Is the Time Now Right for Consumer Telehealth? Ochsner Forges Ahead

As consumers begin to embrace virtual care, the need to enhance the patient experience drives strategies that appeal to a new generation.

A "build it and they will come" strategy has not always worked for direct-to-consumer urgent care telehealth programs. Despite this, health systems like Ochsner Health System are moving forward with these initiatives anyway because virtual care helps meet organizational goals related to changing consumer expectations, enhancing the patient experience, and increasing access.

The timing could be on target. A new study published by JAMA on Nov. 27 indicates that the tide is changing, and consumer adoption rates are on an upswing.

Ochsner Anywhere Care debuted in November. Developed in partnership with the vendor, American Well, this consumer-facing virtual platform offers live, on-demand urgent care video visits with board-certified primary care providers for $54 a session through a smartphone app or an online portal.

A look at Ochsner's strategy provides insights into why organizations should consider incorporating these programs among their offerings, and what guard rails should be put in place to ensure a successful launch. First, a quick review the urgent care telehealth landscape:

Consumer Acceptance is Accelerating
 

Some research studies and anecdotal evidence paint a picture that's less than rosy for consumer telehealth programs.

• One study published by JAMA Internal Medicine earlier this year indicated that while fewer people were using the emergency department for low-acuity issues, they were far more likely to visit an urgent care or retail clinic than to engage in a virtual visit. The study examined data from 2008 to 2015. It's interesting to note that most data in this study is more than five years old, a considerable gap in a digital world where things can change rapidly.
    
• American Telemedicine Association CEO Ann Mond Johnson, recently shared with HealthLeaders that member adoption rates are as low as 20% among employers who offer these programs to employees.

Newer data point to a more optimistic outlook. The latest study, published by JAMA last week, analyzed private health insurance claims data from OptumLabs Data Warehouse between 2005 to 2017. As reported by Reuters, researchers at Brigham and Women’s Hospital in Boston determined:

• Overall, annual telemedicine visits increased from 206 encounters in 2005 (less than one per 1,000 people in the study), to more than 202,000 visits in 2017, or more than seven per 1,000.
   
• While the average annual compound growth rate was only 52% from 2005 to 2014, it rose to 261% between 2015 and 2017.

“If the growth rates we are observing continue, in a decade telemedicine will be seen as quite common,” said lead study author Michael Barnett, MD, MS, assistant professor at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women's Hospital, to Reuters.

Another interesting finding: During the study period, 53% of telemedicine visits were for mental health visits, followed by primary care exams at 39%. By the final year of the study, however, primary care was the most common form of telemedicine.

Patient Experience and Changing Consumer Expectations Drive Strategy
 

Like many health systems, Ochsner isn't waiting for the numbers from these studies to justify a need for its program. Instead, leaders rely on a different philosophy to drive strategy.

"Telehealth isn't a future offering in medicine; telehealth is here, and the future is now," says David Houghton, MD, MPH, medical director of Ochsner CareConnect 360, which manages telehealth solutions across the Ochsner enterprise. Houghton echoes the sentiments of those in his position at other healthcare systems who feel it's vital to operate at the leading edge of these practices.

Ochsner Anywhere Care "is in line with everything that our healthcare consumers are looking for today," says Houghton. "I won't be the first one to say this, but hospital medicine and clinic medicine have remained pretty analog in a digital world." With apps like Uber that connect people to rides within minutes, and the ability to buy items easily online without leaving home, he says that consumers expect the same convenience when it comes to healthcare.

"This is a unique opportunity for our patients to receive the right care—and the highest quality of care—at the right place, at the right time, while improving access and enhancing the patient experience," says Houghton. "Patient experience drives [everything] we do right now."

The team at Ochsner was cognizant potential challenges might exist. "We recognized that to start a new offering with direct-to-consumer urgent care, we might run into similar problems that other organizations have run into," says Houghton, "but we put several mechanisms [in place] to make it to our advantage."

Key factors included the following four elements:

1.  Build on Backbone of Long-Term Successful Program

Ochsner has been involved in telehealth for two decades, initially offering consults for pediatric echocardiograms to other sites across the state. About 10 years ago, the system launched a telestroke program, now serving 350 patients each month to 80 partner organizations in the Gulf South region.

The robust array of 120 virtual services available today through Ochsner CareConnect 360 also includes teleICU, telepsychiatry, and a variety of adult and pediatric services, as well as specialty diagnostic consultations. Last year the program handled 140,000 telemedicine sessions.

"We felt that the next type of encounter for us to [address] would be direct-to-patient encounters, says Houghton, who also serves as Ochsner's chief of the division of movement disorders. "It builds on the background of what Ochsner has done in the telehealth world."

2.  Partner with a Vendor for Technology and Staffing

To avoid pitfalls and "inconveniences that have been associated with other homegrown products," says Houghton, Ochsner decided to partner with a vendor, choosing American Well for "the technology, as well as a deep bench of providers available through the company's online care group."

Rather than train its own physicians to provide telehealth care as the program launched, Ochsner relied on American Well's board-certified physicians. The system automatically routes to physicians licensed to practice in the state where the caller is located, providing access throughout the United States. By slowly phasing in the system's own physicians, they have the flexibility to determine what staffing model will work best.

"Right now, it's 100% staffed with [American Well's] online care group," says Houghton. "In the coming weeks we're going to be folding our own physicians from our urgent care group into it." Because the vendor's physicians also will continue to take calls for the foreseeable future, service can continue 24/7 without disruption to patients calling in or to those visiting urgent care facilities. Staffing options include:

• When activity is slow at the urgent care facility, Ochsner providers could maximize productivity by picking up calls
   
• When call volume is high, a certain number of Ochsner providers might be dedicated to taking calls

Regardless of how it is staffed, there are no plans to house Ochsner Anywhere Care providers in one facility. Physicians will take calls and continue to see patients at the system's 14 urgent care centers, reducing the need for additional overhead and facilities expenses. "I think that's the beauty of telehealth," says Houghton. "It's it's connecting providers remotely with patients remotely."

3.  Pilot the Program with Employees and Their Families

Before launching Ochsner Anywhere Care to the general public, the program was opened to employees and their families as part of the system's health insurance package. "We almost literally went door-to-door helping people get signed up across our campuses," says Houghton. "It had a very personal feel." As employees reported their positive experiences, news spread by word of mouth, resulting in an initial influx of calls.

Beginning the service this way also helped build confidence in the program. "We felt very comfortable with the quality of the service," he says, "and that gave us a great experience over the first couple of months."

4.  Develop a Marketing Campaign to Drive Awareness, Reach Millennials

To develop awareness and prompt consumers to download the app and initiate calls, the health system conducted a print and digital advertising blitz, along with a social media push. Houghton even participated in a Facebook Live event, with participants submitting questions for him to answer in real time.

The campaign was "critical" to the successful launch of the program, he says, and the digital and social media components were essential to reach the millennial and Generation X consumers they were targeting, he says.

About 75% of callers are between the ages of 18‒50; the majority are 30‒39 years old. These figures align with the recent JAMA study, where the average age of users from 2015 to 2017 was 38 years old.

Because the program is so new, Houghton was not ready to release the number of callers to date, but considers it a success not only because volume continues to rise weekly, but because it's helping the organization meet bigger objectives.

"We have been diligent with developing the right programs that enhance our patient experience, improve access to healthcare providers—particularly urgent care and specialists—and give [patients] the highest level of quality that they've come to expect from Ochsner," he says. "That mantra ought to be the same thing that we think of when we build a bricks and mortar program, when we partner with a new healthcare facility in a rural part of the state, or we start a telehealth program."  

By the Numbers
 

The following figures reflect statistics gathered since Ochsner Anywhere Care launched:

• Users have awarded the experience and the providers 4.9 out of 5 stars, when prompted by the app following their session.
   
• Most calls occur between 6:00 a.m. and noon, with calls continuing until about 9:00 p.m. Although physicians are available 24/7, calls are slow overnight.
   
• Most patients access the service through an app on their smartphone; a small portion use desktop or laptop computers, and some have tried a walk-in kiosk located on the Ochsner campus