Designing and Offering Responsive Telehealth Support

Since the beginning of the COVID-19 public health emergency in mid March 2020, primary care practices across the nation have adopted telehealth at astronomical rates. Working closely with California provider organizations, the Pacific Business Group on Health’s California Quality Collaborative (CQC) designed technical assistance webinars supporting primary care practices rapidly implementing and optimizing telehealth to care for patients unable to be seen in-person during the pandemic. CQC’s work highlighted significant challenges providers are experiencing, as well as lessons on how to maintain telehealth gains in the future.

What Provider Organizations Need Today

To better understand operational needs and challenges after several months of telehealth use, CQC conducted a survey and interviews with five primary care provider organizations representing 700 providers. Three takeaways emerged:

1. Providers reported their top concern for the future is addressing patients’ care deferred during shelter-in-place orders
2. 100% of the five provider organizations representing over 700 primary care clinicians surveyed think primary care telehealth visits will increase in next 6 months
3. Practices are likely not able to take on “optional” operational improvements this fall as they recover and also prepare for later COVID-19 waves

Lessons from Designing Responsive Telehealth Support

Throughout the early months of the pandemic, CQC hosted regular expert webinars and curated a COVID-19 resource page for primary care provider organizations. Our team observed five key learnings that quality improvement organizations should consider when designing telehealth support, which we shared with national peers on a recent webinar for the Network for Regional Healthcare Improvement:

1. Telehealth implementation can happen very quickly.
   Most provider organizations who reported launching telehealth capabilities during the months of March and early April had, prior to the pandemic, been delivering very little care virtually.
2. Most providers and patients like telehealth.
   The rapid adoption of telehealth proved popular with both providers and patients. In a CQC webinar poll, 73% of providers were satisfied or very satisfied with telehealth, and most reported that they and their patients wanted to continue using telehealth into the future.
3. Most care can be delivered virtually.
   Even before the pandemic, some primary care practices are successfully offering 95% of their care virtually, including for high-risk patients. For recent adopters of telehealth, provider organizations have found that they are able to conduct many types of visits, especially chronic condition management, virtually.
4. Billing and reimbursement are challenges.
   Providers are worried about keeping up with changing guidelines and getting paid, especially when in-person revenue is down. While there have been promising signals from the federal government, the precise future of telehealth reimbursement remains unclear.
5. Providers must ensure patients are equitably able to use virtual care tools.
   Providers are concerned about equal access for their patients for technology and broadband. In the course of the pandemic, we’ve seen some viable solutions that clinicians can practice, which include: asking patients their preferences between audio or video visits, using patient advisory bodies to incorporate feedback, and simplify workflows whenever possible.

The Opportunity: Join CalHIVE

Using this feedback, this fall CQC is launching a technical assistance program, CalHIVE, which will support provider organizations as they re-design primary care delivery for people with chronic conditions by fully leveraging the capabilities of virtual care. California-based provider organizations are invited to participate in CalHIVE and can learn more on CQC’s CalHIVE website. Interested organizations can reach out to Michael Au at mau@pbgh.org to learn how CalHIVE can help their organizations improve virtual care to help their patients.