Prior to the COVID-19 pandemic, the healthcare industry was slowly embracing telehealth as a new modality to deliver patient care. At the same time, technologies like Apple FaceTime and WhatsApp were becoming mainstream for personal video calls.

THE PROBLEM

Horizon Health Alliance, based in Buffalo, New York, was watching the telehealth industry expand to meet the demand for patients. In the months prior to the declaration of the COVID-19 global health pandemic, Horizon had been making preparations for and testing the implementation of an innovative telehealth system to expand service options for its patient population – persons with mental health and substance use disorders.

"Horizon noted we could likely reduce wait times for appointments; reduce no-show appointments; eliminate transportation barriers like lack of transportation and/or people medically unfit to drive; eliminate distance between counselor-patient; and engage those hesitant to come onsite, if we offered a secure platform via which counseling and therapy could be effectively conducted," said Jake Haacker, CIO and security officer.

"Horizon went live with this solution in November 2019, gradually offering the service by clinic and type of treatment," he added.

In 2019, Horizon Health Services received grant funds from local Western New York grant foundation agencies to work with telemedicine technology and services vendor Amwell to implement a new virtual care department at Horizon.

Building a new virtual care model involved the traditional clinical and operational staff, but also included and expanded the role of information technology and cybersecurity personnel. In November 2019, Horizon launched a controlled pilot to assess patient demand and clinical/operational workflows.

"Horizon needed to outfit our clinical staff with hundreds of pieces of equipment to allow them to attend to patients virtually."

Jake Haacker, Horizon Health Alliance

"When the COVID pandemic hit in March 2020, Horizon, like the rest of the world, had to change our organization to meet our patient demands while adhering to changing regulations," Haacker recalled. "Within one week, we had our whole organization shifted from bricks-and-mortar to a virtual healthcare provider.

"It was a lot of effort on the IT department and support/clinical staff," he continued. "The organization had the framework in place from the pilot, and successfully and securely shifted itself to continue to treat our patients."

PROPOSAL

Through a vendor-selection process, Horizon Health Alliance chose Amwell. Amwell's virtual care approach and past implementation projects fit Horizon's strategic vision of patient care, while addressing the major barriers it hoped to alleviate.

"Specifically, Amwell's solution was flexible enough for Horizon to configure and brand the solution to meet our operational workflows," Haacker explained. "Items such as customized patient messaging, pre-appointment questionnaires and satisfaction surveys, coupled with a secure video connection, were main points."

The vendor was experienced with addressing the aforementioned common problems and barriers of concern to Horizon.

MARKETPLACE

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MEETING THE CHALLENGE

During COVID-19, a majority of appointments for both mental health and substance use disorder were shifted to telehealth due to in-person restrictions.

At that time, the telehealth technology was a stand-alone system not integrated into the electronic health record. Horizon Health Alliance was able to integrate other technologies such as text reminders and credit card payments, which enhanced the patient experience. But several back-end operations were duplicated without the integration.

From 2019 to 2022, the telehealth department continued to mature and work closely with Amwell to identify several areas of improvement. In May 2022, Horizon upgraded its EHR to Cerner Millennium, a version that supported the Amwell integration.

This integration improved both the patient experience and back-end operations by eliminating several duplicative workflows. Items specifically addressed:

• Removing the required patient username/password.
• Single system for patient information, scheduling and clinical health record.

"It was essential for us to integrate telemedicine into our service model, but the reimbursement rates we receive for our services did not increase to reflect this additional cost of care," Haacker noted.

"Telemedicine did not replace our brick-and-mortar locations. It supplemented the work we do there, which made it significantly more expensive to treat our patients than it did before technology became a tool many of our patients now depend on."

RESULTS

Haacker offers three program goals and the outcomes for each goal:

• Reduce average wait time for psychiatric services by 10% via telehealth. Outcome: Horizon was able to achieve a decrease of 40 days wait time for psychiatric services by the end of the grant period.
• Expand tele capability to residents of two targeted underserved rural areas within 12 months. Outcome: Horizon has served 891 unique patients who reside in rural areas with limited access to mental health and substance use disorder services.
• Reduce wait time for initial appointments from 5.35 business days to 1 business day. Outcome: Given the option of in-person or virtual visits, Horizon is able to triage cases to accommodate appointments within one business day, as determined by need.

USING FCC AWARD FUNDS

In addition to the aforementioned grants, Horizon Health Alliance was awarded $697,590 by the FCC telehealth grant program.

"In March 2020, when COVID-19 abruptly eliminated face-to-face outpatient visits – and with our initial pilot completed – we fast-tracked our telehealth rollout and made our services available to our entire outpatient population by our entire workforce within a matter of two weeks," Haacker recalled.

"In order to accomplish this enormous feat, Horizon needed to outfit our clinical staff with hundreds of pieces of equipment to allow them to attend to patients virtually," he said. "In addition to clinical staff, all other supportive operations needed to continue as employees were sent home for safety purposes, and for indeterminate amounts of time."

Horizon supplied staff with laptops, docking stations, monitors, iPads, keyboard/mouse, and webcams to continue performing jobs remotely. Additionally, Horizon upgraded cybersecurity systems, given the confidential nature of patient visits and the information shared over networks.

"We were also able to support a year of our telehealth license costs in light of the significant increased operating costs we faced due to COVID," he said. "Horizon was fortunate that the FCC COVID-19 telehealth program supported all of these expenses.

"As we emerged from the worst of COVID, many patients elected to continue their mental health and substance use disorder treatment via telehealth for ease and efficacy of attending appointments," he continued. "If appropriate, given each patient's unique circumstances, this is agreeable."

Today, Horizon is equipped with the hardware required, and it has found solutions to telehealth challenges faced early on. Currently, clinical staff serves about 70% of patients via telehealth and patient surveys have shown very high satisfaction rates with this medium.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email the writer: bsiwicki@himss.org
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