To help providers leverage telehealth solutions, CMS has expanded reimbursement for telehealth and granted providers greater flexibility for connecting with patients, and many private payers have made similar moves to make virtual visits more accessible.

Here are three ways you can tap into telehealth today to prevent, triage and treat COVID-19 cases—and expand your system's capacity.

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3 ways organizations are using telehealth to expand capacity

1. Shift existing appointments to telehealth visits when possible to proactively manage capacity.

Mine upcoming visits to identify patients with existing medical conditions who are particularly vulnerable to contracting COVID-19 and proactively suggest virtual care options. For patients with chronic illnesses, assess capacity to substitute in-person visits for remote patient monitoring.

Approach in action:

• Intermountain Healthcare in Utah plans to expand telehealth offerings to deliver home health care for patients with chronic illnesses who are at an increased risk of COVID-19. When possible, patients can take their blood pressure or blood sugar readings at home and have a nurse provide consultation via video visit.
• NYU Langone Health in New York directs patients with minor medical conditions or those who are concerned about the new coronavirus to the system's virtual urgent care platform and asks patients with existing medical conditions to choose virtual over in-person care. At NYU Langone Health, providers who are self-quarantined are able to continue to safely treat patients by doing so virtually.
• The University of California San Francisco Medical Center in California partnered with health care technology company Cipher Health to develop an automated telephone outreach program that screens patients with existing appointments for COVID-19 symptoms. Possibly infected patients are connected with a care team to triage their case instead of coming into UCSF facilities.

2. Stand up remote triage capabilities for patients who suspect they are ill—and direct everyone to virtual channels as a first stop.

Start with a phone triage line or chatbot as the first line of defense to assess patient risk. Then, direct patients who present with symptoms to a virtual visit for further consultation before scheduling an in-person visit. To streamline triage, develop standard guidelines for staff who are triaging patients via phone or chatbot to assess patient risk, recommend further care, or reassure "worried well" patients. Your guidelines should also communicate clear referral pathways to primary care and other low-acuity settings.

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Approach in action:

• Providence Health in Washington updated its website's symptom chatbot to ask visitors about symptoms, travel history, and possible exposure to the COVID-19 virus to determine their risk level for infection. Based on their responses, the bot either prompts patients to schedule a visit with their primary care provider or to call into the system's nurse triage line and schedule a virtual urgent care visit.
• Sutter Health and Kaiser Permanente in California ask patients to call into their nurse advice line for direction on the proper level of care. To ensure patients know the Advice Center should be their first stop, Kaiser pushed an e-mail to all members advising them to call if they or any of their family members display symptoms or are exposed to ill contacts. Sutter asks patients who plan to use their walk-in clinics to call ahead to reduce the number of individuals with cold and flu symptoms in their facilities.

3. Deploy remote monitoring capabilities to care for patients who have COVID-19 or COVID-like symptoms.

For patients who test positive for COVID-19 or exhibit symptoms resembling COVID-19, organizations should consider remote monitoring or consultations to reduce the chance that providers or other patients contract the disease. For patients who exhibit symptoms of COVID-19 but do not require inpatient care, providers should monitor them remotely and recommend inpatient care only if symptoms escalate. When possible, use virtual visits for admitted patients to limit the number of people interacting with the patient.

Approach in action:

• Providence Health in Washington remotely monitors ED patients who exhibited COVID-19 symptoms but were not admitted to the hospital. Providence also gives patients a thermometer and pulse oximeter to monitor their symptoms at home, and providers check in over video visit to screen for symptom escalation. To reduce delirium and social isolation for quarantined patients in the hospital, especially those who are older, Providence allows patients to communicate with family and friends with iPads.
• Kaiser Permanente physicians communicate with patients who test positive but have mild symptoms and are quarantining at home. Doctors check in with COVID-19 patients over multiple remote channels, including video visits, phone calls, and text-style messaging.
• Intermountain Healthcare used virtual visits to care for a coronavirus-infected patient who was a passenger on the Diamond Princess cruise ship. The patient is in an isolated room, but is monitored by doctors via live video feed to prevent transmission. The technology allows doctors to zoom in and out to view the patient so providers can perform a full assessment remotely.

Together, these approaches help keep patients and providers safe—while maintaining your organization’s capacity to take on new cases as they arise. As you think about how to prepare your organization’s telehealth response, read on to see the three steps you can take to prepare.

Your top resources for coronavirus readiness

You're no doubt being inundated with a ton of information on how to prepare for possible patients with the 2019 coronavirus (COVID-19). To help you ensure the safety of your staff and patients, we pulled together the available resources on how to safely manage and prevent the spread of COVID-19.

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