Healthcare’s STD Infection Crisis – How Virtual Care Can Help

Last week, the Centers for Disease Control and Prevention announced that rates of chlamydia, gonorrhea and syphilis in the U.S. climbed for the fifth year in a row. The newly released data prompted a call for federal intervention at the 2018 STD Prevention Conference. This begs the question, how did we get here? And more importantly, what can we do about it?

STD Infection by the Numbers

In 2015, the American Sexual Health Association noted that rates of chlamydia, gonorrhea and syphilis reached a record high. And they’ve kept growing from there.

Preliminary CDC data from 2017 shows a 31% growth rate in diagnoses of these three common STDs since 2013. Individually, diagnosed cases of gonorrhea increased 67% and syphilis 76%. Chlamydia didn’t see quite the same rate of increase, but it remains the most common of these conditions with more than 1.7 million diagnosed cases in 2017.

Candy Hadsall, RN, MA, a prevention nurse specialist with the Minnesota Department of Health was at the conference and noted that the data wasn’t particularly surprising. “The CDC’s announcement that STD infection rates climbed again in 2017 just confirmed what we’re seeing in the field,” she said.

These numbers present a concerning – and initially, more than a little baffling – trend. After all, each of these infections is curable with appropriate antibiotic intervention, and the long-term effects of going untreated can be serious. So, why are infection rates continuing to grow?

The Root of the Problem

The factors influencing the increase in infections are complex and varied. A 2007 study in Sexually Transmitted Infections found an abundance of socio-demographic influences on infection rates, including race, income, gender, state of residence, age and history of incarceration. It also notes that attitudes toward sexual behavior and STD testing are prime factors in the diseases’ spread.

In the CDC’s recent announcement, Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention noted, “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

At its core, the STD infection crisis is driven by this combination of attitudinal, demographic, economic and healthcare infrastructure influences.

Virtual Care’s Role in Fighting STD Infection

One of the best ways to stem the tide of STD infection is by reducing access barriers to testing and treatment, and here is where virtual care shows its value. The ways that virtual care can help patients overcome common barriers to care like geography, time and cost is well-documented. When it comes to sensitive issues like sexually transmitted diseases, virtual care can help mitigate emotional barriers, as well.

In an interview with MedCity News, Geri Lynn Baumblatt (then of Emmi Solutions from Wolters Kluwer Health) noted that patients tend to “engage in impression management” when seeing their doctor. What that means is, they try to paint themselves in the best possible light – consciously or unconsciously – in an attempt to avoid judgement and shame. While Baumblatt was speaking specifically about addiction concerns, this concept translates to sexual behavior. A solution that doesn’t require a face-to-face discussion can often produce more honest answers about sexual behavior and STD risk.

Hadsall concurs that the feeling of anonymity could help patients overcome the shame and stigma associated with STD infection. She also notes that adequate resources are a challenge in STD screening. “It’s just not possible to effectively screen everyone who should be screened,” she said. “Even at very high infectivity rates of 10-15%, that’s still 85-90 out of 100 people who are screened and test negative. With an online screening option, we could do a lot more and potentially make a real dent in STD infections.”

A Virtual Solution

Image: Stop STD Infection

Understanding the value of lowering barriers to STD testing and treatment, we developed evidence based protocols to support health systems as they work to manage steeply climbing STD rates for their patient populations. Our expedited partner therapy protocol enables patients whose partner has been diagnosed with chlamydia to get treatment. As the most commonly diagnosed STD across the country, and the one that is most frequently asymptomatic, this facilitates quick, discreet care for patients – without even requiring a test. By lowering barriers to receiving care for known chlamydia exposure, health systems can help reduce the continued spread of chlamydia.

We also recently created an evidence-based virtual care STD testing protocol that gathers risk assessment data and enables patients to access lab tests for chlamydia, gonorrhea and syphilis. This protocol leverages lab integration workflows to capture patient information and seamlessly route them to a lab location for testing. Our aim is to help health systems use the asynchronous patient interview to overcome the embarrassment patients feel talking about STDs, potentially increasing the likelihood of individuals to seek testing.

The continued rise of STD infections is a complex issue, impacted by everything from socio-cultural norms to poverty rates and education to healthcare access. It may feel overwhelming, but looking at individual pieces can still make a sizable impact. There are many factors virtual care can’t impact. What we can do is help take the strain off of the systems currently unable to manage this growing health crisis and lowering barriers to STD testing and treatment.

About the Authors

Dr. Lisa Ide

Lisa Ide, MD, MPH

Dr. Lisa Ide is the Chief Medical Officer at Zipnosis, where she works to ensure the Zipnosis platform meets our customers’ clinical needs. She is a veteran physician with more than 25 years of experience. Dr. Ide specializes in occupational medicine, and brings the same commitment to patient safety and quality to her work at Zipnosis as she does when treating patients at the Center for Victims of Torture.

Kevin Smith - Zipnosis Chief Clinical Officer

Kevin Smith, DNP, FNP, FAANP

Kevin Smith, Chief Medical Information Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

Winter is Coming: Prepare for Cold and Flu with Virtual Care

For most people, the end of summer is characterized by back to school ads, discounted swimwear and the promise of crisp autumn air. In healthcare, it’s more than stacks of new notebooks – it’s time to plan for managing cold and flu season.

Cold and flu season can strike anywhereEach year, health systems and providers brace themselves for an onslaught of stuffy noses, hacking coughs and spiking fevers. And this year, as staffing plans are made and vaccine doses ordered, the question on everyone’s minds will be, “What do we do if we see a repeat of last year?”

If you work in healthcare (and unless you were, say, living off the grid in the Alaskan tundra last winter) a repeat of the 2017-2018 flu season likely strikes fear—or at least concern—into your heart. While not as terrifying as the white walkers in Game of Thrones, the onset of cold and flu season requires similar preparation to withstand a viral invasion. So, how can health systems deal with the visit volumes, the potential for infection to spread in waiting rooms, and overwhelmed clinic staff?

Virtual Care Can Help

Having a virtual care service in place can help mitigate some of the challenges that are part and parcel with cold and flu season. It’s not the only answer, certainly, but virtual care adds real value where it counts.

Support Vaccination

“An ounce of prevention is worth a pound of cure,” as the saying goes. It’s no secret that the best way to reduce influenza cases is vaccination, and health systems often have well-developed strategies for promoting annual influenza vaccination. A virtual care service can add value by creating an additional channel for patient communication.

Providers can remind patients to get their flu shots during video visits. Health systems can include a note about getting vaccinated in patient education materials. And, Zipnosis customers can use their virtual care platform to incorporate flu shot reminders into their virtual visit (a feature successfully deployed during last summer’s measles outbreak in Minnesota).

Manage Provider Time

Here’s where virtual care really shines. A store-and-forward / asynchronous virtual care model enables providers to diagnose and treat patients in a fraction of the time as an in-person visit, as noted by our VP of Customer Success, Catherine Murphy, a couple weeks ago.

In a look at data from six customers over the course of last flu season (October 1, 2017 to March 31, 2018), the average provider work time per asynchronous virtual visit was just shy of 2 minutes and maintained high quality standards. During that time, these six customers completed close to 12,000 visits, amounting to less than 340 provider hours. For comparison, 12,000 in-person visits at 15 minutes each would total about 3,000 hours. On average, virtual care saved each of these health systems 440 hours of provider time. That’s nothing to sneeze at.

Mitigate Waiting Room Infection

One of the biggest challenges about cold and flu is that they are just so darn infectious. A study in Infection Control and Hospital Epidemiology found greater than 3% increase in influenza-like illnesses in children and family members within 2 weeks of annual wellness visits.

Hospitals, health systems and clinics have a variety of tactics to help stem waiting room infection – from handing out face masks to regular sterilization procedures. Virtual care can be added to the list. By offering a remote option for treating highly infectious conditions like influenza, patients don’t have to come into their doctor’s office for treatment. Plus, patients with common conditions like urinary tract infections or pinkeye can also get treated at home, lessening the chance they contract an influenza-like illness at the doctor’s office or urgent care.

Take the 2018 On-Demand Virtual Care Benchmark Survey

Now’s the Time

This isn’t Game of Thrones, and we aren’t facing an influx ofwhite walkers, but winter is coming. Getting a virtual care service launched now will go a long way to help health systems manage the impact of cold and flu season on their providers and patients. Starting now will mean your virtual care service is up and running when it counts. Pair that with some smart marketing tactics, and you’ve got winning combination to combat the coming cold and flu season. 

 

Trend Watch: Virtual Care as an Employee Benefit

There’s a new trend in employee benefits: offering a virtual care service. And, employers are embracing these additional health benefits. A study by the National Business Group on Health found that 96% of employers plan to make virtual care services available in states where the regulatory environment allows it by the end of 2018. Which raises the question, what is fueling this employer adoption and how can the healthcare industry address this rising demand and help drive success in virtual care benefit programs?

Employer Gains from Virtual Care

Employers have numerous and varied reasons for leaping on the virtual care bandwagon, but they all come down to seeing the advantages virtual care brings their organization. Typically these fall into two categories: cost savings and employee satisfaction.

Cost Savings with Virtual Care

This is the most tangible value employers get from offering virtual care as an employee benefit. According to a Willis Towers Watson survey, employers expect to see healthcare costs increase 5.5% in 2018. And collectively, employers spend more than $650 billion on health benefits. Virtual care offers employers – and their employees – a lower cost access point that meets the need for convenience typically addressed by high-cost urgent care centers or emergency rooms.

On average, an in-person visit costs approximately $175. This is based on average cost of care at various in-person locations – from primary care clinics up to the emergency department – and the average spread of utilization among them. Shifting even a small percentage of these in-person visits to a virtual access point can produce significant cost savings over time. For example, in a population of 5,000 employees and dependents, driving just 3% of anticipated visits to a virtual access point could produce savings of more than $65,000 per year.*

These are relatively rough calculations, but if you want to see how shifting care from a high- to low-cost access point can produce cost savings, we have an interactive calculator that can help.

Virtual Care and Talent Strategy

Increasingly, employers are faced with managing competitive talent markets. In the fight to acquire and retain the best talent, offering a benefits package that meets or exceeds the market standard is critical to an effective talent strategy. Remember, 96% of employers expect to offer a virtual care employee benefit by the end of 2018. Companies that want to attract and retain the best people, will almost certainly need to include virtual care in their benefits package to stay competitive.

Virtual care can produce other, “softer” wins for businesses, as well. Workplaces with a virtual care benefit may see reduced absenteeism and a corresponding increase in productivity, as employees don’t need to take time away from work to visit the doctor. Further, including virtual care in a benefits package signals that the company understands employee needs and is committed to their wellbeing, which can help increase employee satisfaction.

What it Means for Health Systems

Like other employers, health systems are also increasingly embracing virtual care. But unlike employers, they are adopting it as a care delivery channel. As a result, when health systems offer their own virtual care service as an employee benefit, they stand to gain even more than employers in other industries.

For starters, when launching a new virtual care service, health system employees make a phenomenal pilot population. They represent a clear, distinct population with a vested interest in organizational success, as well as being readily available to collect feedback on how the program is working. Piloting virtual care with employees can also help produce a rapid return in investment through the cost savings outlined above.

If you’re looking to launch to a broader population, one of the of the top drivers of virtual care utilization is provider recommendation. By launching virtual care internally as an employee benefit, health systems can increase provider acceptance and buy-in. When clinical providers and other patient-facing employees use the virtual care service as a patient, they can see first-hand the convenience it offers and the safety and quality of care delivered. Satisfied with their virtual care experience, these employees will be more inclined to recommend it to their patients, further driving utilization and return on investment.

How to Produce an Employee Benefit Win

With all these advantages untapped, what can organizations do to drive success with their virtual care employee benefit? Three things:

    1. Contract locally – One of the big challenges in healthcare is care fragmentation. Oftentimes, employers can unknowingly add to this by encouraging employees to use a contracted telemedicine service provider – taking care out of the standard care continuum and fragmenting their medical records. Health systems and employers can combat this by partnering to offer virtual care staffed with local providers. By contracting with local health systems, employers and patients get the value of a virtual care benefit without adding to healthcare fragmentation. Health systems win too, by adding a new avenue to acquire patients and improving virtual care utilization. 

 

    1. Find the right price – For employees to truly benefit, and employers to see utilization that will drive cost savings, the service needs to be priced appropriately. When working with an employee population that has both traditional and HSA health plans, this can be tricky. According to the Society for Human Resource Management, understanding HSA eligibility is a key barrier to an effective virtual care employee offering. Under current regulations, employees on an HSA plan cannot receive virtual care for free. At Zipnosis, we recommend either a nominal fee of $5-$10, which still presents significant cost savings to employees, but doesn’t run afoul of HSA plan regulations.

 

  1. Spread the word – The biggest mistake employers and health systems make once they have a benefit offering in place is to “set it and forget it.” Organizations should use multiple channels to keep the virtual care offering front of mind for employees. These can include benefit materials, a benefit portal, intranet site, employee newsletters, HR emails, and company or department meetings, among others.

 

*Assumes an average of 2.5 visits per member per year

 

About the Author

Dr. Lisa Ide

Lisa Ide, MD, MPH

Dr. Lisa Ide is the Chief Medical Officer at Zipnosis, where she works to ensure the Zipnosis platform meets our customers’ clinical needs. She is a veteran physician with more than 25 years of experience. Dr. Ide specializes in occupational medicine, and brings the same commitment to patient safety and quality to her work at Zipnosis as she does when treating patients at the Center for Victims of Torture.

Meet Cold & Flu Season Head on with Virtual Care

Summer is slowly ending here in the Northern hemisphere, meaning short, crisp days, bright foliage and bonfires. These signs of the season also presage something less pleasant: cold and flu season.

There’s good news though – launching virtual care now can help you more effectively manage increased volume, curtail waiting room infection, and maximize the opportunity to create patients for life.

Virtual Care and Cold & Flu Volume

Brick and mortar locations, including primary care practices, retail clinics, and urgent cares, bear the brunt of increased volume that comes with cold and flu season. Virtual care can help alleviate that burden by routing patients to a convenient online access point, taking the strain off clinicians and support staff and freeing up appointment slots for higher value, more complex conditions.

Minimize Waiting Room Infection

Health systems go to great lengths to prevent waiting room infection. Nonetheless, when cold and flu season strikes, all bets are off. Offering a virtual care solution where patients can receive diagnosis and treatment recommendations for highly infectious diseases like cold and flu helps keep patients out of the waiting room and reduces the likelihood of waiting room infection.

In an article on Health IT Outcomes last fall, Zipnosis’ Chief Clinical officer Kevin Smith noted, “one of the best ways to be a good healthcare citizen and avoid spreading germs to others in overcrowded waiting rooms at clinics, urgent care centers, and emergency rooms is to take advantage of online virtual visits.”

Create Patients for Life

Cold and flu season is more than a challenge for health systems – it’s an opportunity.  With the uptick in volume that comes along with cold and flu season comes the potential of adding patients to your health system. With more and more patients seeking convenient options and looking for care online, a virtual care service is a fantastic way to attract those patients to your health system. What’s more, a recent white paper from Carrot Health found that approximately 25% of virtual care users converted to health system patients within one year of their virtual visit.

Imagine the impact if even a fraction of your cold and flu visits could be addressed through a virtual care solution. Your clinicians and support staff would be freed up to better serve patients, the decrease in infectious patients in your clinic would lower the likelihood of your staff and patients becoming sick, and you have the opportunity to create lasting relationships with new patients. Win-win-win.

How to Prevent Your Emergency Department from Becoming an Urgent Care

The Challenge:

Across the country, emergency departments (EDs) are experiencing, well, an emergency – specifically, overuse. Patients – for a variety of reasons – are treating emergency rooms like urgent care facilities. A report from the New England Healthcare Institute estimates that this overuse of EDs is responsible for $38 billion in wasteful spending each year. Additionally, a literature review published in the American Journal of Managed Care found that on average 37% of ED visits were judged to be non-urgent. The CDC’s numbers match up, finding that of the 130 million ED visits in 2013, only 8 percent could be classified as “immediate” or “emergent”.

Little girl in the emergency department with a broken arm

Patients treating the emergency room as an urgent care can cause problems for hospitals and health systems. ED use can cause fragmentation, and even with an efficient EHR, can make effective care coordination challenging. What’s more, an ED being used as an urgent care for non-emergencies may increase wait times for all. Using “broken bone” as an example, ProPublica’s ER Wait Watcher shows an average wait time of between 38 and 72 minutes.

Another major concern for health systems related to ED overuse is uncompensated care. Patients treating the ED like an urgent care my receive a rude awakening when they find that their visit cost is only partially covered by insurance or is exponentially higher than a PCP or true urgent care visit. According to an article in the Annals of Emergency Medicine, only 50 percent of ED charges are reimbursed – including reimbursements through Medicare, Medicaid, and private insurance.

With the mean cost of care delivered in the ED over $2,000 per visit (approximately 300% the cost of primary care) according to research published in the Journal of Medical Internet Research, that adds up quickly – for both health systems and patients. A study in the American Journal of Medicine found that medical debt is a contributing or primary factor in more than 40% of personal bankruptcies. This creates a financial strain on health systems, and has the potential to result in ED closures, which in turn compromises access for patients experiencing a true emergency.

Why Patients Choose the ED – Access, Access, Access

There is no doubt that many patients go to the emergency department due to a bona fide emergency. But an article in the Journal of Emergency Nursing found that the reasons for going to the emergency department for non-emergency care were centered around access and inappropriate referrals. Specifically, patients visited the emergency room because they were unable to obtain a PCP appointment, were told by staff (not physicians) to go to the emergency room, or felt that it would take less of their time.

A review in the American Journal of Managed Care found similar reasoning around convenience, access, and cost. But the inability to access quality care elsewhere was the foremost reason for patients visiting the ED for non-urgent conditions. This is a particular challenge for uninsured and underinsured individuals and families, as well as those classified as having a low income, and why the top strategy for reducing ED overuse is broadening access to primary care services, according to the Centers for Medicare and Medicaid Services.

Ultimately, many patients go to the ED because they think it is easier than the alternatives. Younger patients, in particular, view the emergency department as a reasonable alternative to a primary care clinic for receiving care. This is part of the larger trend of consumerism in healthcare, in which patient choice is driving change in how and when care is delivered.

So, What’s the Answer?

Unfortunately, there’s no magic bullet to the challenges of supporting efficient use of an emergency department. The good news is there are things health systems can do to help reduce overuse. And one of those things is launching a virtual care service line and driving patients to the online access point in lieu of the ED.

For patients who are unable to obtain a PCP visit, virtual care offers an alternative access point. Available 24/7, unlike primary care clinics or even urgent care facilities, virtual care gives patients unprecedented access to care. Patients who can’t afford to or are otherwise unable to take time away from work to seek care during normal office hours can use the virtual care service to get the care they need. And, when using a virtual care platform that incorporates  evidence-based algorithms and best practice-driven protocols patients are only directed to the urgent care or emergency department visits when clinically appropriate.

Improve Patient Access with Zipnosis Virtual CareWhat’s more, patients seeking convenience in addressing non-urgent needs will likely find virtual care more appealing than the emergency department. They no longer have to leave their home, drive to the hospital, and sit in the waiting room. And virtual visits take a fraction of the time a primary care visit or even a trip to the emergency room would take.

The low cost of virtual care can also help steer patients away from the ED. Patients who don’t have insurance, are underinsured, or are taking on a larger portion of risk with a high-deductible health plan may struggle to pay for emergency care, leaving health systems with higher rates of uncompensated care. Patients who cannot cover a several-hundred dollar (or higher) emergency visit (see the shocking ED price tag example above), may be better able to pay the $30 or $40 for a virtual visit, about the cost of a typical copay.

Most importantly, with a virtual care service, health systems are expanding access to care. That means common conditions can be treated quickly before complications develop and the danger to the patient increases. This can be the difference between a simple urinary tract infection and a kidney infection or an upper respiratory infection and pneumonia. That means, getting patients treatment early could help reduce ED visits and improve patient outcomes.

About the Author

Kevin Smith - Zipnosis Chief Clinical Officer

Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

Virtual Care and Public Health: Helping Manage a Measles Outbreak in Minnesota

You may have heard that our home state of Minnesota is in the grip of a measles outbreak – primarily in the Twin Cities metro area, though there are several cases in outlying counties. As I write this, there are 78 confirmed cases of measles, and the number is growing. I’m not going to get on a soap box about vaccination (though, the vast majority of patients were, unsurprisingly, unvaccinated). Instead, I’ll use this example to illustrate the role of virtual care in a public health crisis like this one.

How Virtual Care Can Help

When managing certain outbreaks of infectious conditions, the value of virtual care is two-fold. First, it provides a unique channel for evaluating potentially contagious patients, taking them out of the waiting room and limiting the opportunity for infections to spread. This is particularly important when a communicable disease is active (think cold and flu season). By directing patients to the virtual visit, rather than into clinics, virtual care can help health systems curtail the spread of illnesses like influenza.

Second, and most important in this recent measles outbreak, it offers a front-line communication channel for health systems to share critical information with their patients and the community.

The early symptoms of measles are very similar to those of an upper respiratory infection – one of the top conditions patients seek treatment for via the Zipnosis platform. We collaborated with one of our Twin Cities clients to find a solution that we could deploy quickly to help manage communication about the outbreak. This is particularly important, since Minnesota medical regulations allow any person to seek virtual care or telemedicine; some states require a person to have an established relationship with a clinic to be eligible for virtual care.

Through collaboration with our health system client, we rapidly developed and deployed an online messaging feature enabling health systems using the Zipnosis platform to share important information about the measles outbreak for patients using the virtual visit system. Accessible and editable by staff within the health system, our Minnesota clients are now using this functionality to provide important patient alerts about the measles outbreak and to educate them about early symptoms, dangers, and the steps they should take if measles is a possibility.

This new feature goes beyond this one outbreak or use. Health systems can now relay information about other things their patients may need to know: updates on allergen and pollen levels, reminders to get a flu shot prior to flu season, or information on seasonal diseases like Lyme disease and other outbreaks.

Public Health and the Potential of Virtual Care

Virtual care is more than a technology – it’s a digital care delivery channel, just as important to supporting health outcomes as a nurse line or clinic. And, as patients continue to adopt virtual care in greater numbers, its value as a channel for communication, education, and care delivery will increase too.

Today, we see nearly limitless possibility for virtual care to support health systems and providers as they work to drive positive health outcomes for their patients and communities. Health systems are just beginning to understand how they can use virtual care to do more than treat common conditions, and we are excited to help them realize this potential. While this particular feature may not be a groundbreaking industry disruptor, it gives our health system clients another option for supporting the health of their communities – and to us, that’s huge.

About the Author

Kevin Smith, Zipnosis Chief Clinical Officer

Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

Value-Based Care: It’s Here and Virtual Care is Part of the Equation

We’ve all seen the news. Value-based care is coming, it’s inevitable, it’s here. But many health systems have yet to see major impacts from value-based reimbursement models such as accountable care organizations (ACOs), bundled payments, or patient-centered medical homes. Consequently, it’s easy to think that the hype around value-based care is just that: hype. We need to think again.

It’s not Hype

Value-based care really is coming, and soon health systems won’t be able to escape it. In early 2015, the Healthcare Transformation Task Force announced that 20 major health systems and insurers committed to moving 75% of contracts into value-based arrangements by 2020. The U.S. Department of Health and Human Services (HHS) expects that by the end of 2018 half of Medicare payments will go to alternative payment models, such as ACOs and healthcare organizations that accept bundled payments. And, a 2014 study by Avility revealed that more than 60% of providers expected value-based payment models to become dominant going forward.

What is Value-Based Care?

Traditionally, reimbursement has been volume-based. Under this model, providers are paid based on the number and type of visit. At its core, value-based healthcare encompasses a series of alternative payment models designed to support the triple aim of better patient access, lower healthcare costs and improved clinical quality. These models include accountable care organizations (ACO), patient-centered medical homes (PCMH), pay-for-performance and bundled payments. Under each of these payment models, health systems and providers are rewarded when they deliver quality care using fewer resources.

So, how can health systems who still operate in a volume rather than value-based reimbursement environment get ready for the shift? Look to virtual care.

The Impact of Virtual Care in a Value-Based Environment

Health systems looking toward the transition from volume to value-based care can benefit from launching a patient-provider virtual care solution. Virtual care can help health systems reduce costs by transitioning patients to a lower-cost access point, minimizing office visits, urgent care encounters and even trips to the emergency room. Health systems can also see the benefit of enhanced patient health outcomes, including stronger patient engagement and population health management.

Dr. Deborah Greer of John Muir Health discusses the online adaptive interview from the perspective of value-based care. 

Lowering Cost of Care

The online access point in a virtual care service offers health systems and patients a lower-cost diagnosis and treatment option. Using a “store-and-forward” solution like the Zipnosis online adaptive interview enables providers to diagnose and treat common acute conditions quickly and efficiently. Provider time per visit on the Zipnosis platform is typically around 2 minutes to diagnose and treat, compared with 15-20 minutes for an office visit.

Improving Patient Outcomes

Patient engagement isn’t just an industry buzzword. According to HealthAffaris.org, people who are actively involved in their health and healthcare tend to have better outcomes. Offering a convenient, online access point can help increase engagement by making healthcare fit into patients’ lives. Additionally, patients may seek treatment through a virtual access point when they might otherwise decide against seeking care. That could be the difference between a routine UTI and a serious kidney infection.

Health systems and patients can also use virtual care as a population health tool. Online health assessments, for example, can help identify patients who are at risk for chronic conditions before those conditions become problematic. And, using an online access point for follow-up visits can help keep patients engaged in their care by making it quick and easy to provide their physicians with health information in between office visits.

Act Now to be Prepared for the Future

In the 2016 HIMSS Cost Accounting Survey only 3% of respondents indicated their health systems were highly prepared to to adopt value-based care reimbursement and leave behind volume-based, fee-for-service payment models. A full transition to value-based care may seem distant, but leading health systems are taking steps to prepare for the inevitable transition to value-based reimbursement.

Health systems who launch virtual care as a means for providing cost-effective care in a value-based environment will have the time to:

    • Work through change management and build clinician buy-in across their organization

 

    • Develop and implement a strategy that ties together online care delivery across departments and specialties

 

    • Monitor and enhance their virtual care service to ensure it meets the needs of both patients and the health system

 

  • Fully integrate virtual care with internal IT systems to promote a seamless patient and provider experience

Download the Best Practices Guide to Virtual Care

Bryan Health Goes Virtual with Zipnosis

In growing numbers, patients are expecting convenient, accessible care from health systems. At Zipnosis, we hear this all the time. This need is compounded in areas where patients may need to drive hours to reach a physical clinic. Seeing these market forces play out in their community, Bryan Telemedicine, the virtual care arm of Bryan Health—a leading health system based in Lincoln, NE—decided to meet this challenge head-on by offering virtual care.

The Search Begins

Like many health systems, Bryan Telemedicine began looking for a virtual care solution to meet the demand for accessible, convenient care. They had a wish list that included being able to leverage current staffing and internal clinical expertise, support continuity of care for their patients, and achieve high levels of clinical guideline adherence. Initially, it seemed they might have to settle for a traditional video only (synchronous) telemedicine solution – then they found a unique approach by Zipnosis that better addresses their requirements.

The Start of a Beautiful Partnership

Bryan Telemedicine was attracted to Zipnosis’ evidence-based protocols and proven clinical quality they deliver. Bryan Telemedicine was also excited by how Zipnosis leverages marginal clinical capacity – a feature that allows them to provide 24/7 virtual care without adding staff. But what about those patients that can’t be treated online? The Zipnosis platform routes these patients to the most appropriate level of care within the Bryan Health system. You see, we’re all about delivering the right care at the right time – whether online or in person.Bryan Health - Zipnosis

One Year Later…

Bryan Telemedicine launched their virtual care service, Bryan Health eVisits, in late summer 2015. Since then, they’ve been pleased to see how virtual care fits seamlessly into their overall continuum of care. They have also seen an increase in new patient acquisition and a reduction in patient leakage to other virtual care solutions and health systems.

Recently, Bryan Telemedicine has expanded their virtual care service through a partnership with Memorial Health Care Systems(MHCS) in Seward, Nebraska. The arrangement takes advantage of the virtual care expertise of Bryan Telemedicine and their Nebraska board certified physicians. Bryan Telemedicine physicians will staff the new service, reviewing patient information and making an appropriate on-line diagnosis.

The Zipnosis team is continually impressed by Bryan Telemedicine’s innovative approach to care delivery. To help tell their story, we worked together to build this case study. Check it out and learn more about Bryan Telemedicine’s journey and the results they’re seeing as a Zipnosis partner.

virtual-care-best-practices

It’s Not Too Late for Health Systems: Get Ahead of Cold & Flu with Virtual Care

Cold and flu season is just around the corner and as health systems across the country prepare to meet the challenge of full waiting rooms and sniffly noses, there’s one solution that can help: virtual care. Having a virtual care service in place during cold and flu season can help mitigate the sick visit surge and strain that many health systems face as fall turns to winter. 

Cold and Flu Season Puts Health Systems Under Pressure

Upper respiratory illnesses, in particular influenza-like illness (ILI), account for a major portion of annual visit volume in settings such as retail clinics, urgent cares and emergency rooms. Throughout the US, cold and flu visits account for 27.4% of all retail clinic visits, 9.7% of all primary care visits and 5% of all emergency department visits each year, according to research published on healthaffairs.org

According to a study published in Academic Emergency Medicine, the greatest number of urgent care visits occur during the winter, with the highest number of daily visits recorded from November through February. At Zipnosis we see this each year, with visit volume increasing during the fall and winter months (see Figure 1). Information from Google Trends, which aggregates web search data, follows a similar curve with more searches on cold and flu occurring during the winter (see Figure 2).

Cold and flu visits peak during the winter months

Figure 1: Zipnosis visit volume for cold and flu follows the general trajectory for urgent care and primary care clinics. 12-month visit data from the Zipnosis platform.

Cold and flu searches peak during the winter

Figure 2: 12-month data on Google Trends “cold and flu” searches

How Can Virtual Care Help ?

Implementing a virtual care solution can help health systems mitigate some of the challenges that come with cold and flu season.

Take the strain off of brick and mortar care locations

Regardless of how visit volume from cold and flu is distributed across your health system—urgent care, retail clinic, primary care or emergency department—it’s likely that locations are operating at or beyond maximum capacity during cold and flu season. Moving visits to a virtual care service takes some of the strain off your clinicians and support staff, and can free up visit slots for higher value, more complex conditions.

Virtual care has the potential to significantly reduce the burden of clinics during cold and flu season (Tweet this). For example, a large midwestern health system with a well-established virtual care service through Zipnosis saw nearly 6% of cold and flu visits shifted from in-person to virtual care, opening up appointment slots for more complex patient needs and relieving pressure on providers and staff.*

Keep your waiting rooms safe

Keeping patients healthy is important, and one element of this is minimizing exposure to illness. In a recent study, researchers from the University of Iowa noted that well-child visits for children younger than six years old increased the probability of a flu-like illness in these children or their families during the subsequent two weeks by 3.2 percentage points. This seemingly incremental risk translates to more than 700,000 preventable illnesses annually with a price tag of nearly $500 million. By moving office visits for highly contagious conditions like influenza to a virtual visit, risk of healthy patients becoming sick decreases (Tweet this).

Support patient retention and continuity of care

During the high volume times associated with cold and flu season—particularly when health systems are at capacity—it’s increasingly likely patients will seek care elsewhere. Whether they choose a retail clinic, competing urgent care or direct-to-consumer telemedicine service, visits outside your health system open the door to potential patient leakage. Moreover, seeking episodic care means that if patients return to their primary care provider, their record may not be reflective of the care they received elsewhere. Offering your own virtual care service can help capture these patients who might otherwise seek care elsewhere, while supporting continuity of care and maintaining accurate patient records.

There’s Still Time to Act

Many health systems are already beginning to see patients for cold and flu visits, but with peak influenza activity predicted for mid February to mid March 2017 according to the Epidemic Prediction Initiative, there is still time to launch and market a virtual care service. With Zipnosis’ 60-day guaranteed implementation, you can have your virtual care service up and running to handle cold and flu season – and help provide safer care for your patients.

*Assuming 9.7% of visits are for cold and flu (per the healthaffairs.org study referenced).

Killing the Video Myth

There’s a pervasive myth in the telemedicine space that video might be necessary for effective virtual treatment of patients – for any condition. Proponents argue that there’s no way clinicians can fully understand a patient and provide a diagnosis without a face-to-face interaction, even if that interaction is digital. This is simply not true.

Virtual care using adaptive online interview technology gives clinicians the ability to effectively diagnose and treat patients without a video encounter. How effectively? A Zipnosis review of more than 1,700 virtual encounters for sinusitis found that clinicians provided guideline-adherent care in 95.4 percent of cases.

Sometimes called asynchronous visits or “store-and-forward,” adaptive online interviews offer the patient benefits of convenience and access, while providing high levels of clinical quality, efficient diagnoses and a streamlined provider workflow.

What is an Adaptive Online Interview, really?

Maybe it’s best to start by stating what an adaptive interview isn’t. An adaptive online interview isn’t an online questionnaire like the Epic toolkit provides. Rather, it is a powerful expert system that uses branching logic to intelligently interview a patient about their symptoms. This smart approach asks patients only relevant questions determined by demographic information and previous responses, just like an interview with a provider during an inpatient visit.

Zipnosis Online Adaptive Interview

Adaptive online interview (also called structured asynchronous or store-and-forward) collects patient data and sends electronically to the provider.

What’s so Great About the Adaptive Online Interview?

On the Zipnosis platform, we leverage the adaptive online interview to gather patient-entered information in a structured and efficient way. Our adaptive online interview asks the same questions a clinician would ask during  in-person visit – but never forgets a question. The information collected is packaged into a comprehensive clinical note and sent to the clinician for diagnosis and treatment. The result is a totally digital diagnosis and treatment process. Unlike any other platform on the market, Zipnosis unlocks immense benefits:

Time savings: On average, patients complete their adaptive online interview in a fraction of the time taken by an in-person visit. No travel time, no waiting rooms – just convenient access anywhere, anytime.

Clinical quality: The adaptive online interview is grounded in clinical best practices, and the Zipnosis platform leverages patient responses and clinical guidelines to offer clinical decision support, including curated diagnosis and treatment pathways. This helps clinicians provide high quality, guideline-adherent care.

Clinical efficiency: On average, providers trained on the Zipnosis platform can review the provided clinical note and make a diagnosis and treatment recommendation in approximately 2 minutes. And patients typically receive diagnosis and treatment recommendations within an hour of completing their virtual visit.

Provider experience: Providers appreciate the comprehensive information provided, the ease of use and the ability to focus their time on patients with more complex needs, while still offering high quality care for common conditions.

Reporting and analytics: The adaptive online interview model captures a great deal of visit and program data. Using our Statnosis™ reporting and analytics tool, health systems can follow trends related to conditions treated, visit timing, guideline adherence, and triaged patients. All data is de-identified and HIPAA compliant.

But Don’t I Need Video?

Short answer: maybe. But the efficiencies of virtual care are best realized when tasks are shifted from the clinician to the patient. Leading health systems understand this and leverage the adaptive online interview in concert with video to reap the benefits of clinical quality and efficiency while meeting patient or regulatory needs. And with Zipnosis’ intelligent video capabilities, you can, in fact, have it all.

Some health systems incorporate video as an additional step to help treat some patients that would otherwise be triaged to physical locations. Others operate in a regulatory environment that requires video; they leverage the adaptive interview on the front end of the encounter to help save time for both clinicians and patients. Still others choose to launch an adaptive online interview platform alongside their existing video telemedicine service as an additional entry point to their system.

As for video alone? Well, our CEO Jon Pearce says it best: “When’s the last time you ordered something from Amazon with a video call?”

So, what you’re saying is…

Whether employed alone or alongside a video or telephone encounter, adaptive online interview technology offers both patients and providers a quicker, more effective diagnosis and treatment option. Adaptive online interview technology is the future of virtual care; welcome to the future.

Shopping the System by Zipnosis

Maintaining Quality in Healthcare Continuum

Imagine having the equivalent of a clinic in your pocket without the concern that the quality of care would be less than you want or deserve. When done well, virtual care can improve access, decrease cost, and save time without sacrificing quality and continuity of care.

As the market becomes crowded with organizations offering various iterations of telemedicine, healthcare organizations must consider several key factors to determine whether a particular offering is right for the organization. For instance, will clinicians within your network field the inquiries of your patients or will they be handled by clinicians outside the network? Another key factor is whether you will have the ability to integrate information about a patient’s visit into your electronic health records (EHR) system – a key element for providers who strive to utilize all information about a patient in their encounters.

Through its virtual care solution, Zipnosis patients receive treatment for minor medical conditions quickly and safely from healthcare providers within their own network. Patients are treated using its pioneering software-guided online interview that mimics the questions physicians would ask in a clinic. An in-network clinician reviews the interview and either offers a treatment protocol, triages the patient into a phone or video encounter or directs them to visit a clinic.

The entire process is grounded in evidence-based medicine and complies with national best-practice guidelines. If at any point the patient provides information indicating a serious illness, Zipnosis will determine that virtual care is not appropriate and direct the patient to the most appropriate level of care. For example, if a patient believes she/he has a sinus infection and also indicates a fever of 103, the Zipnosis platform will stop the virtual visit and recommend an appropriate in-person site, such as the health system’s urgent care clinic.

With its white-labeled, fully integrated virtual care platform, Zipnosis also offers the technology that will enable you to seamlessly integrate patient visits into your EHR.

Virtual care, if designed to fit not only into the slipstream of your patient’s life, but also into the continuum of care your organization strives to provide, can make clinical care more convenient while maintaining quality – one patient at a time.