We hear a good amount of anxiety from our members about falling behind on adoption of telemedicine. But the truth is that few providers are offering a robust multi-component virtual visit service.
The successful telehealth pilots we’ve seen are often targeted at specific needs, and the success of Stanford Medicine’s Clickwell Care offers a useful case in point. As of the end of 2015, one year into its launch, Stanford had completed more than 4,000 visits across a panel of 2,000 patients.
Targeting a specific patient population
The Clickwell Care model emerged as a response to a well-defined need: improving access for Stanford Medicine’s low-utilizing ACO population who predominantly used urgent care and emergency medicine instead of primary care. Leaders initiated focus groups with the 20% of patients who had not had any contact with their PCP to understand their needs and priorities.
Surprisingly, Stanford leaders found that these patients didn’t necessarily want an on-demand service for episodic urgent care. In fact, these comparatively young, tech-savvy patients did want a relationship with a primary care doctor—but felt that the times available to them were inconvenient.
To meet this need, Stanford prioritized improving service accessibility by expanding clinic hours and building a virtual visit functionality into its existing EPIC software (accessible from a smartphone or computer). Recognizing its relatively healthy patient panel, Stanford integrated wellness coaching from nutritionists and trainers into its clinic services. To improve patient convenience, Stanford partnered with a pharmacy vendor offering free same-day medication home delivery.
Integrating virtual service as a tool within the primary care clinic
Stanford managed to go from vision-setting to implementation of its virtual visit service in just five months. The keys to Stanford’s success lie in two key decisions: first, prioritizing seamless user experience, and second, building virtual visits into existing primary care relationships rather than positioning it as a substitute.
Stanford recognized that adoption wouldn’t occur without seamless user experience and kept pressure-testing its EPIC interface until its pilot end users were satisfied. They realized that only then could there be a realistic expectation of scaling provider and patient utilization.
Once they established a viable platform, Stanford encouraged patients to choose the visit modality that best met their needs. True to their focus group findings, 70% of new patients chose to have their first appointment in person. Just 40% of all visits were done in person; an additional 23% were done by video, and the remainder by phone. Strikingly, up to 60% of Stanford’s visit volumes were done virtually.
To keep providers busy while virtual clinic volumes ramped up, leaders based their new clinic out of a bricks-and-mortar urgent care center. Moreover, PCPs partner with wellness coaches, also available by virtual visits, to help patients meet stress reduction or weight loss goals.
Promising figures on cost reduction and clinical efficacy
Early results from the Clickwell rollout show promising results in total utilization as well as both operational and clinical metrics. After a year of program operations, clinic leaders estimated that 55-60% of all 4,000 clinic visits were done virtually with the remainder done in person.
Importantly, Stanford found that the cost of its virtual clinic is 30% below the cost tracked for its comparable in-person clinics. Although these savings may partly reflect a somewhat healthier patient pool, leaders believe the predominantly virtual model has also allowed them to cut overhead costs, such as medical assistant staffing.
Virtual access to wellness coaches also shows favorable clinical outcomes: among patients who have stress reduction or weight loss goals, patients have achieved their goals in 93% and 78% of the time, respectively.
Instead of seeing virtual care as a substitute for existing care delivery, Stanford approached telehealth as a new tool to help providers better execute against existing priorities. Through intentional integration of virtual visits into existing care pathways, Stanford was able to make progress against known cost, quality, and access goals.