Kayla Cousineau

Telemedicine’s moment is here

February 05, 2021
by Gus Iversen, Editor in Chief
Telemedicine has been a topic of interest in healthcare for many years, but the COVID-19 pandemic was a catalyst for embracing and implementing it. There are many advantages that come with saving a patient from a trip to the facility, but perhaps none greater than avoiding possible contact with an infectious and potentially deadly disease.

We checked in with Kayla Cousineau, vice president of clinical operations and strategic initiatives at Allegheny Health Network to get some behind-the-scenes insight into the medical system’s own journey into telemedicine. Dr. Amy Crawford-Faucher, medical director of telehealth at AHN also contributed to these responses, which were provided over email.

HCB News: Prior to the pandemic, to what extent was AHN utilizing telemedicine?
Kayla Cousineau:
Prior to COVID, we were doing about 8,400 visits annually. Since March, we’ve done 400,000. That’s nearly a 5,000% increase in 9 months. We were also doing telehealth in just a few specialties like behavioral health or for very specific programs like telestroke. At our virtual peak in April, about 75% of all our total ambulatory volume was virtual.

HCB News: What hospital stakeholders were involved in the decision to pivot more heavily into telemedicine?
Leaders at AHN were supportive of the move to telemedicine — both clinical and nonclinical. However, this was not solely any healthcare leader’s decision. This was a survival strategy to the public health emergency and the shutdowns that were occurring. The world was rapidly changing in March and we had to change with it in order to maintain access for clinical care for our patients. It was a collaborative effort like most of us had never seen before. Our success was attributed to the fact that we all had a single priority: stand up telehealth for over a thousand providers as fast as possible. The Operations and IT partnership drove the train but many from around the health system were on board and contributed to the overall success.

HCB News: Can you share some of the initial considerations that had to be addressed prior to making the jump?
KC: Three main considerations jump to mind. First, we had to figure out which technology platform we were going to broadly use to stand up telemedicine. Then, there’s the matter of ensuring providers have the adequate devices — what devices are needed? Who does not have one and how do we get it to them? Finally, there’s the communication aspect, meaning how do you get training and education for both providers and patients? That last part was instrumental and remains ongoing.

HCB News: Any tips for other healthcare facilities interesting in ramping up telemedicine?
Engage clinical champions in telemedicine and sit down with your payer partners. The post-pandemic reimbursement model is still being defined and understanding that impact on a hospital/health system will provide insight needed to build any ramp-up plan. Physicians need to be strong advocates for both themselves and patients for payment. It starts by providers defining what is appropriate virtually versus in person, and then sharing that with the commercial payers.

HCB News: We think of telemedicine as allowing patients to stay home, but are physicians working from home too?
Some are, absolutely. We want people to be safe — that includes all office staff, from registration and schedulers to nurses and physicians. If people can do their job from home and we can reduce exposures in the office at the same time, it’s a win-win. There is a facility brick and mortar footprint question in play here in the long run. If a certain percentage of clinic visits are virtual, we have the potential to lease less clinic space and have providers rotate into a smaller footprint of facilities.

HCB News: Did you experience challenges getting seniors to embrace telemedicine?
We found that patients were flexible and willing to make the jump to virtual when their personal physicians and office staffs promoted it — and helped them navigate the technology. Office staff became IT consultants, but it has paid off. We have patients in their 80s who have become techy and see several physicians virtually.

There are technical challenges, really, within every demographic — some things are just outside the patient’s control. Our clinics did an exceptional job of helping patients get to their video visits, and it shows in the data: over 20% of our virtual encounters this year have been patients 70 years or older. To contrast, 24% of our visits occurred across patients, ages 18 to 39.

HCB News: How does telemedicine support the financial recovery and sustainability of AHN?
Telemedicine has allowed us to maintain patient access which is essential for any health system. The financial recovery needed to make up for things like reducing elective surgeries cannot be supplemented solely by telemedicine. However, telemedicine allows health systems to continue caring for patients in a capacity that we were not able to do prior to the technology existing.

HCB News: In 2021, will AHN's telemedicine strategy be different in any way?
In 2021, we will continue to fine-tune the work we started in 2020. Each ebb and flow of the surge allows us to gain additional clinical and operational knowledge for the optimal use of virtual care. The more we do, the more we learn. Our core focus will remain on patient and provider experience, clinical quality, effective technology and payment parity.