The New Reality in Virtual Health (Part 2): Evolving Platforms, Care Models and Key Metrics

At our Executive Summit meetings this summer, we discussed how virtual health can extend your health system’s reach, create new access channels and respond to the growing demand for direct-to-consumer programs. Our presentation generated some interesting discussion and thoughtful questions about virtual health’s current landscape, evolving care models and the best way to roll out virtual health initiatives at your organizations.

In the second installment of our 2-part series covering your questions on virtual health, we address evolving platforms, new and developing virtual health models, and metrics to measure success. For the first installment of the series, please click here.

1. How are virtual health vendors evolving their platforms? Will they integrate with my EMR?

Virtual health vendors are quickly evolving their platforms to meet the need of a diverse client base. Platforms traditionally used for medical care are expanding to include behavioral health services. MDLIVE, Teladoc and American Well will all soon be offering virtual access to psychiatrists and therapists across all 50 states. Vendors also are realizing the popularity of employer-sponsored virtual health programs and are designing products to support this space. For example, in June 2016, Teladoc acquired HealthiestYou, an employee health benefits app maker, for $125 million.

Vendors are also incorporating advanced analytics into their solutions. This is particularly relevant for vendors focused on home monitoring. For example, Homeward Health, a platform that provides solutions for decreasing readmissions, uses analytics to assess a patient’s medical condition and social environment to determine a risk score for readmission. Following discharge, home monitoring tools, coupled with real-time data streaming, allow care providers to become aware of minor medical issues sooner and intervene quickly, while the patient is still in the home.

Sg2 recommends making EMR integration a top goal of any virtual health initiative. When assessing vendor partners, ask specific questions relating to EMR integration and information-sharing capabilities during in-person patient consults. For example, can the vendor platform double-check patient-entered data (such as meds) with info from the EMR? Can the platform check for drug-drug interactions during live consults? Are virtual visit summary notes transferred easily into the EMR? Including your chief technology officer in these conversations is a critical success factor.

2. What new virtual care models are other organizations developing?

Results from Sg2’s 2015 survey of national virtual health providers showed that the top virtual health offerings included specialty physician consults, remote patient monitoring and virtual conferencing. The majority of programs were focused on neurology, behavioral health and cardiovascular service lines. While the cited health system pain points of access and clinical scale are not new, progressive organizations are developing novel, interesting approaches to virtual care.

Many organizations have considered tele-ICU as an alternative to increasing the number of intensivists, allowing 1 intensivist to remotely cover multiple locations. Since the centralized tele-ICU model can be cost prohibitive, organizations are beginning to adopt a round and respond model. First developed by the University of California, Los Angeles, the round and respond model was so named by Dignity Health Telemedicine Network (DHTN) because it allows remote physicians to virtually round on patients in the ICU via a mobile unit (eg, robot) while also being available for emergency response. This model allows the remote specialists to move from bedside to bedside with the care team, increasing collaboration among all providers. For emergency response, ICU staff page the remote intensivist, who responds within 5 minutes via the mobile unit to assess the patient and provide a treatment plan.

In addition to increasing care team collaboration, this model is gaining popularity due to its lower cost of implementation (~$7,000 per bed) compared to centralized tele-ICU models (~$70,000–$80,000 per bed).

3. What metrics should we be using to determine the success of our virtual initiatives?

Of respondents to Sg2’s virtual health survey, 70% said they were not obtaining a positive return on investment (ROI) from their virtual health initiatives. With continued improvements in reimbursement, the financial picture should brighten, but, for now, it is important to track additional metrics to determine the success of your virtual health programs.

Metrics will vary by clinical program and by site of care. For example, key metrics for a tele-emergency program will include:

  • Month-over-month growth of virtual consults
  • Average time from teleconsult request to teleconsult initiation
  • Patient throughput in ED
  • Transfers avoided
  • Cost per consult (number of consults per month divided by monthly program costs)
  • Avoided unnecessary or duplicative tests
  • ED disposition changed due to consult

Providers launching virtual primary care/urgent care programs should consider the following metrics:

  • Month-over-month growth of virtual consults
  • Percent of consults provided to patients unaffiliated with health system
  • Average time from teleconsult request to teleconsult initiation
  • Patient wait times to see provider in person
  • Patient retention
  • Ratio of providers referring patients for virtual consults to total number of providers
  • Cost avoidance through reduction in readmissions and low-acuity ED visits
  • Accuracy of diagnosis
  • Provider and patient satisfaction

Have a question that wasn’t on this list? Check out part 1 of this series. Also, feel free to give us a call to discuss your current virtual health needs and how Sg2 can help.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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