During the pandemic, the need for behavioral health services has increased significantly in communities served by Geisinger, a health system headquartered in Danville, Pennsylvania. With a large patient population in rural areas, Geisinger has expanded its use of telemedicine to expand access and leverage the national workforce to serve them.
Today, Geisinger Behavioral Health serves more than 45,000 patients each year, with more than 80% of services provided via telemedicine.
PROBLEM
While telemedicine creates accessibility, challenges related to pre-visit preparedness remain an issue. For example, sending patient questionnaires and collecting signatures on documents such as consent forms is challenging when patients are not coming into the office.
This is largely because telemedicine visits are not embedded in the patient portal, MyChart from Epic, Geisinger’s EHR vendor, said Benjamin C. Gonzales, director of operations II, virtual care, behavioral health, at Geisinger said.
“Many pre-visit requirements, such as signing certain consent forms and completing certain health checks, have both regulatory and qualitative implications when not already done,” he explains. complete”. “Geisinger needed a way to integrate these required steps into the video visit itself to maintain compliance, enable pre-visit readiness, and reflect recorded information prior to in-person meetings.”
PROPOSE
One of the challenges in providing telehealth services at scale for the Geisinger Behavioral Health team is collecting pre-visit items that are typically collected in the clinic during registration and payment .
“Patients have the option to complete many items such as questionnaires and document signing in MyChart before telemedicine integration, but most do not complete these steps because the video visit itself is launched from a link sent to their email instead of via MyChart,” Gonzales notes.
“Additionally, many of the items presented in e-Check In were not configured to meet departmental requirements prior to telemedicine integration,” he continued. “By adding all the necessary items to e-Check In and integrating the video visit launch feature into the patient portal itself, patients will be provided with the necessary items for their visit before they are given the option to begin their visit.”
This will enable them to comply and help them with preparations and necessary information for their visit, he added.
MEETING THE CHALLENGE
Working with the health system’s telemedicine and digital engagement teams, Geisinger Behavioral Health outlined all the required elements that should be included in a video visit.
These items include electronic signatures of documents such as consents and benefit assignments, health questionnaires, copay collection, insurance verification, and shared facilities and signatures in plans. patient’s treatment plan.
“All items except the treatment plan that were presented to the patient during the eCheck process are presented to them prior to the start of the visit and are provided up to 14 days before the visit,” explains Gonzales. visit”. “Once these items are completed, the patient will have the option to begin the visit, ensuring all required items have been completed prior to the visit.
“After launch, patients and providers are both provided with the Teladoc telehealth provider user interface, which is identical to the interface used prior to the integration,” he continued. Go to MyChart”. “After their visit, providers can share a copy of the patient’s treatment plan through specialty care plans in Epic EHR.”
Patients can also sign treatment plans, thereby allowing compliance with state regulations.
“Finally, all items not required by regulators and behavioral health payers were made optional for patients to complete,” Gonzales said. “However, the level of completion remained high as all items were presented prior to the visit in the same environment from which the video visit would be launched.”
RESULT
More than 50,000 patients completed video visits via MyChart in the first five months of the pilot. More than 88% of patients were able to successfully complete video visits after being integrated into MyChart, higher than pre-pilot measures.
“Since going live, 96% of patients have completed electronic signatures of required documents, up from 66% at the start of the pilot,” Gonzales reports. “This has made our team’s compliance efforts significantly more manageable.
“In addition to completing the electronic signature of required documents, 81% of patients completed all components of E-check In, up from 18% from the start of the pilot,” he continued. ”. “This includes payment of copays, health questionnaires, demographic updates, and insurance verification.”
Finally, 94% of patients now have an active MyChart account, up from 81% at the start of the pilot.
Gonzales notes: “It is estimated the system generates $96 in cost avoidance and value for each patient participating in MyChart; this is mainly due to reduced phone calls, postage savings fees and reduce the likelihood of missed appointments”.
“With a 13% increase in the number of patients activated on MyChart, we estimate savings of more than $560,000 from this pilot program,” he said.
ADVICE TO OTHERS
For organizations considering this type of integration, think carefully about what components of the pre-tour experience should be added and required, Gonzales advises.
“While they may save time during the exam, the patient may be overwhelmed and can create delays in the start of the exam, leading to patient dissatisfaction,” he said. “It is important to consider the support structure for patients and providers who need support accessing, using, and activating their patient portal.
“If possible, patients should be allowed to access these functions without activating an account,” he concluded.
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