Skilled nursing facilities extend patient access leveraging telehealth
Skilled nursing facilities face a severe shortage of workers. As it is there is a documented shortage of primary care physicians and the gap keeps getting wider.
On top of it, SNFs have been known to have a shortage of direct care workers. Add to this, the primary care shortage – makes matters even worse.
The fact that a majority of baby boomers are above 65 and will soon be entering into the purview of skilled nursing facilities, this acute shortage needs to be addressed.
One way to deal with this is to provide primary care providers on call. This is exactly what one telemedicine company wanted to do – they had a roster of USA licensed physicians that were ready to provide on-call services.
This is not a new business model per se, as primary care providers have been provided on an on-call basis for a while. However, in this particular case, the telemedicine company wanted to provide video and voice calling facilities to the skilled nursing facilities.
The basic idea was that when the SNFs would face a volume of patients without having enough primary care providers on site, they would immediately book an appointment with these on-call doctors. Each provider would have VPN access to the EMR of the skilled nursing facility hence would have the ability to look at patient records as well as update with diagnosis and treatment/care plans.
The idea was executed quite simply – the nurse would create appointments on available providers’ calendar. The provider being on call, would always have their calendar up to date. At the time of the call, the provider would read the nurse’s note for the upcoming patient video call, login to the SNF’s EMR, read the patient chart and thereafter, start the video call.
While on a video call with the patient, the provider would take as many notes as needed and as part of the after-call-work (ACW), they would update the patient’s record on the SNF EMR to reflect these notes.
At all times, these recordings needed to be available for audit and security reasons, stored on a HIPAA secure infrastructure.
Hopefully this gives you an idea of how to deploy a telehealth strategy at your practice.
Ophthalmology group uses telehealth
An ophthalmology group that deals with a large diabetic population wanted to offer teleretinal screening services to their referring partners. This not only assisted in medical marketing for them but at the same time extended patient compliance in addition to assisting the primary care providers to meet their yearly CDC screening goals.
Diabetic retinopathy is the leading cause of blindness in the USA (mostly for adults 20-74 yrs of age). About 30 million Americans and 414 million people worldwide have diabetic retinopathy. With early detection, vision loss is preventable in up to 95% of the cases.
AAO, NCA and NQF recommend annual retinal exams for diabetic patients – however, only 20-50% really comply. Here are some reasons for this:
- Lack of patient awareness and education
- Lack of access to healthcare and even more so, specialists.
- Patient logistics are usually the biggest factor.
NCQA HEDIS and CMS STAR rating include retinal exams. CMS ACO diabetes management scores also includes retinal exams.
Regardless, DRE compliance increases incentives under HEDIS/STAR ratings, compliance has been poor.
Fort Drum Regional Health planning organization had started a telemedicine based diabetic retinopathy screening program where 95 % of the target population live in a health profession shortage area (HPSA) across various sites (see here). In less than a year after launch, they reported pretty promising results here.
As reported numerous times, the main challenges of patient logistics are due to the current workflow (as below)
- A patient visits their PCP for a check up (not necessarily related to diabetic retinopathy)
- The PCP office is supposed to do yearly retinal exams. However, many PCP offices are not equipped with this clinical decision support system.
- The PCP office refers the patient to a specialist office (ophthalmologist). They typically do so by handing the patient a note or a referral pad referral.
- The patient leaves the office – there’s no further follow up.
- A minority of those patients call the ophthalmologist offices. Since they are a high demand specialty – usually, they are already backed up.
- The patient faces barriers in setting up an appointment with the specialist office
- Finally, and when the patient does get an appointment with the specialist office, they may or may not show up.
- Even when the patient does actually show up for the visit, the encounter/visit notes may or may not be sent back to the PCP office.. Therefore leaving an open care loop.
The options already out in the market include the likes of retinalscreenings, Welch allyn RetinaVue network etc.
An ophthalmology group in NYC that deals with a large diabetic population wanted to offer teleretinal screening services to their referring partners.
This not only assisted in medical marketing for them but at the same time extended patient compliance in addition to assisting the primary care providers to meet their yearly CDC screening goals.
Solution – how it helped
In this particular case, the PCP office was responsible for patient acquisition, identification for retinal screening cases and therefore the ophthalmology group depended on the PCP offices.
The PCP office would create the patient as a new screening case to be diagnosed. They would then upload their images (right and left eye) to the web portal. This would send the alert to the retinal specialists on staff at our ophthalmology group and the specialists would immediately diagnose the images.
More often than not, while the patient was still at the PCP office, the PCP would get a report back. The system would generate a report with all information and notes necessary for billing purposes as well.
For patients that were diagnosed with NPDR, the PCP office could immediately send an electronic referral to the ophthalmology group so the patient compliance was already expected to be higher.
While WelchAllyn and retinalscreenings offer a slew of retina specialists that grade images, this does not help individual ophthalmology practices generate new patient business. Using those existing services is like listing themselves on ZocDoc – you cannot predict the amount of business you can generate, because every retina specialist is already on those networks.
Since the patient referral was generated immediately and the patient got an appointment before leaving the PCP office, the problem of patients forgetting to follow up with the specialist office was entirely eradicated.
Occupational therapy practice uses telehealth to gain new patients
Here’s how an Ergonomist and Occupational Therapist uses telehealth solution (app) to acquire, serve and retain patients for life. Workpose (Ergolution) staff are working in the field of injury prevention for hi-tech, insurance and healthcare enterprises.
Much like any service based business, Ergolution understood that the only way to grow revenues was to add more staff / increase headcount. The more headcount they added, the more the overheads – in other words, profit margins kept getting smaller. Increased headcount also led to higher revenue & cash flow requirements… all the problems that you know very well.
- Acquire – Generate more patient leads with a “foot in the door” offer, at a low cost of acquisition
- Convert – Provide tangible value to these new patients with this low priced offer. This is serviced with minimal effort from our client’s side.
- Nurture – Be in regular contact with these new patients, provide tangible value and aim for the larger business – being introduced to the companies these customers work for.
- Up-sell – Present these initial customers with a slightly higher priced service offering that isn’t a big ask from these new leads. For this, only two pictures were required from the customer. Again, this was also serviced with minimal effort from our client’s team.
How it was executed
Our customer launched a simple mobile app that allows their providers to achieve all of the above (telehealth doesn’t necessarily need to be a mobile app).
The mobile app presents 4 paths to help someone with aches/pains (patient)
- Self assessment – the patient is asked a series of questions to help them with their aches and pains
- Solutions for body discomfort – wherein the patient can click on various body parts to identify self care and ergonomic tips.
- Help videos – helps the patient make immediate changes to their posture with self help videos
- Ergonomic equipment recommendation – helps the patient choose from various products to ease their aches and pains.
Facebook was a perfect venue for advertising the app. Considering the segment that the app was going to help, this would have been a very large audience.
The app was advertised on Facebook with a small ad spend of $5/day (of course, proper audience creation, segmentation etc was done to identify the right kind of audience and show the app to only these users).
In fact, the audience was limited to California as well since it provided more than enough ROI.
Mobile app downloads were achieved at a very low cost per acquisition.
The “foot in the door” offer was for patients to immediately see value in an ergonomic consultation.
Approximately 80% of people that downloaded the app used both the self assessment.
Approximately 20% of these users also used the various solutions the app provides for body discomfort.
About 35% of these users that downloaded the app also signed up to hear more directly from the practice
About 20% of the users that answered various assessment questions, also signed up as a lead to hear more from the practice
To service this “foot in the door” offer, the practice owner and their team didn’t have to spend a single minute. These assessment questions and the solutions for various body discomfort were all canned responses.
In other words, the initial “foot in the door” offer was a raging success !
Nurture – Be in regular contact with these new patients.
All leads that were signing up to hear more from the practice are constantly nurtured via various methods.
Push notifications – there are several ways that the practice is staying in touch with their patients. Push notifications is one of them.
As an example, when a patient is seen using the app within the past hour (i.e. they are actually active), a push notification is sent to remind the patient to take a 2 min break and stretch every 30 mins of sitting at their desk. This has a dual purpose. First, for people that are really using the app, it keeps them engaged and helps them achieve their goals. On the other hand, if someone hasn’t opened the app in the last hour, it doesn’t bother them at all.
Does that mean that the practice is not going after these “inactive” patients? Nope !
Campaigns are set up and regular push notifications are sent to patients that have downloaded the app but are not using it actively. The practice also monitors the conversion rates of these mobile users.
For patients that have already provided their email address or phone number, they are nurtured via email/ SMS providing various occupational hazards and tips on how to avoid them.
Up-sell to existing patients
The idea was to present these initial customers with a slightly higher priced service offering that isn’t a big “ask” from these new patients.
Once we saw that people were interacting with the app and using the various self help and self assessment areas of the app, it was now time to up-sell these customers to a personalized recommendation. We called this “Ask an expert”.
Of course, for their regular practice, this would require an in-person visit from the patient or if this was being done at a contracted enterprise, the team would have to make in person visits to their offices.
Instead, this up-sell, again, required minimal inputs from both the patient and the practice team.
The patient was asked for a single picture from the side of them sitting at their desk (capturing the computer, keyboard and their feet). This allowed the practitioner to “virtually” see the patient and immediately recommend posture changes, recommend any changes to various equipment in use in addition to recommending any alternate desk/chair options.
This was a very easy up-sell as the patient had just undergone self diagnosis, already obtained a lot of tangible value from the get-go.