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Are Patient Satisfaction and Outcomes Better with Telehealth?-The HSB Blog 3/29/21

Our Take: Increased adoption of telehealth will improve patient satisfaction and outcomes. Telehealth has become a core part of the healthcare system in the U.S. following a dramatic increase in use during the pandemic. Providers and payers have implemented new platforms into their care delivery systems to more directly cater to patients’ needs. The combination of a number of these tools all of which encourage flexibility and patient engagement, including 1) Home-based diagnostic tools, 2) Digital self-service tools, and 3) Wearable healthcare devices leading to better health outcomes, reductions in no-show rates, and improved patient satisfaction. While the pandemic may have been the catalyst, the trend towards incorporating telehealth into care delivery plans will continue forcing providers to work towards better delivery of services through a digital medium to create a more user-friendly and customer satisfying experience.

Description: As a result of the pandemic, digital health has proven to be a convenient means to receive proper care in a timely manner. Prior to the pandemic, only a small minority of patients routinely utilized digital health tools to track their health conditions or visit doctors. While the adoption of digital health was slowly advancing and was recognized as having great potential for the delivery of care, it hadn’t caught up to speed. COVID fast-tracked the whole dimension in the use of technology in healthcare. Consequently, more than ever with the incorporation of digital tools and patient/provider acceptance, technology has become a crucial part of the healthcare delivery system. Along with increasing use and increased choice in offerings has come improved patient satisfaction. For example, according to the J.D. Power 2020 U.S. Telehealth Satisfaction Study, overall patient satisfaction score across all telehealth providers came in at 860 on a 1000-point scale. This was the highest patient satisfaction score for a healthcare service study ever done. According to Symphony Performance Health Analytics (SPH), 70% of patients preferred virtual visits over in-person visits to save time. Similarly, according to a study entitled “Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic”, the convenience of telehealth services reduced caregiver burden for a certain patient demographic and saved travel time and cost as well. They reported, “telehealth is not only advantageous for patient satisfaction but also for increasing the efficiency of healthcare resources by significantly reducing patient no-show rates.” The study demonstrated a 7.5% no-show rate for telehealth visits as compared to the in-person no-show rate of 29.8%. The Cleveland Clinic is also conducting a study to compare no-shows among in-person visits and virtual visit appointments. While the study is ongoing, based on Cleveland Clinic’s historical experience, the hypothesis estimated a 76% in-person no-show rate and 51% for virtual visits. The assumption is that no-shows are due to poor engagement, inconvenience, and difficulty of getting to appointments. Health systems and clinician practices consistently report lower no-show rates with telehealth, especially in behavioral care where telehealth removes the stigma of visiting a behavioral clinic. For example, the baseline no-show rate for psychiatry services is between 19 and 22 percent of appointments – while MDLive reports no-show rates of only 4.4-7.26 percent for its behavioral health telehealth visits.

Implications: Telehealth uses technology to provide convenient, high-quality care and patient access, which ultimately leads to improved patient satisfaction and outcomes. As many of the healthcare systems rolled out broader telehealth services they acknowledged their patients easily adopted telehealth as they didn’t have to deal with transportation issues, take time off work or find childcare in order to make it to their appointments. While this required additional investment in technology and services to cater to patients’ needs, it also led to a decrease in no-show rates, long a challenge for the industry. Nevertheless, while improvements have been made, patients also reported varying degrees of satisfaction with their healthcare payers, many of which provided telehealth services through their health plan benefits. For example, Cigna was the top-ranked payer-provided telehealth service, receiving a patient satisfaction score of 874, with the Kaiser Foundation Health Plan getting a score of 867, ranking second, while UnitedHealthcare ranked third, with a score of 865 out of 1,000. However, though telehealth convenience has been acknowledged there are barriers that need to be addressed. There are still limited services, technology requirements are confusing as some patients are not as technologically-savvy, and issues remain with broadband availability. Enhancement and expansion of telehealth will further improve health outcomes as well as satisfaction but that will depend on policymakers, governments, and perhaps public-private partnerships to make broadband access more equitable and available. In-person care has been leading to an increasing number of missed appointments which ultimately decrease care plan compliance and lead to more expensive care needs. However, telehealth has shown offsetting effects on no-show rates along with better care plan adherence which has contributed to downstream cost savings likely mitigating some of the incremental costs. In addition, digital tools such as telehealth, remote patient monitoring, and virtual care could likely aid in reducing costs for patients requiring costly long-term chronic care, which can be done in the comfort of the home, For example, in diabetes care management, routine visits can help prevent long-term costly effects, yet patients often end up missing their monthly/3monthly check-ups due to inconvenience- this ultimately hampers their health leading to a rise in the cost of care and additional potential complications.. As policymakers evaluate the proper guidelines for telehealth, and with oversight bodies such as MedPAC saying they want to take 1-2 years’ time evaluating telehealth’s impact on outcomes before changing regulations, it is imperative that indirect costs such as these be considered in the equation. In addition, NCQA also reported the need to consider telehealth’s impact on no-show rates. If we truly want to move to a value-based paradigm, telehealth must not be viewed just as a replacement for episodic in-person visits, a key element in a model of continuous care given its ability to make delivery more convenient and easily accessible with more frequent but shorter encounters. This model provides many more opportunities for early testing, diagnosis and intervention for the health of the patient. Telehealth should further aim to improve the quality of healthcare, with special attention to overcoming existing barriers in access to care, including the burden of time and financial costs that patients and families bear in non-medical costs such as lost work, wages and the need for family caregivers associated with traditional in-person visits.

Patient Satisfaction with Telehealth High Following COVID-19; Findings and Recommendations: Telehealth Effect on Total Cost of Care; Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic

How Can Hospitals Prepare for the Hospital at Home?

Event: Healthcare IT News recently interviewed Tom Kiesau, Director and leader at Chartis Group, a healthcare advisory and analytics firm. Kiesau discussed the importance of identifying the right patient populations that stand the most benefit from acute care remote patient monitoring as organizations move toward expanded use of the hospital at home in the near future. The article emphasized that more hospitals and health systems are pushing to expand remote patient monitoring programs – up to and including the provision of acute care at home.

Description: The hospital at home is a clear pathway for parity reimbursement during public health emergencies, and it is here to stay. On the contrary, many questions remain as regulations and reimbursement mechanisms are unpredictable as momentum builds behind the concept of hospital at home. Amazon has teamed up with blue-chip health systems such as Ascension and Intermountain for the new Moving Health Home collaborative, whose goal is to "change the way policymakers think about the home as a site of clinical service." The group plans to lobby policymakers to broaden coverage for care services in the home, which include expansion of the Centers for Medicare and Medicaid Services' Hospital Without Walls provisions – advocate for bundled-payment models, home-based care, and more. Based on this goal, Kiesau implied that health systems should be prioritizing their investments in patient-facing tools and technologies, command centers, delivery services, administrative support, IT infrastructure, and more. He also explained that the hospital of the home bears many benefits such as lower costs, reduced readmissions, and may be a better replacement for acute care. Yet, a paradox exists because clinical populations must be identified that are deemed appropriate for remote services. Once this is resolved, thought must be given to what unique tools are needed to service these populations, the financial implications, and economic viability. Understanding the population that one intends to serve involves looking at the data you will target and how the hospital at home would impact them. Many organizations figure that a hospital at home model will provide a better experience with increased positive outcomes and reduced readmission rates. The interview also addressed considerations that should be given if unforeseen problems occur, such as unreliable internet connection or how someone would get into a patient's home if there is a medical emergency.

Implications: According to the study, Telehealth: A Technology-Based Weapon in the War Against the Coronavirus (2020), researchers predicted that the pandemic would continue to reshape care delivery and provide major opportunities for virtual care. Researchers were right because the COVID pandemic prompted an enormous uptick in virtual care use from patients and providers. Telehealth, remote patient monitoring, digital therapeutics, provider home visits, and shareable medical records have "shown that care in the home can be at least equivalent to, if not better than the care offered in facilities." The “hospital at home” will provide flexibility to patients and providers alike by offering remote support through a digital infrastructure that will take the place of major health institutions. As discussed in the interview, the hospital at home will lead to better patient experiences and clinical outcomes by providing convenient and cost-effective access to patients seeking care. The CMS estimates that home health care in Medicare will save at least $378 million a year in just the nine states that are part of the Home Health Value-Based Purchasing. Additionally, research shows that home-based care is likely to reduce hospital readmissions by about 25% within 30 days of discharge. This new transformation of healthcare at home makes it possible for clinicians to observe, report, and analyze patients' acute or chronic conditions, no matter their location and in real-time.

Leveraging Real-World Data in Cross-Sector Partnerships

Event: A recent article in MobiHealthNews highlighted presentations from the HIMSS’ Accelerate Health event. During the event, Christopher Boone, VP and Global Head of Health Economics and Research Outcomes of Abbvie shared his game plan for how stakeholders can use big data. According to Boone, big data can be used to further the quality, safety, and effectiveness of drug therapies in a post-pandemic environment. He suggested leveraging as many lessons as possible from his pandemic experience to institutionalize them in the health system.

Description: During the event, Boone explained that big data can be used to reimagine clinical discovery, clinical development, and commercialize drug therapies. Using real-world data gathered outside of the clinical trial setting and used across the life cycle of drug development must be expanded in order to achieve this. This kind of data will be used to determine the feasibility of clinical trials, recruit participants, inform regulatory safety decisions, lead commercialization and customer support programs. It is essential to have this data to understand the benefits and risks of all drug therapies and think about what precision health looks like from a cross-sector partnership perspective. Boone added three strategic steps that can be taken to achieve quality, safety, and effectiveness of therapies include: 1) Establish a shared vision and agenda for clinical practice and development focused on the issues of all communities, specially those facing health disparities; 2) Develop a joint plan of action that addresses systemic racism, inequalities, social determinants and diversity; and, 3) Invest in foundational data analytic capabilities such as curation, tagging, linking and searching to allow for public health surveillance.

Implications: As the world begins to move towards the end of the pandemic, stakeholders are strategizing on how to use the lessons learned and apply them to a post-pandemic environment. As noted in the article, it is essential to understand the needs of individuals based on trust and transparency. In addition, siloed sectors of the industry need to form new models of collaboration. New cross-sector relationships among pharmaceutical companies and provider organizations will provide many opportunities for both sides and patients. As part of the transition to value-based care, pharmaceutical companies can demonstrate their therapies' effectiveness while giving providers the benefit of optimizing treatment for better outcomes and allowing them to achieve their value-based goals. The three strategies outlined above will facilitate faster, better, and cheaper clinical discovery and development efforts of drug therapies. These strategies suggest how partnerships can continue to be created and sustained, overcome hurdles, and build trust between two entities, which is key to success.

Drones That Can Make Telehealth House Calls

Event: On March 19th, mHealthIntelligence reported that researchers at the University of Cincinnati are creating a drone with the ability to make telehealth house calls. With the emergence of the COVID pandemic causing the increased need for telehealth care delivery, the creation of this tool is vital to improve patient’s accessibility to healthcare resources and to ensure that those with life threatening or chronic illnesses are still receiving care while still social distancing and avoiding potential exposure to the Coronavirus.

Description: The drone has several features and capabilities that will greatly aid users with telehealth needs. According to the article, it includes an audio-visual telemedicine platform along with a waterproof compartment for carrying medical supplies and sample tests. With its small design, it can effectively maneuver into and around a patient’s home to bring patients their essentials. Researchers are also not limiting the drone’s capabilities to inside homes and medical facilities but are also exploring its ability to deliver medications, supplies, and labs to the country’s most secluded regions. This will enable clinicians to conduct many different functions including chronic disease management, post-operative care monitoring, health coaching, and consultations. Additionally, the drone may have applications where living conditions need to be assessed and even deliver interventions in special cases when a patient may be unable to contact anyone. This is pivotal in the case of the elderly or disabled patients, who live alone, especially during the pandemic.

Implications: While the drone is still exploratory, adoption of it and other devices like it can help fill a void for patients with a lack of access to healthcare resources. For example, such devices could be used in rural areas to provide services to those who routinely cannot access care due to limited access in transportation. Devices like the drone are very timely in that many people continue to test positive for COVID and still need medications and everyday resources while remaining in quarantine. This is especially true in rural areas, where people already face issues of limited access to physicians and healthcare facilities, grocery stores, and other essentials. This drone could easily be coupled with telehealth systems, to help fight health inequality and help reduce other negative factors associated with the social determinants of health.

UnitedHealthcare Launches Virtual Hearing Aid Program

Event: On March 18th, UnitedHealthcare unveiled a new virtual care option called Right2You. The program expands access to custom-programmed hearing aids that will potentially reduce the need for in person appointments for fittings or adjustments. The introduction of this product will provide greater convenience and affordability for eligible hearing impaired UnitedHealthcare members, addressing any disparities patients may face with traditional models which typically require an in-person visit to an audiologists office.

Description: The introduction of the Right2You hearing device is based on UnitedHealthcare’s already established home delivered hearing healthcare model. The device adds a virtual care component that is designed to reduce the need for in-person appointments for hearing aid adjustments and support. According to the article, eligible patients can take an online hearing test to determine what their current hearing status is and if the tests indicated potential hearing loss, the patient could obtain the results of the audiogram from an in-person appointment with an UnitedHealthcare Hearing audiologist or another credentialed hearing healthcare provider. Custom-programmed hearing aids are then shipped directly to the person’s home. According to UnitedHealthcare, the program allows further customization remotely with a smartphone or tablet paired to the hearing aids instead of through an in-person appointment. They can then have the custom hearing aids sent to their homes. For those who don’t wish to take advantage of the online model, the program also allows the option for patients to see an audiologist from United’s large network or credentialed audiologist and hearing professionals.

Implications: As a result of the pandemic, hearing aid sales have declined significantly as patients who are at risk seek to avoid exposure to COVID. This is a major issue since there are more than 48 million Americans with hearing loss and a number of viable solutions exist to improve the quality of their lives. This virtual care option removes the barriers to care that have developed because of the pandemic, enabling people to conveniently receive treatment while minimizing exposure to COVID through this virtual platform. Hearing significantly impacts overall well-being, therefore, improving the cost and access to hearing health treatment and hearing aids will help to improve overall health outcomes.


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