STRATEGY

Taking an Enterprise-Wide View to Adopting Telemedicine

Michigan Medicine had made dozens of investments in telemedicine for the better part of a decade. But it wasn’t until recently that the academic institution decided to take a more strategic approach to addressing this fast-growing trend. 

Leaders of the health system — with owned and affiliated sites of care throughout the state, delivering more than 2.4 million outpatient visits a year — knew they needed to be more thoughtful in their strategy, with other competitors across Southern Michigan already developing virtual care programs. 

“We were still in the mode of triaging requests,” said Alison Neff, director of virtual care and ambulatory care technology. “It was all about providers coming to us and we would help them get video visits up and running with no technical or operational standardization. There generally were no strategic goals in mind, so there was no way to prioritize requests or focus on specific virtual care programs.”

Michigan Medicine began its virtual care makeover by centralizing a team under the umbrella of ambulatory care services a few years ago. That helped to integrate virtual visits into the health system’s current infrastructure, workflows and electronic medical records, and allowed for a much easier-to-use interface. 

After poring over market data to validate the need for a more strategic approach, leaders formed a workgroup to synthesize the information and further flesh out their strategic plan. Neff and colleagues met with physician, hospital and ambulatory care leaders to gather potential virtual care services to develop. They also worked side by side with technology leaders to understand current and future virtual care infrastructure requirements needed to provide proposed services. Members of the C-suite were also consulted roughly every quarter to ensure the process was on the right path. 

This all led to a clearer vision for Michigan Medicine to systematically leverage virtual care services to expand access, demonstrate value to its consumers and drive transformation toward a “virtual-first” model of care delivery. Michigan Medicine spelled out three strategic goals to reach this vision: 

1. Access and manage the health of the local population: This would include virtualizing low-acuity care to free up clinical capacity, reducing hospital length of stay through virtual prep and follow-up visits, and triaging patients electronically to further relieve acute care capacity constraints. 
2. Extend access statewide through strategic partnerships: Enable patients to stay in their local communities through virtual subspecialty consults and improve interoperability of clinical technology platforms. 
3. Enhance the value of Michigan Medicine: Leaders hope to achieve this by reducing readmissions, improving patients’ functional status, optimizing the patient experience to further fuel growth, and enhancing performance under value-based payment models.

From there, Michigan Medicine developed a detailed scorecard to rate different virtual care options and determine which were high or low priority. Over a dozen different possible telemedicine programs were rated on six different criteria, including whether they support the enterprise’s goals, provide clinical value, are operationally feasible, can integrate with the current IT infrastructure, require technological investment and make economic sense. 

Leaders determined patient e-visits and consultations for primary and specialty care to be early strategic priorities. Meanwhile, they decided that operational and clinical logistics needed to be addressed before virtual visits for emergency care or critical care would make more sense. Michigan Medicine set future “trigger points”— such as changes in reimbursement policies — to revisit those lower-priority services down the line. 

In 2018, Neff said the system then developed implementation roadmaps for e-visits, consultations and other high-priority use cases. For example, when an e-visit program was piloted, it had a modest volume of 100 visits annually. The roadmap recommended extending the platform to all primary care in 12 months and subsequently beginning specialty rollout. In five years, the strategic vision was for e-visits to become a primary access point for routine care, with well over 10,000 visits a year.   

Michigan Medicine leaders are pleased with the early returns on e-visits. They are on track to achieve around 3,000 in the second year, and are looking to expand to other primary and specialty care conditions beyond the simple rashes, flu or urinary tract infections. 

Neff said success is predicated on working in tandem with all parts of the health care system. 

“You really do need a village to build a telemedicine program office,” she said. “You need to work with your technology, revenue cycle, legal and compliance, and marketing departments. You must make sure you’re going into this understanding how it impacts the entire organization.” 

Royce Cheng — principal with the Chartis Group, which helped advise Michigan Medicine on its strategic planning process — offered three key takeaways: 

1. Design telemedicine programs to meet your organization’s patient access, clinical delivery and strategic growth goals. 
2. As Neff stressed, establish a central program office to provide the structure and resources needed to accelerate implementation and manage the improvement process. 
3. Prepare for favorable reimbursement models and market trends that should significantly increase demand for a broader portfolio of virtual health services in the next three to five years. 

Cheng cited recent consumer surveys, which have found that about 66% of patients are willing to see a doctor via video, and almost 20% are even willing to switch their primary care physician for the opportunity. Another survey of health system leaders also found that about half have implemented or are actively pursuing telehealth strategies, according to the National Business Group on Health. 

“Over the next three to five years, you’re going to see enormous evolution in this space,” Cheng said. 

This article features interviews with: 

Alison Neff
Director of Virtual Care and Ambulatory Care Technology
Michigan Medicine
Ann Arbor, Michigan 

Royce Cheng
Principal, The Chartis Group
Chicago, Illinois