This first appeared in Health Data Management.
As the cost of healthcare increases and access decreases, hospitals and healthcare providers are searching for alternative methods of care delivery to supplement the existing care pathways. Over the last decade, telehealth technologies have emerged as a means to solve many of the concerns around access and cost.
Despite various barriers to growth – from reimbursement and regulatory barriers, to concerns around adoption, or lack of evidence to support the effectiveness of telehealth programs—data indicates that telehealth adoption is on the rise and shows no signs of slowing down.
As investors continue to fund the development of telehealth technologies, the number of hospitals using telemedicine is also increasing. According to the 2016 HIMSS Analytics Telemedicine study, about 45 percent of existing hospitals use some form of telehealth, which is expected to increase to about 53 percent by 2020. Still, many healthcare providers across the country are struggling to demonstrate both the financial and clinical value these programs bring to their hospitals and patients.
So the questions remain: How do we make telehealth pay? How do we ensure that the funding required to support a telehealth program will actually drive financial value for the hospital and improve clinical outcomes? In other words, what can we do to ensure its success? This then leaves many care providers who are hoping to launch a successful telehealth program wondering, “What approach should my organization take to build a successful telehealth program?”
With these questions in mind, we developed a four-step process to help companies achieve successful telehealth programs.
Step One: Define and agree on what success means to your organization
A number of studies have demonstrated the clinical value of telehealth programs to hospitals and care providers—increased patient throughput, lower total cost of care for patients, fewer hospitalizations and higher utilization of less costly healthcare providers. However, the ability to demonstrate financial value for your organization must be paramount.
Without a target ROI or a large enough population, there often isn’t enough data to support “success.” For example, imagine a $40 million tele-stroke program that saves 10 additional patients per year, but lacks the capacity to save more. Is that successful? Maybe, but it depends on how success is defined and what the goal of the program was in the first place.
As such, it is critical to define what success means for your organization before you begin the program. For some, success may mean “significant” cost savings, yet for others it may be “improved” clinical outcomes. But what does “significant” or “improved” really mean? These must be clearly defined, quantified, and agreed with leadership up front to ensure program success.
After success is defined, organizations should determine how they will measure that success. This criteria checklist should not be over-engineered, but achievable and measurable in order to track progress and correct course along the way. To that end, the use of metrics will be key in order to shape the story you are trying to tell and also show by how much a clinical outcome or financial marker has improved.
Step Two: Develop a clearly defined strategy
Hospitals must develop a clearly defined telehealth strategy that is aligned with their people, processes and technology capabilities. The strategy must first carefully define the problems the telehealth program is meant to solve, such that these solutions are easy to refer back to and measure. Equally important is the alignment of the telehealth strategy with the overall strategic goals of the organization.
To that end, a clearly defined scope is key, including population and use cases. Start small and focus on quick wins, with the goal of expanding scope as the program matures. You must also ensure that any changes to the people, processes and technology underpinning the telehealth program are realistic and achievable. Think through the technology requirements, possible organizational changes, impact on provider workflow and provider training. For example, is this a major change for the organization? How will the technology impact provider workflows? Can providers be easily trained or will it be cumbersome, causing resistance?
Step Three: Identify and engage ALL stakeholders throughout the program
Stakeholders and key participants must be engaged early on and throughout, as building trust is key to harnessing support for the program. For instance, providers operating the telehealth program must buy into the technology and believe it will improve patient care. As such, their workflow cannot be negatively impacted, especially during early stages. Simply put, if the people who are meant to use the program are not part of the design and development, it is likely going to fail.
Still, engaging providers alone is not enough; consider all impacted parties and gather feedback from them throughout the design of the program. This includes nursing staff, medical staff, administration, hospital leadership, patients, etc. Furthermore, some of the more powerful stakeholders (e.g. leadership) should feel–to some extent–like the program design was their idea. This way, they will feel more compelled to bring the necessary resources to correct course if things go awry. Accordingly, organizational awareness and education about the program will be essential to its success. If affected staff and participants are left unaware of the changes to the traditional care processes, there will likely be resistance. Leadership must get involved early on to perpetuate enthusiasm for the program. Make sure there are no unhappy individuals, who may ultimately destroy the culture of change that is necessary to drive success. Don’t let one bad seed spoil the crop.
Step Four: Don’t forget about cultural impact
Finally, and one of the most overlooked requirements for success, is to ensure the existing culture is preserved, regardless of the program size. While some degree of change is inevitable, find out what really matters to your doctors and medical staff and make sure those qualities are maintained. Even small and seemingly insignificant changes can have a significant impact on smaller organizations. For example, if you are planning to move a psychiatry practice entirely to tele-psychiatry, make sure that the staff and the patients being treated want this, or will at least be willing to support this. If the staff is not prepared or motivated to make this shift, the business may die. It’s not necessarily that teleradiology fundamentally won’t work, but rather the impact to culture may be received very negatively by the staff and clinicians supporting the business. Listen to your team; make sure they are on board, and if they are not, find out how you can work together to create a workforce that will satisfy the majority.
Anyone planning to develop or expand a telehealth program should consider these four steps and challenge the existing thinking behind your plan. Simply improving quality of care is not enough. To drive a telehealth program at scale, there must be an ROI to drive long-term investments.
Telehealth does have the potential to solve many concerns around access to care and healthcare costs, but the organization and stakeholders in particular must be fully bought into the strategy, development of the program, and they must see how the program will save money in order for it to thrive. Without ROI, a program will likely never become more than a really interesting pilot. It is your organization, your program, and your dollars at stake – make sure the telehealth program you build will actually pay.
Ashley Amaral is a healthcare expert at PA Consulting Group