big focus for us the past year."
The team has been focusing on making the experience more seamless for providers by ensuring they have support and feel comfortable and prepared for virtual visits. One way they are doing this is with test calls where the telehealth team will check in with a provider before a virtual call is made.
The telehealth team is also working to ensure providers understand the benefits of telehealth by providing them with hard numbers. Furthermore, the team is asking providers to do a minimum of five virtual visits to not only help them feel more comfortable with the technology, but also to re-set expectations.
"Department coordinators are really the gatekeepers to the patient scheduling process," Simoni said. "So after a provider introduces a program to patients, if the coordinators aren't on board and aren't aware what to do next, we realized patients were never making it into the schedule."
Therefore, the team has rolled out patient services coordinator training to help support staff and coordinators understand what telehealth is and what the process will be like. They've also started an incentive program where, for every five patients enrolled, the support staff will receive $100.
Partner with other departments
"Going in together with other programs and initiatives just increases our likelihood for success," Simoni said. "We often go in [with the population health management group] and introduce our programs jointly because many of our clinical health departments have population goals they need to achieve anyway with being part of an accountable care organization."
The telehealth team can then help departments explore how telehealth technologies can help meet certain population health metrics.
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