- UCHealth isn’t making money on its urgent care telehealth service just yet. But that’s OK with the Colorado health system’s medical director of virtual health.
“You can imagine this was not a popular program with primary care doctors,” said Christopher Davis, MD. “But at the same time this is a need, and we have to serve it.”
Speaking at the MaineHealth Telehealth Symposium this week in Portland, Maine, Davis described the eight-hospital health system’s roughly year-old program as an exercise in making tough decisions and learning from mistakes. And to those who think a virtual urgent care service is easy to plan, set up and launch, Davis could have laughed all day. Or at least chuckled.
“It’s a loss leader,” he pointed out, “but it’s an investment in innovation.”
Developed through the health system’s patient portal, Davis said UCHealth learned on the fly as it sought to funnel non-urgent, acute care patients away from the ED or a trip to the doctor’s office. For a $49 fee, the patient logs in online and fills out a questionnaire; the case is reviewed on the back end by the virtual care department, who contacts the patient within minutes for online treatment.
Virtual visits last 6-8 minutes, Davis said. The hospital handles about 50 a day, often concluding with a prescription filed online by the physician directly to the patient’s pharmacy.
“We don’t have vital signs. We don’t have labs. We don’t have X-rays,” he said. This is very simple stuff.”
And yet still very complicated.
Before the platform is launched, Davis said the health system had to make some tough decisions. He listed eight key considerations in developing a telehealth program:
- Build or buy. Should the health system buy a service from a vendor like American Well or MDLIve, lease a branded service from a company like Carena, or build its own platform? UCHealth chose the latter, Davis said, a decision that might have been costly and clunky in the short term but will prove beneficial when the health system smooths out the kinks and expands its options.
- Staffing. Should a health system uses its own people to run the service or contract out? Davis said UC Health chose to stay in-house, with the idea that its patients should be seen by clinicians they know.
- Who owns it. Is the virtual care platform the responsibility of one department, such as the ED, or should it be a multidisciplinary service?
- Shifts. Should the health system create a dedicated schedule of shifts or crowdsource the shifts? Davis said UCHealth initially relied on toxicologists to run the service, since they were always on call, but has since moved to ED staff.
- Compensation. Are clinicians paid per shift or per case?
- Scope. Is the service designed for one-off visits? Can it offer triage services for more complicated cases or serve as a springboard for diagnostic services?
- Target population. Will the service be offered to employees and their families, certain groups like chronic care patients, or for post-discharge or post-ED patients? Will this become a direct-to-consumer platform serving the general public?
Those final two considerations figure prominently in how a health system might want to design a virtual urgent care platform for expansion. Should the platform be designed to treat patients on an episodic basis, or should this be part of a continuity of care? Episodic care might look right for a consumer-facing service, but if a health system is looking to attract and keep new patients, it should find a means of keeping them in the system after that encounter.
Likewise, if a virtual urgent care service is used for chronic care patients or other populations, how should that platform integrate with the electronic health record or incorporate elements of remote patient monitoring?
Davis said an analysis of the service to date finds that the most common cases seen are urinary tract and sinus infections. In addition, he said, women patients outnumber the men by a 2:1 margin, a vast majority are insured, and the platform is most often used during the daytime – especially around lunch – with little business through the night.
In deciding what to treat. Davis said UCHealth came up with the typical list of illnesses and concerns that a clinician could treat online, then created an “other” category – a catch-all for patients looking for help for something outside the norm.
That’s where things can get tricky.
“It’s a Pandora’s Box,” he warned. Though it offers the health system a good opportunity to see what their patients want in a virtual care platform and can aid in planning for expansion.
Davis also noted that, while these platforms often result in very high patient satisfaction scores, not everyone will be happy or understand what the service is for.
“We had some people who were not satisfied,” he said. “They registered under ‘other’ and they wanted, like, their appendix out, virtually.”
Which brings to mind another challenge: Managing patient expectations.
Looking back on the journey so far, Davis outlined five keys to success:
- Make this a part of the organization’s strategic vision.
- The technology isn’t the most difficult part of the platform – culture change is.
- Spend extra time on the process.
- Reward and incentivize early adopters.
- If at all possible, have a dedicated staff.