Advisory Board recently hosted its Service Line Telehealth Summit, which explored how service line leaders can harness telehealth to advance service line goals, as well as how they can integrate virtual health into the care continuum after the pandemic.
During the summit, Megan Director sat down with John League—who leads Advisory Board's telehealth research—for a conversation on the role of telehealth in service line strategy and specialty care. Read on for highlights from our conversation, including League's thoughts on how telehealth can be a service line differentiator, the importance of tracking outcomes, and overcoming the digital divide.
Megan Director: John, you and your team have had a busy summer, and I've appreciated the many insights you've provided on telehealth. But I'm excited to have this conversation today as I'm coming at this from a different angle—from the service line leader's perspective. You've spoken with CIOs, executives, and researchers across our company on this topic. But what do you envision the role of the service line leader to be in telehealth?
John League: Understandably, most of our initial questions around telehealth were focused on technology, placing it in the realm of the IT leaders at an organization. But telehealth is not just a technology problem. It's also a care delivery opportunity. So the service line leader has a significant role to play here.
See, in a perfect world we would bring everyone together—clinicians, IT, procurement, leadership—and they would all hold hands on what they were going to do with telehealth. But during the early pandemic, everyone scrambled to get whatever they could set up. Now that we're done with hair-on-fire implementation, it's time to regroup. And it's the service line leader who has the opportunity here to speak from both lived experience and a growing trove of data about how do we make better decisions on how to use telehealth, and how do we make a better case to plans and clinicians on how we use telehealth to solve problems.
Telehealth needs a strategic reason to exist, otherwise it's just another hassle. But it's very easy to let the day-to-day get swallowed up in responding and executing, where most of our clinicians' minds have been. The service line leader is the person who gets to pick their head up and look around, and act as that bridge between telehealth strategy and execution.
Director: That's well-said, John. With telehealth as well with other system initiatives, I see this as an opportunity for service line leaders to proactively take that seat at the table. If they are not included in these discussions that will directly impact their service lines and patients.
One particularly important role for service line leaders that you mentioned is monitoring the impact of telehealth: selecting and tracking the right metrics. Why is this so important—what is the end goal for service line leaders in using this treasure trove of data you mentioned earlier?
League: I could give you the conventional reason of "you can't manage what you can't measure," but the real reason to get the metrics and data right is that before Covid-19 most orgs didn't have any. Telehealth got such little use before the pandemic that we lack insight into utilization and quality across the industry.
There are two goals I see then for service line leaders. First, is to track what services are being delivered via telehealth and the downstream implications. This is extremely valuable data we don't have now and will go a long way to determine what telehealth we use and who pays for them.
But I really think the goal for service line leaders is to build an understanding of what kinds of telehealth interventions are right for which patients at each stage of their care journey. That's how we're going to get value from telehealth for providers, patients, and payers: by understanding what's the right "dosage" of telehealth for each patient pathway. What are the high-leverage ways that we can use telehealth to promote the care outcomes we want.
Director: And I imagine having that data to say this application of telehealth has led to this outcome—greater quality, reduced readmissions, lower cost or utilization—that would be helpful to bring to payers if you want to have a conversation around where they should be paying for certain applications.
League: Absolutely. And one thing we're hearing in conversations with plans is they are much more receptive to these kinds of conversations about telehealth than ever before.
Plans haven't had to negotiate before. Usually this was just one line item in a giant contract, and telehealth volumes were so low, it wasn't worth fighting over. Now, it's a different story. We may not see a lot of changes heading into 2021 as most plans had to make their determinations about what would be covered in the coming year in Q3. Hopefully we will have more clarity and access in 2022.
But the other reason they're open to these conversations is they've seen the opportunity. Most plans we've spoken with recognize that this is a way to lower total cost of care, and not just through lower reimbursement from in-person visits. If we use telehealth well, we could drive better outcomes via increased adherence, decreased readmissions and inappropriate ED utilization, etc.
But they're starting from the same place we are without data and experience on how to steer, so they are looking to partner with providers who have figured this out. The more meaningful data service line leaders can bring to the table, the better. This is a real opportunity for partnering
Director: I see this as an opportunity for service lines to own the narrative as this isn't an area where there is a defined route already.
Telehealth in the past was appealing for its potential to be a differentiator for specialty providers who had it in place, because there were few who did. But now that all programs are offering some level of virtual care, how do service lines differentiate themselves today with telehealth?
League: The ability to differentiate via telehealth hasn't disappeared, but it has changed. The value of differentiation will manifest primarily in two ways: ease of use and integration.
For ease of use, the issues are the same as they are for in-person visits: Is the platform easy to access? Is it easy to schedule? And this is just as true for clinicians as for patients. Does the clinician like using the platform? Does she do a virtual interaction well? Does a patient perceive value from a virtual visit? I know anecdotally the Zoom-based visits back in March were not perceived to be particularly high-value. These factors will matter a lot more now as it's not just if you offer telehealth, but do you do this well.
The other element is integration. How well are telehealth interactions incorporated into the patient journey? We need to think expansively about where it can be useful: pre-op visits, post-op visits, virtual cardiac rehab even.
And we shouldn't limit ourselves to just clinical care. Can we use the investments we are making in our telehealth platform to serve all the interactions a patient has, like connecting them with financial navigation and counseling.
Director: Now on the other side of the coin from differentiation, telehealth also opens service lines up to additional competition. Suddenly the geographic boundaries are getting a little fuzzier. What considerations should we consider in response?
League: I think competition is the wrong way to look at the choices consumers have in getting health care. I think the right way to look at it is "what can we learn from how other organizations are interacting with our patients?" Not just what services do they provide and what do our patients think about it, but more importantly, why do they offer that in that way? What problems are they solving, either for the patient or for the provider?
Then it doesn't become an arms race in a zero-sum game for patient volumes. Then you're thinking about how to make the care you provide more valuable.
I would emphasize that however you respond here, you need to let patients know about it. Telehealth leaders before Covid-19 all invested significantly in marketing to let patients know that they could access care this way. Telehealth has gotten a lot of free, national media attention in 2020, but it probably won't in 2021. What is your organization going to do to fill that void and to keep this in front of patients in your markets?
And you need to step it up another notch here. We spoke with one health system recently who said that when offered a choice between in-person and virtual, 80% of their patients were choosing an in-person visit. But the flipside was patients were not getting any steerage or guidance—it was entirely left up to their preference, rather getting help from the physician or scheduler that they could do this virtually.
Patients will need guidance at the point of scheduling to know when telehealth is the best option.
Director: I'd like to pivot to an important issue we can't overlook amid the excitement over telehealth: "the virtual divide" – disparities in access to telehealth across different communities. What is the service line leaders' role in bridging this and do you have any early learnings you can share?
League: This is something of supreme importance across the health care industry as a whole. And let's realize that even though the conversation in the industry is about how telehealth has finally reached a tipping point and is on a new path to broader utilization, that's not true for the underserved. For those who experience inequities of digital access and digital literacy, getting value from telehealth remains an uphill climb.
Tactically, I would say that every organization needs patient education materials, both printed and electronic, that outline the visit's cost, what to expect from the care team, what patients need to do beforehand, wait times, the virtual rooming process, appointment length, what patients need with them during the visit, and follow up steps.
I'd also encourage organizations to make sure that they can offer virtual visits that aren't exclusively channeled through a patient portal, which many underserved patients don't use. Make sure there's an alternative way to launch a virtual visit.
This is a topic that we are researching deeply right now, so stay tuned for more research to be coming out on this shortly. And if you would like to talk to our researchers about how your organization is trying to address that, please email me at LeagueJ@advisory.com.
Director: Do you have any final pieces of advice for service line leaders figuring out telehealth for their programs right now?
League: Until March, telehealth research was something I mostly ran off the side of my desk, which is probably very similar to many service line leaders out there. Before the pandemic, most systems did not have the systems or workflows in place to optimize telehealth, so the last few months have felt like we're building the plane while we're flying it.
Importantly, I don't want you to think that where you land with telehealth now is where telehealth will or should be going forward. A lot of learning has happened across these past several months, and now is the opportunity to think about how we want to iterate on this just like we do with any other protocols or initiatives. And that's a perfect opportunity for service line leaders to take the lead.