Commonwealth Care Alliance shares key lessons from its robust telehealth program

The Commonwealth Care Alliance is a healthcare organization that provides health plans and care delivery programs designed for individuals with significant needs. With offerings in Massachusetts, Rhode Island, Michigan, and California, it provides comprehensive, integrated, and person-centered care by coordinating the services of local staff, provider partners, and community organizations.

CCA specializes in managing complex care for individuals eligible for Medicare and Medicaid, as well as those who fall short of the threshold for Medicaid. As a healthcare organization, it provides and coordinates whole person care that integrates primary care, acute care, behavioral health, and long-term services and supports, while addressing social factors that affect health.

Telemedicine has become an important part of fulfilling CCA’s mission. And all healthcare provider organizations can learn from the implementation of CCA.

Adrienne Mullen is Senior Director of Virtual Care at CCA. We interviewed him to discuss why telemedicine has become such a priority, evaluating potential barriers and providing targeted support, CCA’s set of virtual care guidelines to help physicians determine the best care options , and some success metrics of the telemedicine program.

Q. Why has telemedicine become a priority for the organization?

One. CCA prioritizes our virtual care programming because access to technology and connectivity is a social factor that affects health. This enhances care coordination by allowing us to engage members where they are and then leverage our deep, specialized and multidisciplinary team to best meet their needs at that moment.

It was also instrumental in supporting access to care during the COVID-19 pandemic, creating new ways to support our members. For example, CCA reached 91% of our members and patients through virtual care by the end of 2020, providing continuity of care for many individuals during challenging and isolating times.

From March 2020 to December 2022, CCAs conducted a total of 149,723 virtual care visits with 38,082 unique members. This number continues to grow as a direct result of our efforts to increase virtual care programming during the pandemic.

We are also focused on providing choice in the way care is delivered and adding value to ensure members are getting the care they need in the best possible way. With the right supports and resources, virtual care removes significant barriers to access for people who are at home, face difficulties accessing transportation or child care, or otherwise face challenges attending appointments. Are.

Overall, we find that the option of virtual care enables members to better navigate the health care system, especially if they have urgent or less anticipated needs.

CCA is a leader in chronic disease management, and we have seen significant success in this area using virtual care. For our members suffering from diabetes, heart disease, rheumatic disease, obesity, high blood pressure and other chronic diseases, virtual care is an excellent way to improve care plan adherence by providing flexibility.

Often, chronic disease management involves frequent communication between members and their providers, but this is not always done face-to-face. We have found that members prefer to use virtual care for routine check-ins and routine symptom management appointments because it saves time and stress.

Q. In addition to providing the actual telehealth visits, you evaluate potential barriers and provide targeted assistance and options in the way of care to best meet your members’ needs. Please talk about how it all works with ratings and help.

One. We conduct a virtual care readiness assessment for all new members to assess their digital health readiness, which includes device availability, WiFi connectivity, and consent to digital engagement. If we identify a reliable device or lack of connectivity, we work one-on-one with the member to help secure the support they need.

Currently, this involves connecting members to federally funded free phone or internet connectivity services.

Through our efforts to connect members with needed resources, we have seen a 10% increase in device and connectivity access from 2021 to 2022 (from approximately 60% to 70%). We expect this number to grow as we continue to grow our virtual care program in the years to come.

Once we’ve handled any needs, our member video visit support team is available with instructional videos, educational materials, and troubleshooting guidance.

In 2022, the member video visit support team assisted 2,898 members either through a successful practice video visit, where our team facilitated a call prior to the member’s appointment to answer questions and ensure comfort and preparation. Will do, or solve challenges in a jiffy. Anyone wakes up.

Virtual interpreters are also available, which has been helpful in ensuring equitable access to virtual care. CCA provided interpretation services during 1,602 video visits in 2022 representing 27 different languages, including Spanish, ASL, Vietnamese, Haitian Creole and Cape Verdean Creole.

On the provider side, we provide training and technical support to eliminate barriers on both ends of the virtual care interaction. We found that this support increased providers’ trust and use of virtual care.

Q. The Commonwealth Care Alliance has created a set of virtual care guidelines to help clinicians determine the best care options for members. Please describe these guidelines and why they are important to virtual care.

One. As we began expanding our virtual care program, we quickly learned that there is no broad agreement on when to recommend in-person care or virtual care. This uncertainty is a significant barrier to expanding and optimizing the use of virtual care, especially for physicians and patients who are directly involved.

We knew it was important to set parameters and expectations to ensure all members received the care they needed in the right setting. Dr. Dan Henderson, Senior Medical Director of Instead and Virtual Care at CCA, helped us brainstorm and develop the guidance.

When considering how to create guidelines, we were dealing with the intersection of access, comfort, comprehensiveness, cost, and safety. At CCA our view is that members should receive the format of care they prefer, all else being equal, and should believe that their choices are reasonably safe.

When members are uncertain or indecisive, we think that a virtual-first approach – with some constraints – may be right for a few reasons:

• Virtual visits are usually much more available and accessible. Without the need for transportation, it can be easy for patients and providers to come together on short notice or when the time is ideal. Keep in mind, we do a lot of home-based visits, so it’s not just about getting patients to the office, but sometimes there can be more opportunities to schedule through virtual visits.
• Virtual appointments are more readily available than in-person appointments. When physicians’ schedules can be aggregated, or when virtual care can be performed during downtime or no-show times, wait times for visits are reduced dramatically. This matters not only for urgent care issues, but also when a patient is motivated and wants to quickly secure an appointment.
• In-person visits may be more extensive than virtual visits, but this does not always affect the quality of care. Most chronic conditions require only occasional hands-on care. When improving treatment is the goal, it can be more powerful to see patients more often than to see them more widely.
• Virtual care should not stop because it may not be successful. The aim of the approach erring on the side of “bring patients in” is to avoid “wasted” or “unsuccessful” visits. We believe that CCA members’ preferences are the most important factor in choosing a place of care, even if after some visits personal care is needed later. Backed by guidelines and care team members who protect members from unsafe use of telehealth, we feel this approach maintains the customer focus that has long been part of our history and mission.

With a focus on convenience, access and member choice, we need to ensure some protection against trips that are likely to be dangerous or otherwise of little value. To screen for these, our physicians assess the presence of certain red-flag issues that would disqualify a tour from being suitable if conducted virtually. These include:

• Any symptoms that are serious.
• Whenever a member thinks that immediate medical assistance is required.
• Any symptom that is new/unfamiliar and at least moderately severe.
• Certain symptoms may indicate heart problems, especially chest pain, shortness of breath, palpitations (lasting more than a few minutes), leg swelling, dizziness (unless this is familiar or specific to the person) Are).
• Some symptoms indicate brain and nervous system problems, especially weakness of the face, arms, or legs, speech changes, vision loss, balance problems (when new or unfamiliar), or fainting.
• Terrible headache
• Sharp pain in stomach.

In contrast, we see concerns such as well-managed chronic conditions, ongoing care for behavioral health problems, and low-risk health conditions such as rashes, allergies, family planning, and smoking cessation as high-value use cases for virtual care. Let’s agree.

All of the above is within a culture of taking care when physicians have concerns about virtual care, and empowering our members to make decisions that best meet their needs and preferences.

Q. What are some of the success metrics of your telemedicine program? Please describe these metrics and how you achieved them.

One. Through our virtual care program, we define success in many ways. First, we have focused on increasing access to virtual care for our members and ensuring that we are providing high quality services. We continuously track the number of members served through virtual care, the number of resulting virtual care visits, and how many of those are repeat members year after year.

In 2022, we served 25,166 unique members ages 21 to 105 through virtual care, totaling 46,886 visits. 77 percent of them were repeat users from 2021 onwards.

Through a Responsive Care survey, 93% of our members found our offerings helpful or very helpful in their overall care. We continue to use this data and feedback from our members and providers to improve our services.

We are also looking at access to technology as a success measure for our virtual care program, as technology can impact a person’s overall health and well-being as well as their ability to navigate the world around them. Can

Thus, from 2021 to 2022, we see internet access increase by 5% and 9%, respectively, among our CCA Senior Care Options and CCA One Care members. We also found that members reached out to our member video visit support team twice as often in 2022 compared to 2021, indicating that more individuals are seeking the resources they need.

In the future, we look forward to supporting even more members by gaining access to technology and internet service to further expand our virtual care program.

As I mentioned earlier, our providers’ confidence in their ability to provide a positive virtual care experience is another element of our success. We trained 50% more providers on CCA’s virtual care platform in 2022 than last year and expect to continue this trend as we bring our care model to more people across the country.