Adventist Health is a fully integrated health system with 20 hospitals, many in California. It owns and operates the largest network of rural health clinics west of the Rockies. Over the last four years Adventist has been on a journey from occasional telemedicine use to a more formal virtual care network, leveraging telemedicine at 22 rural hospitals and clinics with another 12 sites in development.
In a recent webinar presentation, Robert Marchuk, vice president of ancillary services, said Adventist had been working on telemedicine for several years, but didn’t have a system-wide approach until about four years ago when it started developing a vision around enhanced access to care. As the mechanisms for delivering telehealth services have improved and costs have decreased, Adventist has developed a whole portfolio of telehealth services with a focus on specific business cases, rural settings and sustainability. It received USDA grant funding and worked with both Blue Cross and the Medicaid program in California. “We got additional funding for clinics and funding for the technology,” Marchuk said. In making the business case for investment, they focused on cost avoidance and reducing readmissions and emergency room visits.
Adventist now offers telestroke services at nine rural hospitals and telepharmacy, in half of its rural hospitals. It is looking at adding post-acute care services such as chronic disease remote monitoring and partnering with provider Teladoc for direct-to-consumer e-consults.
“We want to remove barriers and access to outpatient care by interacting with patients in their communities,” Marchuk. He added that Adventist is focused on the “Triple Aim Plus" — with the Plus being about mission expansion developing partnerships with other rural facilities such as federally qualified health centers and critical access hospitals, which are in need of these telehealth services but often don’t have access to them.
Another way Adventist wants to expand its mission, he said, is by focusing on helping people stay healthy rather than just treating them in acute-care settings. That requires a better understanding of patients’ social and economic needs. In rural settings, many patients are on Medicaid or not insured. Often they have difficulty with transportation, child care and taking time off work to travel for a specialist appointment. “Keeping that care in their community breaks down the barriers,” Marchuk said. It also reduces wait times and promotes integrated and coordinated care across the patient’s care team.
There also has to be a value proposition for physicians, he said: Specialists in rural areas often don’t have the volume to keep them busy or engaged. Telehealth can augment their existing practice through additional patient volume and an expanded revenue stream. By broadening their base of patients, they can reduce overhead. “By seeing a patient in Clear Lake virtually from Los Angeles, a specialist can maximize his or her efficiency and time rather than spending time driving to rural health clinics.”
Adventist worked with telemedicine technology vendor AMD to integrate its software into Adventist’s Cerner EHR so the results of every telehealth visit is housed in the patient’s permanent record. Providers now have the ability to query a patient’s record and link it to a telemedicine consult, and then save data back into the patient’s medical record. Critical data that is collected during the telemedicine exam such as vitals and real-time, high definition images, is now sent to Cerner’s EHR.
In 2015 Adventist had 2,000 telehealth visits; in 2016 that number grew to 7,500; and this year it is on track for 11,000 visits. It has also created dashboards to track its telehealth usage volume and executives can view the data by clinic, physician, region or specialty.
One lesson learned, Marchuk said, is to take the time needed to set up the clinical work flow and do adequate training. “We got 13 specialties up and running in three months,” he said. “That was a very short time frame and I wouldn’t recommend doing that. There are gaps in communication when you do it that fast. I would focus on one clinic and one specialty at a time.”
He also recommended taking the time to integrate more closely in the markets prior to launch. He suggests identifying a physician champion and administrative champion up front, and building the program and setting expectations before launch vs. building on the fly.
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