In September 2021, Boston Children’s Hospital Department of Accountable Care and Clinical Integration, in collaboration with the AAP, fielded a “Call for Promising Practices” to identify promising practices in use of telehealth for care coordination for CYSHCN. Seven submissions were received in total. The information below highlights key lessons learned from submitted promising practices.
Promising Practice Spotlight:
Practices that leveraged telehealth for care coordination services reported an increased ability to develop a shared plan of care, in close collaboration and partnership with families. Families no longer needed to travel to participate in shared plan of care meetings and could engage from the comfort of their homes. For more information on how telehealth can be leveraged to support care coordination, view these use cases.
- The majority of submissions were from academic health centers, hospital owned practices, and group practices.
- The majority of practices cared for Medicaid beneficiaries in urban areas.
- Practices provided a variety of services, including primary care, behavioral health, subspecialty care, developmental services, care coordination for patients with complex needs, urgent care, hospice and palliative care, and social services.
- The percentage of total telehealth visits varied per practice (ranging from 0 – 81% and above) at the time of application, as well as over the last 18 months.
- The most common telehealth technologies used by practices were secure video, telephone, email, and portal-based messaging.
- Telehealth was used for the following visit types:
- Well-child visits.
- Acute/urgent care.
- Chronic care management.
- Care coordination.
- Interdisciplinary team meetings.
- Synchronous and asynchronous remote monitoring.
- E-consultations (provider to provider, patient to provider).
Implementation Tips and Strategies
Practices reported using telehealth for care coordination for CYSHCN in some of the following ways:
- Medication and device reconciliation.
- Assessing social determinants of health needs through virtual video visits: food insecurity, housing needs, legal needs.
- Offering telehealth visits as alternative options to quarterly in-person visits.
- Meeting with medical home team members concurrently.
- Using telehealth for discharge planning.
- Coordinating and developing share plans of care. Specifically:
- Telehealth allowed for enhanced partnership with families/caregivers during shared plan of care development, especially for families/caregivers who could not travel to participate in in-person meetings.
- Telehealth allowed for improved integration of mental and behavioral health needs into the shared plan of care.
- Telehealth provided the opportunity for “ownership” of a shared plan of care to be transferred across all team members, depending on acute care needs.
- Monitoring for symptoms of depression.
- Connecting patients, families, and caregivers to community agencies.
- Supporting teleconsultations between patients, generalists, and subspecialists.
- Providing peer support for mental health counselors in rural areas.
- Conducting virtual home visits with community health workers.
- Leveraging telehealth to support medical/legal partnerships.
Practices also reported changes and/or adaptations in workflow to support care coordination via telehealth, including the following:
- Adjust triaging process to ensure that a telehealth visit is appropriate for the patient/family’s chief complain. This involved a lot of education and partnership with the nursing staff.
- Proactively enrolled patients into patient portal, which was necessary to support access to the telemedicine platform. This has also facilitated easier communication for many families/caregivers.
- Implemented a mobile ambulance unit which performed limited physical exams, followed by more in-depth telehealth visits for those with medical complexity to reduce risk of infection.
- Increased communication and coordination between subspecialty and primary care clinicians were built into practice workflows using telehealth. For example, one practice used “Red Flag” alerts to promote communication and coordination with the patient’s primary care medical home.
Impact, Results and Outcomes
The impact of telehealth utilization within responding practices during the past 18 months or currently included the following:
- Improved access to care for families/caregivers through:
- Decreased transportation costs.
- Decreased missed days of work and/or school.
- Ability to see patients/families during inclement weather.
- One practice increased their telemedicine visits from zero to over 400 visits within 14 months during the pandemic.
- One practice reported that they are currently in the process of creating quantitative metrics to support identification of outcome measures.
Respondents shared the following factors as important to consider for sustainability of telehealth for care coordination for CYSHCN in the future:
- Payment parity with face-to-face care delivery.
- Technology integration with current workflows, including into electronic health resources.
- Assuring equitable access to technology across communities.
- Allowance for virtual visits as part of my daily patient care services.
- Ongoing professional education for telehealth utilization.
- Need for patients and families to be trained in virtual care participation.
Practices also shared other aspects of telehealth that would improve care (compared to what is being delivered now) that can be built into telehealth offerings for care coordination for CYSHCN. These aspects included the following:
- Shared records and care plans with families who want to integrate efforts with other care team members.
- Using telemedicine to support local quality improvement efforts.
- Performance measures built into the telehealth process that are fed back to providers to assess care processes.
- Improved visit processes to gather data before visits (pre-visit planning).
- Improved documentation/management tools (e.g. registry of patients under management).
- Improved payment models (e.g. capitated episodes of care for a given time frame).
- Use of peer educators/community health workers to follow up on care plan implementation and explain disease/care processes, especially for resource challenged communities.
- Improved post visit follow up on instructions/referral plans.
American Academy of Pediatrics