Some Problems in Virtual Care Delivery
I am a product guy in digital health, and I really like it. In the past few years, there is a pattern of things that I have noticed, especially when trying to deliver care virtually and I wanted to write some of them down in case it’s helpful.
I hope this inspires some folks to go out and find some good solutions that can be scaled not only to fancy schmancy start ups, but to doctors, nurses, and other providers everywhere who want to deliver some of their care virtually
Checking Eligibility for Care
What does this mean?
Actually, two things:
Has a carrier or employer sponsored the person who is trying to use the app?
Is the specific service the person is trying to use covered by their insurance or employer
Why is it a problem?
Clearinghouse APIs can have mixed reliability & customer service
Flat file (eg. 834) transfers are not real time
Employers don’t have a standard way to share employee information
If contracts vary, we have to keep track of different sets of services for different populations
Managing schedules across states
What does this mean?
As a nationwide telehealth operator, many providers will be licensed in many states, and they have to manage schedules for patients in all of these states.
Why is it a problem?
The legacy EHR infrastructure was designed for physical office locations, where providers have to be in one state at a time. For us, that made it so we had to maintain several schedules per provider and keep track of it without sufficient tools for doing so.
Hopefully next generation EHRs like Elation and Canvas will take this into account.
Maintaining relationship with a provider, while offering timely care
What does this mean?
For most non-urgent things, a patient will often to prefer to ask questions to a doctor they trust and have established a relationship with.
For urgent medical issues, patients will want an immediate response, and their usual provider might not be able to answer
Why is it a problem?
It’s not always easy to immediately parse what a patient will want in text-based communication without adding clicks or other annoying user experiences
Giving Patients Quality Referrals
What does this mean?
If your clinicians are unable to fully diagnose or treat a patient’s complaint, they will refer to a specialist, which can be any of hundreds of specialties, and in a geography that is close to the patient. It also means that the patient gets ‘quality’ care
Why is it a problem?
It’s difficult to provide referrals at scale for a few reasons:
Patients may have different insurance networks & local specialists are only in-network for certain plans
It’s difficult to compile a list of specialists across all the specialties & geographies of your patient population
Checking availability, answering questions and scheduling appointments varies widely in user friendliness for patient or the referring organization.
It’s hard to define ‘quality’ in a way that you build a network of somewhat consistent and positive patient experience and outcomes.
Pleasing Payors vs. Patients
What does this mean?
Keeping patients happy and healthy is obviously very important to any health care organization
However, the patient usually doesn’t pay directly for the care they receive. Instead their insurance or employer will usually pay
Keeping payors happy is often very different from keeping patients happy, as payors want to pay as little as possible.
Why is this a problem?
As strange as it might sound, a care delivery organization can get in trouble by spending all their energy in producing a great patient experience. Great experiences drive up cost, which payors don’t like
To keep payors happy, you have to track and report on a lot of metrics
You also have to be savvy in negotiating a contract, and enforcing the contract, otherwise payors may try not to pay you what you think you are owed.
Documenting & billing extended text-based encounters
What does this mean?
In traditional care, patients see a doctor for an appointment with a defined start and end time. The patient will probably leave with a diagnosis and some other kind of thing like a prescription, a lab order, a referral, etc. etc. that are all coded for and reported for billing the payor
In virtual care a patient might write in to a chat application or email instead, blurring the defined start and end time, and making an ‘encounter’ more difficult to define
Why is it a problem?
It’s a great user experience for the patient to have a continuous chat with a doctor over an undefined period of time and addressing all their issues. BUT
It’s hard to define what an encounter is for billing, and to assign the right billing codes to it.
Conclusion
There are definitely a lot of other problems I missed. I’d love to hear about them if you discover them.
Thanks!