COVID-19 spurred Houston-based AccessHealth to quickly scale up its telemedicine offerings, just as it did with most other health systems nationwide.
And just like those other health systems, AccessHealth faced numerous challenges at first, in trying to adapt to this new normal.
The health system faced patient, staff education, infrastructure and reimbursement challenges.
Staff also had to decide how they were going to educate patients on the platform. Within that training, staff members found that they needed to give their patients peace of mind as well as comfort. Doing this enabled patients to know that a telehealth visit did not mean less quality.
Patients experienced a lack of resources in the areas of having data coverage for video transmission and living in rural areas where there was not a significant signal, which affected how e-consents would be signed.
“As for staff education, training the staff in multi-departmental transitions was necessary for our patient-centered medical home status,” said Jared M. Williams, CFO and senior vice president at AccessHealth. “Then we had to ensure the correct coding and documentation was satisfactory for insurance billing purposes.”
They also had to ensure that all staff were aware of the types of telehealth visits that were beneficial to patients. This aids in avoiding misdiagnosis during a telehealth visit and in reducing the number of possible symptomatic patients exposing healthcare workers.
“Using the features of the telehealth platform, the counselors had the option to still see the patient from their office via laptop to perform the necessary screening and counseling.”
Jared M. Williams, AccessHealth
“On the infrastructure front, operating at an increased capacity, we needed to ensure that we had space for an isolation room,” Williams explained. “With an increased capacity, internet bandwidth was a concern in the areas of workflow and patient access. Purchasing devices and platforms due to pricing was a concern, and HIPAA-compliant platforms and cybersecurity [were concerns] for PHI/patient safety.”
Finally, prior to CMS loosening telemedicine policy for the pandemic, reimbursement was a concern. Staff members were unsure if Medicare and Medicaid would honor the prospective payment-system rate. Decisions were not made yet on the level of payment.
NextGen and Zoom for Healthcare both were proposed as telemedicine vendors. Considering time constraints for implementation, Zoom made the most sense for a quick implementation.
Staff would offer Zoom telehealth capabilities for medical and mental health patients. DocuSign, NextGen and Care Message were also used in order to have necessary documents signed, co-payments collected and appointment reminders sent.
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MEETING THE CHALLENGE
Regarding mental health, Zoom was the easier platform to implement, since there were multiple licensure capabilities. The platform was user-friendly and its pricing affordable, Williams said.
“Implementation with Zoom started with our mental health department,” he said. “Before the immediate switch, we tested the platform with each provider and asked each patient if they would like to have a telehealth visit.
“To our surprise, patients elected to have phone and video consults,” he added. “Using a patient service coordinator to schedule and contact patients to gain necessary paperwork and payments proved to be an effective workflow. Traditional therapy via telehealth is the popular choice.”
Screening, brief intervention and referral to treat, or SBIRT, is a program that falls within the mental health realm. AccessHealth’s licensed chemical dependency counselors are integrated within the medical adult clinics. These counselors provide opportunities for early intervention with at-risk substance users before more severe consequences occur.
“It is important to note that this model is different than traditional therapy,” William explained. “Counselors intervene during the medical visit after a screening tool, CAGE AID, determines the patient’s risk. Using the features of the telehealth platform, the counselors had the option to still see the patient from their office via laptop to perform the necessary screening and counseling. This part of our integrated care model requires teamwork from our medical staff to communicate with our mental health staff.”
Additionally, this process was identical for the mental health counselors (therapists and psychotherapists) who are integrated within the clinical setting, he added.
“Medical patients also were steered to telehealth visits using the same process,” he said. “Patient education within adult and pediatric clinics were lacking tremendously. A large portion of our patients preferred to still come in, and require the ‘provider’s touch.’ The older population transitioned easier than patients under the age of 50. While Zoom did everything that was needed in the telehealth world, we recognized a need for devices that could enable safer patient care.”
The hard results AccessHealth thus far has achieved are an increase in visits and an increase in clinical-quality measures. A few metrics staff measures that can be quantified are:
Percentage of patients with HbA1C blood glucose level of 9% or below. The Hemoglobin A1C measure is an important aspect to the quality program. In 2017, AccessHealth set goals that were modeled after the Department of Health and Human Service’s Healthy People 2020 Program. In 2019, AccessHealth was able to reach a compliance rate of 71% by integrating multidisciplinary departments with medical concerns, such as mental health, nutrition, care coordination and social determinants of health. With the telehealth platform, the staff was able to continue integrated, quality healthcare without disruptions. To date, AccessHealth has been able to maintain that rate of compliance using the telehealth platform to gauge patients in the areas of medical visits/follow-ups, mental health, nutrition, care coordination and social determinants of health.
Percentage of patients screened for depression with treatment plan documented. Patients screened for depression with a treatment plan documented increased 5% year over year. Currently, there is a 96% overall compliance rate. This measure was important because there was a potential for increased anxiety and depression due to COVID-19. Using the technology platform enabled all parties involved to contact patients for visits, assessments and follow-ups. The end result is an increase in mental health visits of 10%.
USING FCC AWARD FUNDS
AccessHealth was awarded $439,286 for telehealth carts and network upgrades to increase clinical capacity and prevent further community spread of COVID-19 by treating primary care patients remotely for COVID-19, diabetes, hypertension, asthma, and other diseases and illnesses.
“The overarching goal for the FCC grant is to provide quality, affordable healthcare for low-income, underserved, uninsured children and adults in Fort Bend, Harris and Waller Counties whose family incomes are less than 200% of the federal poverty level,” Williams noted.
Identified health needs include:
Growing uninsured population in need of access to primary healthcare.
High prevalence of chronic diseases: obesity, diabetes, depression and anxiety.
COVID-19 testing, treatment and prevention measures to stop community spread.
Factors that will be tracked to measure impact include:
Percent of patients with HbA1C blood glucose level of 9% or below.
Percent of patients with blood pressure at or below 140/90.
Percent of patients prescribed appropriate treatment for asthma.
Percent of patients screened for depression with a treatment plan documented.
Percent of patients screened for BMI with a treatment plan documented.
Number and percent of patient care encounters provided via telehealth.
“Telehealth is needed now more than ever to continue safely providing essential healthcare services to residents of Fort Bend, Waller and Harris Counties,” Williams said. “Connected care services to be provided by AccessHealth with the grant include primary care for adults, pediatrics, prenatal care, behavioral health and nutrition services.
“New telehealth equipment will increase AccessHealth’s clinical capacity to prevent further community spread of COVID-19, as well as gain access to primary and specialty care.”
Conditions to be treated include COVID-19, diabetes, hypertension, asthma, COPD, HIV, common cold, sinus infections and other physical health conditions, as well as depression and anxiety, he added.
As the community’s safety-net healthcare provider, AccessHealth will free up hospitals to focus on COVID-19 patients. The new telehealth equipment will allow AccessHealth to care for 20,000 patients who otherwise would have very few options for quality preventive or primary healthcare, he said.
Telecommunications services and devices necessary to enable the provision of telehealth services include:
Telecommunications services and broadband connectivity services, including voice services and Internet connectivity services for healthcare providers or their patients.
Information services, including remote patient monitoring platforms and services; patient reported outcome platforms; store and forward services, such as asynchronous transfer of patient images and data for interpretation by a physician; and platforms and services to provide synchronous video consultation.
Internet-connected devices/equipment, including tablets, smartphones or connected devices to receive connected care services at home (for example, broadband-enabled blood pressure monitors and pulse-oximeters) for patient or healthcare provider use; telemedicine kiosks/carts for healthcare provider site.
The proposed devices to be used are Medpods by Henry Schein. Medpods enable providers to break down the barriers of traditional care delivery and create new care pathways, all while complying with federal and local law, FDA, HIPAA, and CMS mandates and guidelines, Williams said. Some of the highlights of this device include:
Live video consults with telehealth diagnostics.
Acute care, sub-acute care, urgent care or ambulatory care.
Expanded service offerings, including specialty care and practice reach.
Healthcare microsites, including schools and worksites.
Resource load balancing.
“Medpod telehealth will enable high-quality, remote physician-patient encounters on par with a face-to-face visit,” Williams concluded. “It includes integrated, professional medical devices that enable enhanced clinical examination capabilities; live video, audio, clinical and lab data-streaming, and remote tele-diagnostic device control; provider access through web browser, no software to install; EHR integration; and the Medpod platform [that] enables both fee-for-service and value-based models.”