Pennsylvania's Geisinger health system faces several challenges common to the healthcare industry, such as improving access to care, recruiting and retaining providers, and scaling technologies for rapid deployment across multiple campuses and dozens of medical specialties.

THE PROBLEM

Serving predominantly rural communities, many of Geisinger's patients experience barriers to getting the care they need. For example, transportation to and from appointments is a challenge patients may face, especially those living in remote areas that have long drives to their appointments.

Other patients, such as seniors and those with chronic conditions, may be homebound due to health complications. Telehealth alleviates the challenges these patients face in managing their health by creating access to routine and specialty appointments from wherever is most convenient for them.

"To address recruiting and retention of providers, telehealth was intended to facilitate recruiting providers who live outside of central Pennsylvania and enable existing providers who are not able to physically travel to clinics and hospitals due to injury or illness," said David Fletcher, associate vice president of telehealth at Geisinger.

"To recruit clinicians outside of the geographic region, it was necessary to ensure the entirety of the clinician's visits could be completed remotely and that they were licensed in the state in which the patient is located at the time of the visit," he added.

PROPOSAL

To scale for rapid deployment of services, Geisinger invested in a single telehealth platform for inpatient, outpatient and home-based services. By consolidating platforms, Geisinger was able to standardize many of the workflows and training processes required to rapidly deploy a new modality for seeing patients.

Geisinger had been using telehealth prior to the pandemic to create better access to care for patients. However, COVID-19 surges accelerated widespread telehealth adoption, as many couldn't leave their homes or were not comfortable coming to a doctor's office. With this, the health system saw many hospitals experience strains in their ability to accommodate the volume of patients needing care.

"In response to this shifting environment, Geisinger was able to leverage its single platform with its integrations with its electronic medical record system – Teladoc and Epic, respectively – to rapidly deploy telehealth to providers and groups of specialties who had not previously engaged in it," Fletcher recalled.

"We've been able to consistently achieve satisfaction rates well above 80% across many demographic groups, including patients over 65 years of age."

David Fletcher, Geisinger

"In a matter of weeks, Geisinger went from 20 specialties to more than 70 specialties and from about 200 providers to more than 2,000 providers using telemedicine to see patients in their homes, neighborhood clinics or local hospitals," he continued.

To improve recruitment of clinicians, Geisinger was able to expand its search both geographically and to outside sources. For instance, the behavioral health department was able to contract with an outside agency that could see patients using the Geisinger telehealth platform and EHR, with providers licensed in Pennsylvania, though not necessarily physically located there.

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RESULTS

Since the pandemic, Geisinger saw a greater than 2,000% increase in virtual patient encounters. Between March 16, 2020, and March 20, 2022, Geisinger completed more than 784,000 telehealth visits. At its peak, the health system averaged more than 3,800 encounters per day.

"For behavioral health specifically, Geisinger has seen significant decreases in no-show and cancellation rates," Fletcher reported. "Within two weeks of closing clinics due to COVID, behavioral health found it was able to complete more visits than it had prior to COVID because of the improved no-show rate.

"Additionally, during this time of massive change in healthcare, Geisinger has been able to maintain high rates of patient satisfaction," he continued. "We've been able to consistently achieve satisfaction rates well above 80% across many demographic groups, including patients over 65 years of age."

ADVICE FOR OTHERS

"It's important to consider what resources best support your communities' access to the care they need," Fletcher advised. "If telehealth makes it easier for patients to access care, then it's our responsibility as healthcare providers to make that available to them, whether through advocating for legislation to expand telehealth access beyond the pandemic or building community partnerships to provide the tools and resources needed to access telehealth services.

"For instance, as telehealth became more widely available during the pandemic, Geisinger recognized that broadband access was a significant challenge for its rural communities," he continued. "In partnership with a local internet service provider, we have been able to provide broadband access to patients participating in Geisinger at Home, a program designed for patients with multiple comorbidities who are especially at risk for readmissions to the hospital or emergency room visits."

Additionally, it's important to think from the patient's perspective and build a workflow that is intuitive for the whole population, regardless of their technical expertise, he said.

"For instance, Geisinger doesn't require a patient to download an app or sign into a portal to begin his or her visit," Fletcher explained. "Due to the integrations between the telehealth platform and the EHR, a link is automatically sent to the patient's phone or email at the time the visit is scheduled.

"Many of the positive survey responses Geisinger has received specifically mention how easy the patient found it to begin their visit," he concluded. "By putting patients at the center of these efforts, the industry will be able to effectively respond to rapidly changing circumstances due to public health emergencies, shifting regulations, competitive pressures from non-traditional health providers, and changing customer expectations."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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