Telehealth Navigator Program Boosts Video Visit Attendance, Financial Return

Implementing a telehealth navigator program helped improve video visit attendance, providing clinics with a positive financial return, according to a new study published in JAMA Network Open.

The COVID-19 pandemic dramatically drove up the use of telehealth. Like many other healthcare provider organizations, Boston-based Beth Israel Deaconess Medical Center implemented and scaled telehealth visits. But they found that technical issues could hamper video visits, prompting some video visits to be converted into audio-only visits via the telephone, according to the study authors.

The medical center implemented a patient navigator pilot program to reduce barriers to video visit attendance. Through the program, a patient navigator contacted patients one day before their video visit appointment to provide technical support. The navigator went through the steps required for the patient to connect to their visit and addressed frequently asked questions.

The 12-week pilot was conducted between April 19 and July 9, 2021, in Beth Israel Deaconess Medical Center's primary care and gerontology clinics. Researchers assessed video appointments for 4,066 adult patients with a known visit outcome. Of these, 1,035 (25.5 percent) connected with the patient navigator before their appointment. The control group consisted of 3,033 patients (74.6 percent) that the navigator did not attempt to reach.

Researchers found that 91.6 percent of patients who connected with the patient navigator successfully attended their appointment compared with 82.8 percent of patients in the control group.

About 6 percent of patients in the navigation group canceled their appointment versus 9.2 percent in the control group. Further, 2.5 percent of navigation group patients missed their appointment compared with 8 percent of those in the control group.

Without the support of the patient navigator, 29 percent of patients in the intervention group were projected to have unsuccessful video visits, according to the study. The intervention group experienced a 21 percent absolute increase in video visit success rate compared with the control group, resulting in 217 additional video visits.

In addition, the missed appointment and cancellation rate for the group that connected with the patient navigator was 8 percentage points lower than the control group, resulting in 83 more visits.

The 300 additional visits yielded $29,265 in relative value unit (RVU) reimbursement. After taking into account the quarterly patient navigator salary of $17.878, the estimated return on investment of the navigator program "was actualized at $11,387 over 12 weeks for the institutional payer-mix," according to the study.

"Implementing a Telehealth Patient Navigator may be a high-value proposition for health care systems, as it uniquely benefits patients and clinicians while being cost-effective and yielding a positive net return on investment," the researchers concluded.

Other health systems have also seen success with telehealth support programs. An initiative developed by the Permanente Medical Group to support video-based telehealth included 'virtual rooming,' which involved a medical assistant calling the patient 15 minutes before the telehealth appointment to help connect them to the video visit. A study assessing the initiative found that patients receiving care at medical offices with high virtual rooming rates were 7 percent more likely to connect successfully to the video visit.

Further, mitigating barriers to video visit access through patient support programs can help advance health equity goals.

A previous study revealed that patient sociodemographic factors influence whether a telehealth video visit is successful, further exacerbating existing health access disparities related to race, age, income, and access to technology.

According to the study, patients with annual incomes between $75,000 and $231,000 and those who used a tablet or a laptop were more likely to have successful video visits. But Black patients and patients between 66 and 80 years old were more likely to have visits transferred to a telephone service.