MAVEN Project CEO Links Telehealth Consults to Value-Based Care

Telehealth’s greatest gift to healthcare may be that it can connect the caregiver to the patient who, without access to that care, would die. And that’s a real concern for the 100 million Americans who are either uninsured or living on Medicaid, and who have a life expectancy 20 years shorter than those who can afford to access the care they need.

At Xtelligent Healthcare Media’s Value Based Care Summit this past October in Boston, Lisa Bard Levine connected the dots between value-based care and telehealth – more specifically, the MAVEN Project, a telehealth program that connects specialists around the country with physicians treating underserved populations. Without access to these specialists, these physicians working in federally qualified health centers and community health clinics wouldn’t have the resources they need to properly care for their patients.

This, in turn, takes a toll on the physicians.

“The MAVEN Project really focuses on the underserved populations around the country,” she said, (and) telehealth, I believe, is really ideally suited to support and provide needed and necessary resources to under-resourced and underserved clinics, providers and patients.”

“You can bring resources where they are needed most,” she added. “It can be cost-efficient and cost-effective. You can distribute supply to where the demand exists and you can extend your reach where you can reach ordinarily. And this, in my opinion, creates value for all parties involved.”

Launched in 2014 by Dr. Laurie Green, then president of the Harvard Medical School Alumni Association, the MAVEN (Medical Alumni Volunteer Expert Network) Project creates a network of volunteer doctors – many but not all retired – who use telehealth to connect with and counsel physicians working with underserved populations. The network now extends to roughly 90 clinic sites in nine states.

“Our goal is to engage highly qualified doctors that volunteer their time and expertise and to support the primary care provider working in community health centers around this country, serving our nation's most vulnerable,” said Levine, the non-profit organization’s CEO.

“We have physicians that are recently retired, working part-time, and want to volunteer, might be in full-time practice and want to volunteer, or have an active license and have gone into industry,” she added. “They look to join us as a meaningful way to give back, a way to flex the muscles that they have developed their whole career. That's flexible, so they can do it wherever they are, whenever they want. We do have volunteers who have traveled internationally and have found that they still keep their appointments as scheduled. They just load up their computer in their hotel room and they are connected with primary care providers around the country while they are on vacation.”

The network currently boasts 42 clinical specialties, and offers three services:

• clinical consults, during which the volunteer specialist helps a physician with a particularly vexing case in an online session that can last from two minutes to an hour;
• educational sessions, designed to help front-line physicians and clinics increase their clinical knowledge so that they can treat more of their own patients; and
• clinical mentoring, in which volunteers and paired with front-line primary care providers for one-on-one sessions on everything from balancing work and home life to switching from the electronic health record to the patient sitting in their exam room to managing and retaining staff at time when turnover and staff shortages are rampant.

“We think about our solution as aligning with the quadruple aim of improving health outcomes, avoiding costs, providing satisfaction of resources to the care team and to the front line providers, and also satisfaction to the patients,” Levine said. “If you can avoid an unnecessary visit to A: the hospital or the emergency room or B: a specialist where you don't need to go, you don't need to get transportation, time off from work, child care for your kid, pay out of pocket - let's do that. It's better for you and it's better for your family.”

And that’s where the “value” of value-based care is defined: the services offered by the MAVEN Project not only lead to better care for the patient, but to a better work environment for the physician, which in turn improves productivity and reduces stress and burnout.

Levine said surveys conducted after the clinical consults find that roughly 43 percent of the consults re-affirm what the physician would have done, so the physician is getting support in the knowledge that he or she is following the right course of action. More importantly about 75 percent to 82 percent of the consults give those physicians advice or information that they otherwise wouldn’t have considered, giving them added knowledge for future cases.

That knowledge, meanwhile, is spread forward in what Levine called “the multiplier effect.” In other words, a physician receiving guidance on, for instance, diabetes care will use that knowledge not only that one patient, but all other patients living with diabetes under his or her care.

This type of education also allows the physician to treat the patient himself or herself and avoid an unnecessary referral, which would waste both the patient’s and the specialist’s time. And for those cases that require a referral, the patient, specialist and payer will all benefit from knowing that the specific case does indeed merit a specialist’s time and isn’t a wasted experience.

One type of consult the MAVEN Project won’t handle is doctor-to-patient consults. Levine said the organization considered that interaction at first, but found that it involved too much time and effort to coordinate between the primary care provider, the specialist and the patient. That’s time taken away from the PCP which could be used seeing other patients.

In addition, doctor-to-patient consults run into licensing and credentialing issues, and those rules vary by state.

“When you take the model to provider-to-provider, daily operations are only limited by the PCP’s capacity,” she said. “We find that the conversations are more time-efficient and effective, and through the peer-to-peer nature we are able to use doctors across state lines. So a Massachusetts doctor can be accessed in California for advice or education around these cases.”

Finally, there’s the question of documenting the consult into the medical record. Levine said PCPs often choose to integrate the guidance they receive into their own decision-making, perhaps noting that they consulted with the MAVEN Project.

“This used to be called curbside consult in the hallways of the hospital ward,” she noted.

Going forward, Levine said she’s looking to expand the network even further, adding new sites and specialties.

“We're looking to have folks join us,” she said. “We are also looking to add more clinics in need, (and) certainly physician volunteers. Some of the areas in greatest need are, not surprising because you probably all have need for this, dermatology and addiction medicine. We're looking to expand core and financial support. We are looking to get the funding to help us grow.”