Telehealth Sustainability Requires a Willingness to Adapt to New Ideas

When Long Island Select Healthcare tallied up the results of a three-year, grant-funded telehealth program in 2017, administrators saw strong results – an 86 percent reduction in ER visits, a 50 percent increase in access to care, a 26 percent reduction in highest cost use, an 86 percent improvement in patient activation and a 98 percent patient satisfaction rate.

But the $6 million dollar grant from the New York Department of Health was gone, and there was little hope of making that funding up through Medicare or Medicaid. In order to make those telehealth gains sustainable, LISH had to shift gears.

“We had to rethink and rescale the program,” said Terry-Ann Seppala of Telehealth Associates, a consulting firm brought in to help the health system with sustainability.

Sustainability is one of the taller challenges to telehealth success, as it requires those in charge to think beyond grants and pilot projects and those first few years to map out a program that proves consistent value over time. Those early successes may look great, but without funding and administrative support those numbers fade away very quickly.

Seppala and James Powell, LISH’s chief executive officer and CMO, were on hand during the first day of a virtual conference organized by the Northeast Regional Telehealth Resource Center and Mid-Atlantic Telehealth Resource Center to explain how the health system moved from a pilot to a platform that now supports several connected health services.

To begin with, they looked at a program that was serving a very specific population – roughly 2,000 patients with neurodevelopmental and intellectual disabilities – and expanded the envelope. As a federally qualified health center, LISH served a large population, many of which have chronic care needs that often go unmet.

Powell and Seppala designed a connected health platform that included remote patient monitoring and telehealth tools, qualifying for CCM reimbursement through Medicare. They trained medical assistants to be CCM coordinators to help expand that care management envelope to the home.

The idea, they said, was to create a platform that focused on so much more than one select group of patients or one reimburseable service. Adjust to more patients’ needs, and be flexible enough to think in terms of virtual care.

“If we can make a robust CCM project, it will offset the visits we are not reimbursed for,” Powell pointed out.  “You really have to be agnostic in your approach. … You really can’t have a one-size-fits-all with anything.”

To make this work, the health system had to think beyond episodic care and embrace multiple touch points, in a move toward continuous care. Scheduled telehealth visits were preceded by e-mails or messages to make sure patients were prepared for their virtual appointment, and followed up with messages to make sure they had understood the treatment plan.

“What worked well was the engagement and the interaction with everybody,” said Powell, who calls this the “quality of touch.”

They also learned that going digital means investing in education. Many of their patients needed help acclimating to the technology – either full-on lesson in how to use telehealth or just a helping hand. The health system developed protocols to screen patients for technical literacy, and to tach those who needed help, and they secured funding from the Federal Communications Commission to improve broadband resources for their patients.

Of course, the coronavirus pandemic had a part to play in this transition.

COVID-19 “changed the game,” Powell said. “Our walk turned into a very quick race” to shift from a predominantly in-person care provider to a virtual care provider. “Many of us became experts in change management.”

Moving forward, the health system is embracing virtual care as a necessary part of the platform. They’re adopting what is called a “hybrid approach.”

“Be mindful of where the new normal is and all the variations of the new normal,” said Powell, who expects his July in-person traffic to be one-third of what it would normally be.

Seppala said healthcare providers like LISH have to balance virtual care with in-person care, and give patients the flexibility to choose how to receive care.

“If you’re a hybrid practice, you can care for patients who are not digitally competent and who never will be,” she said.

By thinking outside the box, LISH has parlayed that three-year, $6 million pilot program serving 2,000 people into a network of telehealth and mHealth services, serving not only the FQHC but a diagnostic and treatment clinic in the Bronx and a home health agency and skilled nursing facility in Nassau County. They’re securing more than $2 million in grants for these programs, as well as additional institutional investment and reimbursements. And they’re launching new pilot programs to expand their RPM network and offer telemental health services.

“People aren’t mindful of the whole process and all of the variables that go into virtual care,” said Powell, who noted that care providers often look for value in only one service, such as urgent care, or one modality, such as the video visit, instead of considering the broad envelope of care that can be provided.  

“Thinking about all those opportunities makes a big difference.”