Over the course of the pandemic, demand for behavioral health services increased dramatically in the communities served by Geisinger, the Danville, Pennsylvania-based health system. With a large patient population in rural areas, Geisinger expanded its use of telemedicine to scale access and leverage a national workforce to serve them.

Today, Geisinger Behavioral Health serves more than 45,000 unique patients annually, with more than 80% of services offered via telemedicine.

THE PROBLEM

While telemedicine created access, challenges related to pre-visit readiness remained a problem. For example, delivering patient questionnaires and collecting signatures on documents such as consents was challenging when patients did not come to an office.

This was largely because telemedicine visits were not embedded in the patient portal, MyChart from Geisinger's EHR vendor Epic, said Benjamin C. Gonzales, operations manager II, virtual care, behavioral health, at Geisinger.

"Many of the pre-visit requirements, such as signing certain consents and completion of certain health screeners, had both regulatory and quality implications when not completed," he explained. "Geisinger needed a way of integrating these required steps into the video visit itself to maintain compliance, enable pre-visit readiness, and mirror the information captured prior to in-person encounters."

PROPOSAL

One of the challenges offering telemedicine services at scale for the Geisinger Behavioral Health team was capturing pre-visit items that would normally be collected in-clinic during registration and checkout.

"Patients had the option to complete many items such as questionaries and signing documents in MyChart prior to integration of telemedicine, but most did not complete these steps because the video visit itself was launched from a link sent to their emails rather than through MyChart," Gonzales noted.

"In addition, many items presented in e-Check In were not configured to meet department requirements prior to the integration of telemedicine," he continued. "By adding all required items to e-Check In and integrating the launch of video visit into the patient portal itself, patients would be presented with required items for their visit before they were given the option to launch the visit."

This would enable compliance and help prepare them and the information needed for their visit, he added.

MEETING THE CHALLENGE

In partnership with the health system's digital engagement and telemedicine teams, Geisinger Behavioral Health mapped out all required elements needed as part of the video visit.

These items included e-signature of documents such as consents and assignment of benefits, health questionnaires, co-pay collection, insurance verification, and a means of sharing and obtaining signature of the patient's treatment plan.

"All items except for the treatment plan were presented to the patient in an e-Check In flow presented to them prior to the start of the visit and were made available up to 14 days prior to the visit," Gonzales explained. "Once these items were completed, patients would be given the option to launch their visit, ensuring all required items were completed prior to the visit.

"Once launched, patients and providers alike were presented with telehealth vendor Teladoc's user interface, which was identical to the one used prior to integrating in MyChart," he continued. "After their visit, providers had the ability to share a copy of the patient's treatment plan via specialty plans of care in the Epic EHR."

Patients also could sign the treatment plan, thus enabling compliance with state regulations.

"Ultimately, all items not required by behavioral health's regulators and payers were set as optional for patients to complete," Gonzales said. "However, completion remained strong given that all items were presented ahead of the visit in the same environment the video visit would be launched from."

RESULTS

More than 50,000 patients completed video visits via MyChart during the first five months of the pilot. More than 88% of patients were able to successfully complete their video visits after being integrated in MyChart, higher than pre-pilot measures.

"Since go live, 96% of patients completed e-signature of required documents, up from 66% at the start of the pilot," Gonzales reported. "This has made our team's compliance efforts significantly easier to manage.

"In addition to completing e-signature of required documents, 81% of patients completed all components of E-check In, up from 18% from the start of the pilot," he continued. "This includes payment of co-pays, health questionnaires, demographic updates and verification of insurance."

Finally, 94% of patients now have an active MyChart account, up from 81% from the start of the pilot.

"It's estimated the system creates $96 of cost avoidance and value for every patient engaged in MyChart; this is primarily attributed to decanting phone calls, saving on postage and decreasing the likelihood of a no-show appointment," Gonzales noted.

"With a 13% increase in patients activated on MyChart, we estimate a savings of more than $560,000 from this pilot," he said.

ADVICE FOR OTHERS

For organizations considering this type of integration, be thoughtful about which components of the pre-visit experience need to be added and required, Gonzales advised.

"While they can save time during the encounter, overburdening patients may occur and can create delays in beginning the encounter resulting in being a patient dissatisfier," he said. "It's also critical to consider support structure for patients and providers who need assistance accessing, using and activating their patient portal.

"If possible, it may be advisable to allow patients to access these functions without the need to activate an account," he concluded.

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