Executive Perspective: Video is not Virtual

Video is not virtual
Discover emerging technologies that will ramp up your telehealth program

By: Mike Rhoades, CEO

To most, telehealth means video – and there is a lot to say about that. My colleague Jill Lineberger recently shared several blogs that tap traditional and emerging technologies to offer innovative, and potentially efficient, methods of patient engagement.

But let’s think about what may be termed the standard process, pre-pandemic. If we break down the mental health and/or substance-use clinical encounter from an operational lens (or any medical encounter, writ broadly), it typically goes like this:

• Pre-Visit Engagement/Orientation:  The clinician or their representative(s) deliver appointment reminders, conduct triage, collect payment and clinical information, and share appointment expectations (“Dr. Smith wanted me to remind you to bring your daily mood log to your next appointment.”)

• Discovery:  Prior to or during the session, the clinician/rep “catches up” with the happenings of the patient.  Much of this data collection is rote, with the caveat that clinicians also use this moment to measure verbal and non-verbal cues for risk assessment and screening.

• Discussion/Practicum:  The meat of the encounter, in which effective clinicians use a multitude of patient-optimized modalities (lecture, role play, scenario planning, etc.) to convey information (including self-discovery) and help the patient apply knowledge.

• Aftercare Instructions:  Under the guidance of an overarching plan of care, the clinician and patient agree on a set of tasks and homework that can be conducted in the absence of the clinician to facilitate learning.

• Crisis Planning:  Effective clinicians routinely reassess whether newly discovered information warrants a revised crisis plan, and typically remind the patient their options in the event of a behavioral health crisis.

• Payment, Scheduling, and Logistics:  The clinician/rep collects co-pays/payment, schedules the next appointment, and summarizes any instructions.

I have no doubt there are variants to this breakdown (and I have skipped the documentation and UM procedures for simplicity). My goal is to draw attention to those functional tasks that one might consider “low-value” tasks ripe for automation and to set the stage to think about virtual health, rather than simply “video” health. For all the value video brings to telehealth, virtual health is much bigger and includes tools such as Remote Patient Monitoring (RPM) and Remote Patient Engagement (RPE). Both RPM and RPE are often misconstrued as a Bluetooth scale or FitBit, selling short the broad applications of passive and active smartphone technology to track, engage and support our patient.

 As I am sure you have heard, both Android and Apple have shown the strength of passive tracking by hot-spotting potential COVID-19 transmission sites. That same passive RPM is also being used, for example, as part of a social isolation reduction program in an assisted living community. Certainly we could ask the clinician to call the patient daily (or perhaps several times a day) to orally screen for loneliness, but the cost-benefit ratio of the manual labor would probably be upside down.

Consider RPE applications in our outpatient visit scenario above: An RPE app loaded onto a patient’s phone during the initial encounter could include a care/crisis plan along with daily and weekly tasks. The patient could, as an element of treatment, be prompted to share daily “check-ins” related to mood, treatment progress and/or trigger events, the results of which are tracked and trended for clinician/patient discussion. These same apps can collect payment as well as biostats, coordinate scheduling, and push out appointment reminders, educational material, and care/crisis plans. They also provide platforms for secure care team communication and can link to video portals for synchronous or asynchronous patient communication. Operationally, RPE/RPM can automate low-value tasks, saving administrative costs, extending caseloads and allowing clinicians to practice top of license. Most importantly, they can improve the health outcomes critically important to payers and managed care organizations. Blaze Advisors has piloted a number of these tools for deployment across our ONEcare networks, producing a wealth of psychometric data for study, alerts and quality improvement.

Bottom line: Don’t see your telehealth program as strictly a mode of service delivery; discover its value as an operational and quality improvement tool.