Transitioning from episodic to relationship-based care using telehealth

More than 40% of medical groups stated they are or are planning to offer telehealth services this year, while another 20% had not yet decided, according to a Jan. 9 MGMA Stat poll. With telehealth adopters seemingly on pace to become the majority, many groups are considering how to evolve their telehealth services beyond episodic online visits.

The next step in the telehealth journey is to forge a relationship with patients through consistent home-based communication and interaction. Web conferencing, in addition to automated text messages, educational videos, surveys and other motivational techniques delivered through a mobile device, allows groups to increase patient engagement and improve treatment plan adherence to two key populations: post-discharge and chronic disease patients.

Both populations can increase costs while potentially driving down reimbursement under value-based payment models. By utilizing web conferencing integrated with other communication and engagement tools such as telehealth services that reach patients in their homes, groups can take control of population health management.

Solving care transition and chronic disease challenges

Although avoidable hospital readmission rates among Medicare beneficiaries decreased about 8% from 2010 to 2015, they still constitute a major cost burden at $17 billion a year, according to the Centers for Medicare & Medicaid Services.

This cost burden further demonstrates the need for better communication and engagement between patients and providers following treatment. Unfortunately, it is typically office-based physicians, not the hospital-based ones, who bear the responsibility of helping prevent readmissions by providing prompt post-discharge appointments and ensuring that patients understand and adhere to hospital physicians’ treatment plans.

Chronic disease is another major cost challenge for the industry, estimated to grow to $42 trillion in medical costs and lost productivity between 2016 and 2030.

Again, medical groups’ primary care and specialty physicians are charged with helping these patients adhere to their medication, diet and therapeutic plans to prevent adverse events that can lead to a hospital stay.

However, educating and monitoring post-discharge and chronic disease patients can be costly because practices must:

• Add staff to coordinate care among different providers
• Increase staffing in call centers to remind patients of appointments and follow-ups
• Schedule additional nurse home visits to help patients understand instructions and overcome adherence obstacles
• Offer additional in-office visits, which increases the risk of missed appointments or late arrivals
• Update and distribute paper-based educational materials

Instead of time- and cost-intensive phone calls, in-person home visits and office appointments, medical groups can improve care transition and chronic disease management through existing telehealth platforms combined with automated, personalized and interactive mobile text and video communication.

Taking the next steps for safer discharge

Here’s a common care-transition scenario that telehealth and modern mobile device-based communication can help remedy: A cardiac care patient misplaces a stack of paper instructions and education booklets given at discharge to help manage her procedure recovery as well as a newly diagnosed chronic condition.

An updated scenario would involve the patient receiving targeted information and instructions via her smartphone. She would also participate in a survey so she can receive the most relevant resources and bookmark them for later access. The next day, instead of sending a nurse or other ancillary care specialist to her home to follow up or asking the patient to travel to the practice, the patient would have an online appointment to go over instructions and ask questions. Consultations with physician specialists, if relevant, could also be conducted online.

The following day, the patient would receive a text with a link to a survey about how she is healing from the procedure. She might indicate she is worried about the bruising around the wound. A nurse would then contact her through secure chat or a web conferencing visit, sending her a link to a video on bruising and answering all her questions in real time.

Establishing a relationship for chronic disease management

While the previous example applies to post-discharge, the same types of protocols could be followed for patients with chronic diseases. For example, a health status check could be conducted periodically through text messages where patients would indicate how they are feeling on a 1-to-5 scale. Depending on responses, a web conferencing visit could be arranged with a nurse, or a behavioral health specialist if the chief complaint is mental health related.

The key for chronic disease maintenance support through telehealth is to forge a relationship in two ways:

1. Telehealth encounters for real-time human interaction
2. Mobile-based electronic text and video reminders, communication and motivational support to help build trust, credibility and reciprocity

Combined with the web conferencing visits, patients receive personalized, step-by-step directives, which can simplify complex clinical protocols into digestible bites of information that are easy to follow and are actionable. This consistent support empowers patients to be actively involved in their recovery and chronic-condition management improvement.

In addition, clinical content specific to their recovery or condition would be coupled with health, wellness and lifestyle tips and ideas. This information can be applied to patients' daily lives, keeping them engaged and motivated to improve their disease management.

Making telehealth the new normal

The benefits of telehealth extend beyond increasing appointment volume or offering a convenient service to time-pressed patients. Rather, virtual visits through web conferencing are ideally integrated with mobile device-based interactions and information delivered strategically to patients at home.

The result of combining these advanced population health management tools can be greater engagement and treatment plan adherence and support for the in-person care that are still so crucial for both recovery and chronic disease management. Through stronger engagement, medical groups can improve outcomes and help lower the overall cost of care to increase reimbursement under value-based care payment models.