Digital Health's Impact on the Quadruple Aim

The healthcare industry today is faced with an aging population, increased prevalence of chronic diseases, provider shortages, regulatory challenges, rising costs, and more. Fortunately, even with political discord over healthcare policy, there is unequivocal bipartisan support for digital health technologies that can help address many of these issues.

Over the past few years, Washington has loosened restrictions on digital health, and now healthcare organizations are thinking strategically about digital health’s role in driving the quadruple aim — improved clinical experience, improved patient experience, better outcomes, and lower costs. The question is, how can organizations build a cohesive, cross-enterprise digital health strategy that impacts all four dimensions?

Dimension 1: Improving the Clinical Experience

Physician burnout affects nearly 80 percent of physicians today, primarily driven by fatigue with electronic health records (EHRs) and interoperability, regulatory and insurance requirements, and loss of clinical autonomy. The American Medical Association estimates an organization's cost of physician burnout is between $500,000 and $1 million per doctor.

Interestingly, there is a correlation between physician burnout rate and willingness to use digital health. According to the Advisory Board Company, urologists, neurologists, emergency medicine physicians, and endocrinologists are among the most burnt-out specialists. They are also some of the specialists most willing to use telehealth to see patients — and health systems are taking notice. NewYork-Presbyterian has implemented an Express Care telehealth program in its emergency departments (EDs) to address long patient wait times and help ED physicians better manage patient demand. Through this program, which uses virtual visits to expedite care for low-acuity patients, the health system has reduced wait times to 40 minutes, compared to the average ED wait time of roughly 2.5 hours.

Joslin Diabetes Center, a leader in diabetes care, has turned to digital health to help address the national shortage of endocrinologists and the growing prevalence of diabetes. Through its virtual care program, Joslin Diabetes hopes to extend the reach of its endocrinologists by using virtual care to conduct shorter, more frequent visits for patients to improve outcomes.

Furthermore, there have been many recent advancements in EHR interoperability with telehealth platforms that have helped reduce physician work. We’ve partnered with Cerner to embed our platforms natively within Cerner Millennium, HealtheIntent, and HealtheLife, and launched Epic’s Apple Orchard virtual care platform. Other EHR manufacturers are enabling “app store” like functionality to enable telehealth platforms to be embedded inside of standard EHR workflows, making it easier for a broader set of physicians to access telehealth tools without having to learn new systems and processes.

Dimension 2: Better Outcomes

Healthcare organizations measure and report on hundreds of outcomes annually. Through this reporting, there are opportunities for organizations to identify areas where digital intervention could improve outcomes for patients. Common measurements where digital health could have an impact include readmissions, effectiveness of care, timeliness of care, and the patient experience.

Readmissions: This October, Medicare cut payments to 2,583 hospitals as part of its Hospital Readmissions Reduction Program (HRRP) — that accounts for 83 percent of the hospitals it evaluated. The program, which reduces payments to hospitals with excess readmissions within 30 days, can cost hospitals $563 million a year.

It’s reported that over a quarter of readmissions are preventable. Many healthcare organizations have begun to utilize digital health to help reduce preventable readmissions. For example, the VA reduced hospital admissions by 35 percent among its home telehealth patient population. By combining video visits with remote patient monitoring, healthcare organizations can better monitor patients, and have meaningful interventions when necessary.

Timeliness of care: Digital health plays a large role in reducing wait times and providing timelier access to care, whether it’s for low acuity conditions or serious, time-sensitive situations. Pediatric Associates, a privately-owned primary care pediatric practice in Florida, saw a 75 percent reduction in patient wait times for urgent care conditions through its telehealth triage program. On the other end of the spectrum, UMass Memorial Health Care is utilizing digital care to improve operational efficiencies and provide timelier access to specialty care for stroke and NICU patients.

Dimension 3: Improved Patient Experience

While patient experience is a metric to measure quality outcomes, it is also vitally important to the advancement of the healthcare industry at large. The digitalization of other industries — like retail, transportation, banking, and media — vastly improved the consumer experience, and consumers are ready for their healthcare experience to undergo that same transformation. According to a recent study, 66 percent of consumers are willing to use telehealth for everything from prescription renewals to chronic disease management and behavioral health. Healthcare organizations are findings ways to implement digital care into programs to better the patient experience.

End-stage renal disease (ESRD) patients often must undergo hours of treatment multiple times a week, which can be emotionally and physically taxing. This is an excellent example of a patient experience that could be greatly improved through digital healthcare. The Centers for Medicare and Medicaid Services (CMS) recently extended its coverage of fee-for-service Medicare by eliminating geographic restrictions for virtual dialysis patients’ check-ins. Now many organizations are beginning to treat dialysis and ESRD patients virtually. In fact, Intermountain Healthcare recently announced a new Kidney Care Center that will provide at-home dialysis visits through telehealth.  

Another digital health program that is greatly improving the patient experience is Penn State Health’s teleALS program. Amyotrophic lateral sclerosis (ALS), a chronic, progressive nervous system disease that causes loss of muscle control, requires an integrated team of providers to care for a patient. ALS patients often have an issue with mobility, so routinely traveling long distances for care and waiting long periods of time between provider appointments is burdensome. Through Penn State’s virtual program, patients can see their team of medical providers virtually from their home, eliminating travel, time, and lessening costs.

These types of innovative programs have a large emphasis on the patient experience; however, even urgent care telehealth — while not designed for chronically sick patients — has noticeable impacts on the patient experience.

Dimension 4: Lowering Costs

The International Data Corporation (IDC) estimates that worldwide spending on the technologies and services that enable digital transformation will reach nearly $2 trillion by 2022. For healthcare organizations, key stakeholders need to understand the value and return on investment digital care brings to an organization before investing in technology and services.

Many organizations have begun to try to quantify digital health’s value and cost savings. Anthem released a study on the value of virtual visits for nonurgent care. The retrospective study, which analyzed claims data comparing care and cost of patients receiving care via virtual visits with those receiving care for similar conditions in other settings, found that virtual care saved the health plan an average of $201 per episode. Intermountain Healthcare conducted a similar study and found the average telehealth savings per claim to be $367.

On the acute care side, healthcare systems are calculating the impact virtual provider consultations have on cost. Spectrum Health has a data-driven approach to its digital health program, analyzing and optimizing programs based on results. The integrated health system calculates digital health-associated cost savings to be more than $5 million, which includes reduced transfers. In the case of its infectious disease telehealth program, Spectrum Health has saved more than $345,000 by avoiding just 314 transfers.  

What Can Healthcare Organizations Do?

While value is certainly more than a return on investment, healthcare organizations need to show stakeholders that large investments in digital transformation can also equate to cost savings. These are just a few examples of different healthcare organizations’ digital health initiatives and their impacts on a dimension of the quadruple aim. While these programs are impactful, the next step is for healthcare organizations to weave together telehealth and the quadruple aim to make it a cross-continuum effort. While easier said than done, here are a few steps healthcare organizations can take to begin the process.

Develop a strong digital health vision by engaging all stakeholder groups to help infuse it throughout the organization. To achieve this, your organization should consider:

• Developing a cross-organization plan and rollout: Strategically identify where your digital health program will start, how you will expand, and what is needed to grow the program across the enterprise.

• Executive Leadership Buy-In: Support from leadership and key stakeholders is essential to a digital health program’s success. This support dictates the direction and strategy of the program and ensures adequate staffing and funding. A digital health champion can help influence leadership, and results from a pilot program can prove the impact of virtual care and help ensure expansion.

• A Phased Approach: Choose one or two use cases to focus on initially and build those out. Once workflows are optimized, workflows can be adapted and expanded to other initiatives.

• Clearly Defining KPIs: Defining telehealth program key performance indicators (KPIs) and measuring those KPIs helps organizations prove program impacts. While KPIs vary based on the program, common ones include reduced wait times, reduced readmissions, net new patients, cost savings, increased time-to-evaluation and more.

Collaborate across departments to build alliances and promote information sharing. A successful digital health program will require the collaboration of many departments, including but not limited to:

• Clinical: Maintaining high clinical quality is the top priority for a clinical team. Working with physician leaders to establish clinical guidelines and protocols for telehealth will foster a strong relationship and gain buy-in for providers. It’s also essential to continue to monitor clinical quality through actions like monthly chart reviews.

• Marketing: The growth and success of a telehealth program is directly associated with a strong communications plan. Engaging the marketing team and developing telehealth-specific engagement programs will promote patient utilization. Depending on the type of program, this can include traditional marketing, digital marketing or direct marketing — or a combination.

• IT: A health system’s Information Technology (IT) department is critical, especially if the organization plans to integrate the digital health program with its EHR. The IT department should work closely with the telehealth vendor’s IT department to ensure seamless data flow.

• Legal: The legal team should be involved to review and define the legal text and disclaimers included in a telehealth system and to ensure compliance.

Foster a positive atmosphere that is open to controlled experimentation of digital initiatives. Once leaders are on board with a digital health initiative, strategic internal communications will help inform, educate, and seek out physician champions. Today, many health systems have developed digital health teams designed to take a program from idea to execution. There are those on the teams whose sole function is to work with physicians to figure out how digital health can improve processes, help create workflows, and act as a resource to help sustain the program.

Healthcare organizations that can infuse digital innovation into every aspect of operations — from EHR integration and clinical workflows to patient engagement and marketing — while also integrating it with system-wide IT infrastructures to establish a cross-enterprise program,  will see positive impacts on every dimension of the quadruple aim.