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Sep 1, 2018 · 3 min read

Back to the Future: Outcome-Driven & Team-Based, The Time for Telehealth is Once Again Now

Contributed by Iris Berman, RN, MSN, CCRN-K, Vice President of Telehealth Services, Northwell Health

For more than 15 years, telehealth has been an effective and efficient modality to provide needed access to services across a wide range of specialties. The US Centers for Medicare & Medicaid Services (CMS) first implemented regulations and statutory provisions on telehealth on October 1, 2001, which became effective in the calendar year 2002. While progress was slow initially, CMS has continued to seek opportunities to expand the services that can be provided with this technology. CMS has also started to recognize the clinical benefit of providing care to patients via telehealth, including its ability to:

· Diagnose a medical condition in a patient population unable to access clinically-appropriate, in-person diagnostic or treatment services

· Reduce rates of complications

· Decrease rates of subsequent diagnostic or therapeutic interventions (For example, due to reduced rates of recurrence of the disease process)

· Decrease the number of future hospitalizations and physician visits

· Resolve the disease process

· Decrease symptoms impacting quality of life

· Reduce recovery time

In addition, the focus on quality outcomes and the continuing shift to value-based care has increased the need for accountability among health care organizations. Health care teams are providing patients with timelier and greater access to care, enhancing partnerships between medical specialties and multidisciplinary teams, and improving communication between patients and all care teams. While these patient-centered care models are long overdue, this new paradigm requires innovative avenues for providers to deliver care, utilizing all available tools to do so. Telehealth affords this capability.

Telehealth is here to stay, and the ways we choose to leverage it are forever evolving.

Northwell is committed to being part of this process and improving access for all patients in their communities while increasing the efficiency with which that care is provided. Using social determinants and novel approaches that connect care across the continuum, we firmly believe that patients will be better engaged and more active participants. This will ultimately lead to less waste and more customized treatment focused on health — a more proactive, value-based care model rather than a reactive, fee-for-service model.

One such novel approach can be found by looking within Northwell’s telepsychiatry program, where a multidisciplinary team works together in synchrony to care for each patient. Social workers (behavioral telehealth care managers or “BTCMs”) interview families and provide frontline resources to help maximize the efficiency of the psychiatrist and support a more informed, timelier patient encounter. The program has decreased wait times to be see a psychiatrist by 80% in our very busy emergency departments. In many instances, the patient can be safely sent home, with support services alerted to the need for follow-up care in an outpatient setting, which is more appropriate and less costly. For those that do require admission, time-to-treatment is routinely decreased — thus improving satisfaction and outcomes for both patients and staff.

Northwell has many telehealth programs, including: Telestroke, Teleneurology, Telehospitalist, eSNF, and a number of evolving programs in the direct to consumer world. Our goal is to use this modality to improve the time-to-care across the entire continuum. Nurses, physicians, advanced care providers, social workers and genetic counselors are all adopting telehealth. And soon, it will be part of our medical and nursing school curriculum. Telehealth is here to stay, and the ways we choose to leverage it are forever evolving.

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A forum dedicated to virtual care and telehealth, including the models, practices, and technologies accelerating delivery system transformation.