PrimaryOne Health is a federally qualified medical center located in Central Ohio and one of the largest FQHCs in the state.
PrimaryOne Health provides comprehensive primary and preventive health care services in accordance with the U.S. Department of Health and Human Services Primary Health Care requirements for a Qualified Medical Center Program. Federal for residents of central Ohio who are uninsured, underinsured, and medically underserved.
Prior to the pandemic, PrimaryOne Health was working on regulations that prevented routine telemedicine visits from patients. Some regulations allow visits from one physical location to another; however, in-person visits do not help address any of the patient’s urgent care needs.
Successful pilot projects
Chief IT Officer Jeff McGlade said: “PrimaryOne Health has completed pilot projects with the model of previous regulations. “Pilot projects have been successful, but visits are free and require patient support. However, as the pandemic began, the rules and needs of care changed accordingly. way that allows us to quickly roll out telehealth services.
He continued: “As the pandemic began, in-person visits were slowed and in some cases stopped due to the state of emergency, social distancing and patient risks. “When Ohio declared a state of emergency, PrimaryOne Health received ongoing updates from various organizations.”
“To implement the telehealth model correctly, it is important that medical assistants, nurses, LPNs, and other support staff fully participate in the admissions process to ensure make sure the patient has a smooth examination.”
Jeff McGlade, PrimaryOne Health
The National Association of Community Health Centers, the Ohio Association of Community Health Centers and payers are updating changes and even draft changes to PrimaryOne Health input.
“Regulations began to change rapidly, and on March 20, 2020, Ohio issued its emergency telehealth rule,” recalls McGlade. “After realizing the need, wanting it, and even trying out telemedicine pilots for years, it suddenly became possible very quickly.
He continued: “The rule allows telehealth services to be deployed and delivered in the way that has always been envisioned. “A telehealth team was quickly formed to digest and handle the rapidly changing regulations, and initiated a telehealth program to ensure patient care. high-quality personnel.”
Developing a telehealth program
During this same period, PrimaryOne Health leadership and the board created a contingency plan to ensure patient accessibility and the health of the organization. The plan tasked the team with developing a telehealth program, implementing any technology, training all staff, and transitioning to primarily telemedicine.
“The team quickly developed the plan and it went live,” says McGlade. “One week into operation, PrimaryOne Health has gone from zero telehealth visits to an average of 75% of all visits completed via telehealth. We’ve got able to maintain this excellence throughout Ohio’s stay-at-home order, resulting in more than 51,000 total patient telemedicine visits in 2020, or 38% of total visits.”
This is a significant increase from 2019, when telehealth accounted for 0% of chargeable visits.
“During this time, PrimaryOne Health has attempted to provide telehealth across all available specialties,” McGlade reported. “This would not have been possible without a regulatory change and the ability to transition the amazing support staff almost overnight into a support role in the remote healthcare workflow. .
He continued: “Specifically, to correctly implement the telehealth model, it is important that medical assistants, nurses, LPNs and other support staff are fully involved in the process. admission process to ensure a smooth patient visit”.
Payer focus
The telehealth team’s top items are accurate billing, streamlined workflow, and technology to remove barriers for patient-friendly and easy access. With payments, the team was intensely focused on which payers were reimbursed, and how much and how to accurately record visits.
“Billing guidelines have been developed that cover each payer and are used to customize telehealth shortlists in the EHR to ensure certain documents are properly documented,” said McGlade. corpse”. “This process has proven to be a repeatable method that the team has used on other projects such as a remote patient monitoring program.
“The workflow is generated from the checkout instructions,” he continued. “The workflow started with the planning team, then moved to the medical assistants to do the intakes, and finally with the clinical staff. At the start of this project, the majority of the staff members. Clinicians are all staying home because of pandemic issues related to childcare and have had to temporarily close some clinics for face-to-face visits and other issues.”
Some staff have been redeployed to support telehealth processes. The team found that the best procedure for patients was to do an intake before the support staff visited and then let the patient know what to expect for the telehealth visit. The team realized that the process needed continual tweaking and improvement and quickly implemented them after each meeting.
“The use of technology is critical to removing patient barriers, and new systems have been rapidly adopted and deployed,” notes McGlade. “After the transition to telehealth, the team quickly determined that clinicians had to visit physical locations weekly to do paperwork and sign any controlled prescriptions. Within weeks, Electronic Prescribing for Controlled Prescriptions was rolled out to speed up receipt of prescriptions to pharmacies.
He added: “It has been determined that to implement telehealth with a single patient base, a telehealth platform that does not require a patient portal is required. “The platform allows PrimaryOne Health to send the patient a text message with a link to initiate a video visit. An additional messaging platform has been deployed and has been deployed by the call center and health department. healthy behavior applies.”
Patient and texting
The platform allows patients to text a primary number, chat with a person directly on the website, and initiate video visits. Behavioral health uses this to message their patients and to initiate video visits.
FQHC uses provider Blue Stream Health for telehealth and provider OHMD for messaging.
“In early 2021, PrimaryOne Health began a program to monitor patient blood pressure remotely, in addition to ongoing telehealth efforts,” McGlade recalls. “Using previously learned billing process and research methodologies, a blueprint was developed. The team ensured that technical barriers were resolved for the patient.
He continued: “A platform was found from a company called UnityPopular Health that, like a telehealth platform, does not require a patient portal account. “The platform also eliminates the need for internet access for patients.”
PrimaryOne Health has implemented a blood pressure cuff with built-in mobile connectivity and automatically uploads the results to a monitoring system that feeds into the patient’s chart. Through this platform, patients can easily reach out via text messages reminding them to read and check for issues they may have.
A successful program
“The program was successful and allowed PrimaryOne Health to add patients to the program, regardless of whether they had a patient portal account, or regardless of whether they had an internet connection,” explains McGlade.
He continued: “Other groups considering telehealth should start with billing and regulations, understanding needs/needs, barriers to staff and, most importantly, barriers. obstacles that the patient may face.
By the end of May 2020, PrimaryOne Health began a gradual and safe transition back to face-to-face visits to meet patient needs. The transition places requirements on reception staff that directly impact telemedicine visits.
As staffing needs and staffing shortages increased, PrimaryOne Health switched to primarily face-to-face visits in November 2020. The switch back to face-to-face visits led to the current practice. is about 15% of telehealth visits compared to face-to-face visits.
“A similar version of the original telemedicine visit now exists,” notes McGlade. “Only registered patients can be seen via telehealth and are not required to complete any admissions prior to the visit. We could have eliminated the admissions process, but at the cost of doing so. must limit the types of appointments we can provide with telehealth .
He continued: “In the medical field today, telehealth is a popular option with long-term practitioners with a group of patients. “Someone looking at the full schedule four days a week can fill a fifth day with telehealth compared to a practitioner doing most of the telehealth. Distance has also become a way to help with HR issues.”
Still very popular
Some practitioners have been deployed without staff to assist with telehealth in ways that were not possible before. In addition, telehealth remains a very popular option with the behavioral health team, whose members have become very knowledgeable in how they care for their patients.
“As an FQHC, we have to make sure we are looking for barriers to patient care,” explains McGlade. “Removing barriers to our patients by ensuring that everyone can access healthcare remotely outside of the portal and that any patient can Join our remote patient monitoring program, which is important to our ongoing efforts.
He added: “Not all patients have a smartphone with Bluetooth, with a patient portal on it for a blood pressure monitor. “By addressing typical barriers across the globe, we can still interact and treat patients in ways that make it easy for both our patients and our clinical staff.”
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