IT Forefront

How United Health Services set up its telehealth program for success

by Jordan Angers and John League

United Health Services (UHS), a nonprofit health system in upstate New York, became the first hospital-based provider to earn accreditation for its consumer-to-provider telehealth program in December 2019. The accreditation proved to be a solid foundation as UHS launched its telehealth platform and, only a few months later, rapidly scaled up telehealth offerings in response to Covid-19. Moving forward, UHS plans to build on its existing platform to expand its telehealth capacity as it adjusts to a "new normal."

How Covid-19 will impact telehealth

Undoubtedly, telehealth will be part of the new normal, but questions remain around reimbursement and consumer demand, making it difficult to know exactly what the future will look like. A strong foundation gives organizations the flexibility to scale and adjust as needed. Organizations should consider how they will solidify their telehealth platform, whether fledgling or established, to meet the changing demands of the landscape.

Here are four key takeaways from UHS' decision to go for accreditation.

1. Use accreditation standards as the framework for your telehealth program

Back in 2018, UHS knew telehealth would be a priority for the organization but wasn't sure how to make telehealth a reality. To learn more about telehealth, UHS leaders attended an accreditation workshop hosted by URAC, the first accreditation program to be endorsed by the American Telehealth Association.

In consultation with leading experts in the telehealth industry, URAC identified best practices in areas such as quality and coordination of care, access, safety, systems integrity and reliability, consumer protection and empowerment, and regulatory compliance. Achievement of the URAC Telehealth Accreditation seal is a mark of high-performing telehealth providers who believe in and practice excellence.

After attending the workshop, UHS realized that accreditation could serve as a framework for its telehealth program. Telehealth was an unknown for UHS, so every piece of information was a welcome addition as they learned what makes a telehealth program successful. UHS then aligned the accreditation standards to its platform's components and success metrics.

2. Finalize policies and procedures so you can be flexible in your responses to outside factors

From the beginning, UHS decided on a patient-centered approach. UHS had built a reputation of respect and trust in the community, so leaders decided to use UHS physicians on the platform rather than outsourcing telehealth visits to a third-party. Because telehealth was new to many patients, UHS launched the telehealth platform with targeted marketing and outreach. A lot of effort and funding went into raising awareness and educating patients on when and how to use telehealth. This proactive approach resulted in high patient satisfaction scores from the 1,000 patients registered on the platform as of January 2020.

A couple months later Covid-19 did what even the best marketing plan couldn't—forced patients to try virtual visits. Those 1,000 registered patients increased to 19,000 by May 2020. In the walk-in virtual clinic, UHS went from seeing five to eight patients on a typical day to seeing 100 patients a day. In addition to the wave of first-time users and increase in virtual clinics, UHS also introduced a screening tool and scaled up its scheduled video visits across different service lines and new use cases. To support the increasing volumes, UHS trained and credentialed its entire medical staff in just three weeks.

The increase in volume and different use cases were possible because UHS already had the policies and procedures in place from going through the accreditation process. Standard practices for training and credentialing permitted UHS to quickly add providers to the platform. The backend processes for security, legal, and revenue cycle functions allowed UHS to pivot its platform to align with new government regulations, with little disruption to provider workflows.

3. Don't let outstanding questions around reimbursement and sustained demand postpone your planning efforts

It's not clear how telehealth regulations will change as challenges around reimbursement and patient demand shake out, but leaders at UHS agree that telehealth will continue in some capacity. UHS is confident that its strong foundation will support the new landscape in whatever form it takes.

Reimbursement

  • UHS is working to determine which types of visits are appropriate for telehealth regardless of permanent changes to reimbursement. For example, UHS considers follow-up visits to surgical care a good candidate for telehealth because they're typically part of a procedure that rolls up under one code.

  • UHS is also working on expanding its telehealth capacities that were in place before Covid-19, such as telehealth partnerships with local school districts. UHS contracted a care team of pediatricians, speech language pathologists, and sport medicine providers to assist school nurses through virtual consultations. Now that more UHS providers are trained on the telehealth platform and have experienced the benefits of telehealth, there's a wider pool of providers to support additional contracts with more schools.

Demand

  • Based on early indications, leaders at UHS believe that patients will sustain high levels of virtual visits now that they've experienced the convenience of telehealth. Since UHS restarted in-person visits, telehealth visits have decreased slightly but are still higher than pre-Covid-19 levels. Patients seem to like having telehealth as an option—80% of patients reported having an overall positive experience and would consider doing it again.

4. Start getting a solid foundation in place now

Many organizations realize the need for a permanent telehealth solution, including those that had to quickly put a platform in place because of Covid-19. Those temporary solutions did the job, but telehealth isn't likely to be temporary. Organizations with telehealth strategies of all maturity levels should set the groundwork that will allow them to adjust to unexpected changes. Sean Britton, telehealth program manager at UHS, said, "When UHS needed to scale, it took everything we already knew and expanded. The framework and best practices were already done."

UHS used accreditation, but you can do it on your own. Gather relevant stakeholders (clinical, IT, regulatory, and revenue cycle departments) and think through the standards and processes that work for your organization so you can start putting the pieces in place.

 

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