The National Quality Forum recommends measuring the quality of telehealth in four broad categories: patient access to care, patient and clinician experience, financial impact to patients and their care teams, and effectiveness of clinical and operational systems.
As with all care, virtually delivered care should be system-effective — that is, facets of the system should be coordinated to minimize unnecessary testing and touchpoints. To understand if a telehealth solution is system-effective, one must have a transparent view of the entire journey the patient takes through the healthcare system, not just, for instance, a video visit or a store-and-forward teledermatology session.
Measure Telehealth Bounceback Rates
The combination of the growing U.S. healthcare costs and increasing acceptance of telehealth solutions by consumers, providers, policymakers and insurers over the last decade has sparked an exponentially increasing investment into this area.
The level of breadth and detail around quality is far more likely in integrated delivery systems, as the infrastructure already supports and delivers end-to-end live care, and integrating virtual care complements that system. For example, in the world of emergency medicine, one measure of quality is termed “bounceback,” which is when a discharged patient returns to the emergency department for care within a short period of time for a related condition. This is trackable and reportable across unrelated systems by insurance companies and generally suggests suboptimal care management.
But if you are a single telehealth company and not integrated with a larger care-delivery system, you don’t know when a patient’s condition is unresolved or worsens. Hence, you are likely to underreport your bouncebacks. Some patients may have ended up seeking care from an outpatient clinic, urgent care, emergency room or another telehealth company.
Kaiser Permanente likely overreports bouncebacks from video visits, as the same criteria includes patients referred internally for ancillary services such as lab or imaging, or to an affiliated specialist. Despite potential overreporting, Kaiser Permanente reports a bounceback rate for video visits of less than 10 percent, which is similar to or better than reported by single telehealth companies. This undoubtedly is attributable to the strengths of providing virtual care from an integrated system, including robust electronic health records, patient follow-up access through a secure patient portal, and an incorporated healthcare team and ancillary services.
Dig Deep Into the ‘Why’ of the Patient Experience
While the healthcare industry traditionally measures patient satisfaction using a numbered grading system, that only tells the “what” and “how” parts of the story. For instance, organizations often ask patients “what number would you grade the technology” or “how did your provider do?” on a scale of one to five.
Providers instead should encourage patients to spend a minute writing a few lines about their encounter, capturing the essence — the “why” of their experience. Simply receiving a one out of five on a topic is tantalizing to any potential process improvements, but when joined with statements such as “the audio didn’t work” or “the provider joined 10 minutes late,” the experience inspires refinements.
One of our video visits programs, for instance, received very high comprehensive ratings: 98 percent of patients said they would use it again, and 97 percent said they would recommend it to a friend. Within these ratings, the most reported “why” comments were “convenient,” “easy to use,” “integrated,” “the doctor knew me” and “good follow up.” In addition, since Kaiser Permanente physicians who provide video visits are also seeing patients in clinic, it gives us a truer sense of patient acceptance of virtual care — we can compare grades for the same physician providing virtual care versus in-office care. This comparison revealed that average scores for the same physician providing care virtually were 15 to 20 percent higher than when providing care in clinic, even among physicians with already excellent scores.
Make Sense of Telehealth Dollars
Efficiency should be a key catalyst for every organization’s implementation of telehealth. All Kaiser Permanente physicians are issued a smartphone with the ability to initiate HIPAA-compliant texts or video chat to coordinate and collaborate with colleagues instantaneously. That enables patients who come into our emergency rooms and primary care offices to immediately receive care from both in-person and virtual clinicians, which helps physicians make quick decisions on care management. Our doctors report that these enhanced communication pathways promote a collaborative culture, decrease stress and bolster efficiency and productivity.
In a fee-for-service organization, return on investment is often calculated in a silo, with the return of an investment divided by the cost of the investment. Unfortunately, this doesn’t consider potential waste that often occurs as a result of uncoordinated health systems producing redundancies. For example, a fee-for-service telehealth provider may collect a $79 fee to provide medical advice, and if the telehealth provider is unsure of the diagnosis or the condition is unresolved, another fee-for-service telehealth provider or an unaffiliated emergency department collects additional fees. Multiplied many times over, all entities may report significant ROI, but the patient ends up paying unnecessary fees to cover the waste in redundant care.
The major potential cost savings from telehealth for an organization with an integrated system model are tied to personnel resources, capital space and efficiencies gained in coordinated care, as most other costs that are clinically intrinsic stay constant (such as labs and imaging). The financial benefits to patients in this model are similar, as the average patient saves hours of opportunity cost, other travel costs and sick leave. Additionally, it safeguards patients from paying for the unnecessary redundant costs of uncoordinated systems.