The successes – and pitfalls – of using telehealth for home-based primary care
Home-based primary care allows individuals with chronic conditions – especially older people – to stay in their homes longer, so reducing hospitalization rates and improving quality of life. As the COVID-19 crisis has made evident, telehealth can be a useful tool to help connect patients with services remotely.
However, experts say it is vital to consider the capabilities of patients when trying to implement an at-home care model – and the capabilities of their caregivers.
"It wasn't perfect, but we did learn a lot," said Rachael-Linn Spooner, vice president of clinical transformation at Northwell Health, in an American Telemedicine Association 2020 deep-dive session on employing telehealth for primary care.
Throughout 2018 and 2019, Northwell Health piloted small-scale programs in partnership with the Gary and Mary West Health Institute Collaboration to bring medical services to the homes of their patients virtually.
As New York's largest healthcare provider, Northwell already dispatched healthcare providers to homebound individuals in Manhattan, Queens, Nassau and Suffolk Counties. The average age of patients receiving house calls is 85; two-thirds have multiple dependency needs for activities of daily living, such as bathing, toileting and eating.
Providers were able to see about six such patients per day, panelists noted, often with multiple hours of driving time.
To allow for more patient outreach and increase daily efficiencies, Northwell started small programs connecting its existing patients with virtual care.
For its first program, a direct-to-patient model, Northwell social worker care managers used Amwell telehealth technology to connect with patients via video.
"Our research staff traveled directly to patients' homes for the initial connection," explained Spooner. Providers also were trained on best practices regarding electronic health records and documentation; the Northwell team encouraged them to practice mock consultations with friends or family, and to be open to direct feedback from those loved ones.
"Everybody needs to practice," said Spooner. "The people who were good got better; the people who were hesitant built their confidence."
The results, panelists said, were subpar: Due to technical difficulties, the overall video success rate was 49%. Although three-quarters of patients expressed the highest degree of satisfaction with their visits, only 23% of social worker care managers did.
Such technical issues have been brought to the forefront as COVID-19 has continued to necessitate reliance on telehealth. Multiple lawmakers and industry leaders have drawn attention to the need for increased broadband access, particularly in rural and underserved communities.
Northwell found a greater degree of success with its second program, which dispatched emergency medical technicians from Northwell Health System's EMS agency with three or more years of experience to act as in-person liaisons between physicians and in-home patients.
"It is definitely helpful to have someone there who understands technology, who can troubleshoot with you," said A. Camille McBride, research coordinator at Northwell Health.
"I like that I can touch 10 patients instead of five in one day, and I can see them on my own rather than relying on someone else's assessment," said one provider quoted in the panel presentation. "I know their baseline and when they call, I send the [mobile telemedicine technicians] there."
McBride and other panelists noted that before the COVID-prompted changes from the Centers for Medicare and Medicaid Services, Northwell was not seeking reimbursement for MTT services.
"This was part of a population health strategy," said Dr. Karen Abrashkin, medical director of the House Calls Program at Northwell. It was, she explained, "to expand the care we were providing and to lower the cost of delivery."
Given the enduring nature of the pandemic, the future of telehealth remains an open question across multiple specialties. But, McBride said, it's vital to remember the needs of your patients as a whole.
"This model may not work for other practices and programs," she said. "It's not a one-size fits-all model."
Kat Jercich is senior editor of Healthcare IT News.
Healthcare IT News is a HIMSS Media publication.