Understanding the New Patient Preference for Telehealth Access

March 2020 brought about one of the biggest catalysts for care delivery change at Emory Healthcare. Telehealth access, which once was a key tool for the health system mostly on the hospital side, soon became the crux of the patient experience in ambulatory care, too.

This isn’t a novel story. Most healthcare organizations, big and small, saw a major problem on their hands when the novel coronavirus quarantined people in their own homes and sparked industry-wide calls to postpone non-urgent or elective healthcare. Clinics and hospitals could be a breeding ground for the virus, logic held, and so it was best for patients who weren’t urgently sick or injured to stay at home for the time being.

But also like organizations across the country, Emory Healthcare knew that would leave a major patient cohort behind. Chronic disease management, which hinges on a high-touch and communicative patient engagement strategy, would fall by the wayside of patients couldn’t get into ambulatory clinics to see their doctors.

In a short period of time, these medical facilities put up advanced telehealth access programs that helped patients receive the care they needed without going into the office.

And there’s no going back now, most experts agree.

In June, survey data from Doctor.com revealed that 83 percent of patients expect to use telehealth even after the pandemic ends and they can safely access in-person care again. In July, similar survey results from OnePoll showed that most patients expect to be using telehealth to access care into the fall.

“Customers and patients are now very, very, very comfortable with telemedicine,” Sarah Kier, the vice president of patient access for Physician Group Practices at Emory Healthcare, said in an interview with PatientEngagementHIT.

Telehealth is convenient, Kier pointed out, and patients like that they can get their treatment nearly on demand.

That’s not to say getting to this point was particularly easy, Kier quickly added. Many of Emory Healthcare’s outpatients have multiple comorbidities and are on the older side, which in some cases suggests they are not familiar with the video chat technology often used during telehealth visits. It’s in fact those factors that may have discouraged patient interest in telehealth before the pandemic.

But that three- to four-week stretch during which patients had no in-person care access option proved to be enough to push patients — and their providers — to adapt to the new technology.

“There was essentially a three-week period of time where, unless you were a critical case that had to see a provider in-person for some kind of physical exam, which was less than 10 percent of our appointments, telemedicine was your pathway to get into our system,” Kier explained.

In other words, patients had no other choice but to adopt telehealth.

That led to a few early wins at Emory, Kier said. Patients over the age of 80 soon became proud of their ability to learn a new technology and stay engaged in their own care, providing a great anecdotal example for others who may have been reticent.

And now, it seems unlikely that Emory Healthcare, or its peers throughout the healthcare industry, can easily transition back. Patients are extremely satisfied with the technology, Kier said, and it will not create a good situation for them to have telehealth access diminished.

“We have compelling patient testimonials saying that patients are excited about this type of care,” she reported. “Looking at our patient experience scores as measured by Press Ganey, we’re a full five percentage points higher for telemedicine visits across the first three months that we had this live, which was really interesting.”

“And a lot of it had to do with timeliness of care. Patients appreciate not having to drive and park and navigate our really complicated campus,” Kier continued.

Looking at the data in Emory’s provider search tools from Kyruus showed patients are in fact seeking out clinicians who can deliver care virtually. Once the health system determined it needed to pivot ambulatory care to telehealth, it updated its Find a Physician page to indicate which providers saw telehealth appointments and which saw only in-person.

Within a five business days, Emory could use credentialing data to flag which providers had successfully completed the health system’s telehealth curriculum and highlight them on the website.

“And we saw, especially during COVID and even now, that that filter is really heavily used and it’s clearly becoming a differentiating factor for our patients as they seek care,” Kier said.

It would be hard to return to the old normal, and Kier said Emory Healthcare is currently working under the assumption that they won’t have to, at least not entirely. Ideally, public and private payers will continue to offer some telehealth reimbursement parity that would enable the health system to continue down this path.

After all, it’s that payment parity that allowed Emory to offer telehealth access in the first place.

“We’ve been eager to do this for quite some time,” Kier said. “The trouble was we couldn’t deliver that care and remain financially soluble. We couldn’t do it for free and COVID provided the catalyst for payers and the government to become really flexible about how we were able to deliver care and maintain continuity of care with our patients as this pandemic struck.”

“At this point, the cat’s out of the bag, and frankly we are very hopeful that we’ll be able to continue to meet our patients’ needs in this way,” Kier asserted. “It would be very discouraging to have to unwind the progress that we’ve made in meeting our patients’ needs from the comfort of their own home.”

In the meantime, Kier and her team have a plan to ensure they can continue to get paid for their telehealth visits. A series of waivers with Emory’s payer partners will ideally get the health system through until at least September, she said.

“But we expect to be struggling with COVID all winter so we are working a three-tier strategy,” Kier said. “Tier number one is working directly with our payer contracts to encourage them to continue telemedicine coverage at parity with in-person visits. The second thing is working with our federal and state legislators.”

Georgia has been a slow adopter for some of the national legislation around telemedicine, Kier explained. The team at Emory is working to encourage state and federal representatives to allow telemedicine to be paid for by Medicare and Medicaid.

“And third, Emory has relationships with a number of large employers and large corporations in the Metro Atlanta area. We’re working with them,” Kier stated. “We have several contracts that are direct-to-employer. We’re working with them to see if we can exert pressure combined to both insurance companies and to direct-to-employer solutions to make sure telemedicine is carved into our existing negotiations.”

Reimbursement questions notwithstanding, telehealth has been a saving grace for Emory and its patients alike. The pandemic posed a serious threat to patient care access, with both restrictions on in-person healthcare access and the current fear some patients still experience regarding in-office care. This remote treatment option has allowed the health system to continue to connect with patients and continue to work toward wellness.

“This was a physician-led, physician-supported initiative,” Kier concluded. “It has just been so remarkable how much our providers have leaned into this very quickly and how much our patients have grown to appreciate and then to rely on this channel of care. It really has been one of the most rapidly evolving landscapes I’ve ever seen in my almost 20 years of healthcare experience. And it’s been just so exciting to be a part of.”


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