Think Tank Insights: Telehealth, Remote Care, And Delivering The Hospital At-Home Experience

The benefits of telehealth and RPM have been known for years – particularly as they pertain to vulnerable populations – but it took the unprecedented disruption of COVID-19 to accelerate their embrace.

Now, many Providers are taking the additional steps necessary to integrate these elements with core clinical operations. This Session explored how Connex Members are utilizing virtual care delivery, and its many challenges.

Telehealth trends and digital care applications

• The trend for most Attendees was that telehealth usage spiked during the lockdowns, but has since fallen off and plateaued. That said, the plateau is often significantly higher than pre-COVID levels.
• Behavioral health has thrived within the telehealth model, with several Attendees remarking that nearly 100% of those volumes have remained virtual - and likely will continue to be virtual.
• The use of monitoring and televisit technology is rapidly evolving, with several Attendees remarking they’re using it as part of hospital-athome programs in concert with at-home visits. This also helps decrease length of stay (LoS) and increase throughput as low acuity patients can be expedited to at-home care.
• One Member remarked that they’re using telesitters to broaden sitting capacity within their system.
• Teleconsults have become common, not only in cases where the specialist is off-site, but in instances where they may be located on the opposite end of the medical complex from units like the ED.
• One Attendee mentioned televisits have been integrated into their mobile stroke unit, which along with an in-ambulance CAT scanner, enables radiology teams to act before the patient arrives in the ED.
  
  

Diagnosing the data

Attendees had not yet conducted full, thorough reviews of their recent telehealth data to draw hard and fast lines between usage, costs, and outcomes. However, several improvements were observed:

• There’s an observed improvement in care access, as it’s easier for patients to proactively meet with their physicians, especially in cases of chronic care or when patients have limited mobility.
• Telehealth has also excelled at moving ‘treat and street’ patients out of the ED, improving throughput and decreasing unnecessary volumes.
• Televisits are reported as an excellent way to prep and follow-up with patients undergoing surgery; patient satisfaction in those cases was elevated as patients felt more supported.
• While telehealth can make it easier for chronic care patients to manage their conditions, this has coincided with an increase in patient acuity by the time they’re asked to go in physically.
• Telehealth acted as a patient portal catalyst for many individuals, as well as a catalyst for adult children to become more proactively engaged in their elderly parents’ health.
• One Attendee shared how televisits made it easier for incoming residents to hone their patient observation skills, as they’re more closely focusing on facial cues on a video call than they are in person.
  
  

Helping those in need

• Several Members from California-based institutions explained that statewide CalAIM initiatives are mandating extensive collaboration with community business partners to address social determinants and better care for patients by increasing care access; telehealth will play a key role.
• Additionally, one Attendee explained they’re partnering with community resources and shelters to establish telehealth kiosks that are accessible to the unhoused.
• Another mentioned they’re working with law enforcement to ensure first responders have telehealth access to specialists and other providers when responding to crises.

While digital care delivery has explosive potential to help bring healthcare into the future, its barriers to success are surprisingly analogue. Digital tools can help stretch capacity, but Attendees almost universally expressed that staffing shortages have made it difficult to scale, or in the case of behavioral health, match demand. Others explained that some of the most in-need communities – such as undocumented migrants – are heavily resistant to digital programs out of fear of leaving an identifiable trail that could be used against them. Non-English speakers may also struggle to feel comfortable seeking care, as it would mean involving and recounting personal treatment details to a family member or other translator. Even running the programs themselves can be a hurdle, as employees with the technical skills to support patients and liaise with physicians may not have the medical acumen needed to comprehensively prepare involved care teams. While there’s no silver bullet for rectifying these challenges, investing the time, resources, and executive focus into overcoming them could help entrepreneurial Providers carve out a competitive niche in their market, much to their patients’ benefit.