JeffConnect: Building a Value-Based Care Business Model Through Telehealth

[SHSMD17 Speaker Podcast Series] Stewart Gandolf, CEO of Healthcare Success talks with Judd E. Hollander, MD, Associate Dean for Strategic Health Initiatives, Sidney Kimmel Medical College, Jefferson Health. The topic of this podcast is Dr. Hollander’s presentation at the 2017 SHSMD marketing conference on the topic titled: Building a Value-Based Care Business Model Through Telehealth.

The continuing shift to value-based healthcare has created a quandary for health systems regarding how to create future payment models. A key component of the Jefferson Health strategy is to grow a robust telehealth program—JeffConnect—representing the next step in patient-centered care. JeffConnect delivers high quality, cost effective care to patients when and where they want healthcare.

In today’s forward-looking conversation, Stewart and Dr. Hollander discuss how healthcare delivery is evolving with advances in telehealth. Their timely and insightful conversation—and the upcoming SHSMD17 presentation—touches upon:

• A trend toward increasing consumerism
• Telehealth as the future of healthcare
• Reimbursement issues and challenges
• Geographic service and established patients
• The shift from fee-for-service to value-based healthcare

The absurd concept of “going to the doctor.”

DR HOLLANDER: There is no more absurd concept than “going to the doctor.” The people who go to the doctor are people who are sick…and they are the people who are least likely to actually want to or feel like going someplace. We are not taking care of patients the way we should, and at some point, patients are going to figure out that there’s a better system.

The focus in healthcare delivery today should be “what’s easy for the patient to get the care that they need?” As we all know, and as we all do, you can go on your phone all day long and get information at your fingertips, and you can buy anything you want at any time of day without leaving your house. Yet, when we do healthcare, we think about “going to the doctor.”

What we’re trying to do at Jefferson is figure out options for patients. They don’t all need to get their care by telemedicine, but they shouldn’t all need to “go to the doctor” to get their care. So what we’re trying to do is to grow personalized programs where the patient can decide the best way for them to get their care, regardless of their medical condition.

STEWART GANDOLF: Personally, I just had my first telemedicine visit about a month ago. One of the things that you mentioned is the idea of “easiness” of care. I had a minor dermatology issue, but limited opportunity to take two hours out of my busy workday for a doctor appointment. Instead, I sent a picture to the telemedicine doctor, and in a few minutes on a Sunday, they called me, I got a prescription, and ultimately the problem cleared up. I didn’t have to drive to their office, didn’t have to miss work, it was incredibly easy for me to get care and resolve the issue. And I will still see my dermatologist in the office for other care.

The idea of consumerism in healthcare is clearly something that people want in healthcare. I recall that, the last time I had the flu, I was too sick to go into the doctor’s office. Telehealth care presents amazing and exciting opportunities.

Please help our listeners understand where we are in the adoption of telehealth. Do you feel that we are still in the early adopter phase? Where are we at this point?

DR HOLLANDER: I think we’re still in the early adopter stage. And, if you want to put on the business hat, there are two different markets. There’s the market to physicians, and there’s the market to patients. At our shop, we’ve trained every provider to be able to do patient visits.

But what you see is: one-third of the people think it’s really cool and they want to get in. One third of the people think, “Well, if I have to try it, I’ll try it.” And a third of the people are totally reticent about the idea. A large part of my job is to get the docs to try it. And for most of them, if they try it, they like it, and they find a real use for it. But until they try it, they are intimidated by it.

On the patient side, they don’t know exactly what it is. Telemedicine is so many different things right now that patients don’t understand. Most of what we refer to, as telemedicine at Jefferson is actually a video call between a doctor and a patient. And that mirrors what patients do in an office visit. And for someone who is sick, we need to get the word out to patients how it is far easier for them to do a video visit.

STEWART GANDOLF: You mentioned the doctor side of telehealth. And our podcast listeners know that convincing doctors to do things is a real issue. We need to find the ones that support and can become involved. And top leadership in an organization is vitally important. Do you feel you have enough early adopters who are embracing this idea?

DR HOLLANDER: This is a top-down initiative. If this was Judd sitting in an office trying to convince people, it probably wouldn’t work well. But our CEO & President, Steve Klasko—this was part of his vision. This is front and center to our strategy going forward [at Jefferson]. We believe this is the future of medicine.

I don’t know that we could have predicted where this would be most successful. It has been really successful with asthmatic patients. And, [this has been surprisingly successful] with lacerations, sprains and strains. There are times that I do things that are not definitive care, but are unbelievably useful to the patient who’s calling.

STEWART GANDOLF: Sometimes, surprising things happen. What are some of the other things that apply…and when does this make sense?

DR HOLLANDER: It makes the most sense when the patient wants it to make sense. We’re doing nutritional counseling, we’re doing diabetic counseling, we are doing pre-admission testing, we’re doing post-op care, and we’re doing appointments with every provider in every specialty. And the challenge is convincing doctors.

So—you said this beautifully before—it’s not “telemedicine or not telemedicine,” it is telmedicine-enhanced everyday patient care. I think that when we look at telemedicine as part of the care delivery system, rather than a separate system, we will be better off.

STEWART GANDOLF: Let’s talk about the big issue of reimbursement. Tell us about your experience.

DR HOLLANDER: Reimbursement is horrible. Payors are always going to drag their feet when there’s something new. In my personal opinion, if I can deliver the same quality care, then I should be paid the same amount no matter how I deliver that care. We believe here that, as we move to a more at-risk patient population and more value-based care, that telemedicine will have greater valuable. We expect the reimbursement climate to become more favorable.

It’s a challenge. We align the strategy for what we want to achieve with the climate that’s out there. We have done a lot of telemedicine visits that have not been reimbursed. But we’ve also done a lot of telemedicine visits where we’ve provided better patient care and we’re hopeful that some of that comes back to us in downstream patient loyalty, and the likelihood that they’ll come back because we’re the most convenient. And part of that comes back to us because the program is in place.

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This article and podcast are part of Healthcare Success’ continuing education series featuring speakers at AHA’s Society of Healthcare Strategy and Market Development, 2017 SHSMD Connections, Orlando. Conference attendees will want to attend Dr Hollander’s presentation at 9:15AM, Monday, September 25.