Geisinger saves $560,000 on a pilot by integrating video visits into Epic MyChart
Over the course of the pandemic, demand for behavioral health care has increased dramatically in the communities served by Geisinger, the Danville, Pennsylvania-based health care system. With a large patient population in rural areas, Geisinger expanded its use of telemedicine to scale access and deploy 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 provided access, challenges associated with pre-visit preparation remained an issue. For example, delivering patient questionnaires and collecting signatures on documents such as consents was a challenge when patients did not come to an office.
This was largely because telemedicine visits were not embedded in Geisinger’s EHR vendor Epic’s patient portal, MyChart, 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 completing certain health screeners, had both regulatory and quality implications if not met,” he explained. “Geisinger needed a way to integrate these required steps into the video visit itself to maintain compliance, enable pre-visit preparation, and display the information captured prior to in-person meetings.”
PROPOSAL
One of the challenges of offering telemedicine services at scale for the Geisinger Behavioral Health team has been capturing items before a visit that would normally be collected during registration and checkout at the clinic.
“Patients had the opportunity to complete many items in MyChart such as questionnaires and signing documents prior to telemedicine integration, but most did not complete these steps because the video visit itself was launched via a link sent to their emails was sent instead of via MyChart.” Gonzales noted.
“Additionally, prior to the integration of telemedicine, many items presented in e-Check In were not configured to meet department requirements,” he continued. “By adding all required items to e-Check In and integrating the launch of the video visit into the patient portal itself, patients would be presented with the required items for their visit before being given the opportunity to start the visit.”
This would enable compliance and help them prepare and obtain the information needed for their visit, he added.
MEETING THE CHALLENGE
Working with the health system’s digital engagement and telemedicine teams, Geisinger Behavioral Health mapped out all the required elements needed as part of the video visit.
These items include the electronic signature of documents such as consents and benefit assignments, health questionnaires, copayment collection, insurance verification, and a way to share and sign the patient’s treatment plan.
“All items, except the treatment plan, were presented to the patient in an e-Check In flow prior to the start of the visit and were made available up to 14 days prior to the visit,” Gonzales explains. “Once these items were completed, patients were given the option to start their visit so that all required items were completed prior to the visit.
“After launch, both patients and providers were presented with telehealth vendor Teladoc’s user interface, which was identical to the interface used before the MyChart integration,” he continued. “After their visit, providers had the option to share a copy of the patient’s treatment plan through special care plans in the Epic EHR.”
Patients could also sign the treatment plan, allowing compliance with government regulations.
“Ultimately, all items not required by behavioral health regulators and payers were set as optional for patients to complete,” Gonzales said. “Completion remained strong, however, as all items were presented prior to the visit in the same environment where the video visit would be launched.”
RESULTS
More than 50,000 patients completed video visits through MyChart during the first five months of the pilot. More than 88% of patients were able to successfully complete their video visits after integrating into MyChart, which exceeds pre-pilot measurements.
“Since go-live, 96% of patients have completed electronic signatures of required documents, compared to 66% at the start of the pilot,” Gonzales reports. “This has made managing our team’s compliance efforts significantly easier.
“In addition to completing the electronic signature of required documents, 81% of patients completed all components of E-check In, an increase from 18% from the start of the pilot,” he continued. “This includes co-payment, health questionnaires, demographic updates and insurance verification.”
Finally, 94% of patients now have an active MyChart account, up from 81% from the start of the pilot.
“It is estimated that the system creates $96 in cost savings and value for each patient engaged with MyChart; this is primarily attributed to decanting phone calls, saving on postage and reducing the chance of a no-show appointment, Gonzales noted.
“With a 13% increase in the number of patients activated on MyChart, we estimate savings of more than $560,000 from this pilot,” he said.
ADVICE FOR OTHERS
Organizations considering this type of integration should think carefully about what components of the experience should be included and required prior to the visit, Gonzales advised.
“While they can save time during the encounter, patients can become overloaded and cause delays in starting the encounter, leaving the patient more dissatisfied,” he said. “It is also critical to consider the support structure for patients and caregivers who need help accessing, using and activating their patient portal.
“If possible, it may be advisable to allow patients to access these features without requiring them to activate an account,” he concluded.
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