Virtual Care Expert Shares the “Four Rules of Survival” for Healthcare Providers in the COVID Era
In a recent StartUp Health Expert Office Hour, Terri Seppala, CEO and Founder of consulting firm Telehealth Associates, shared the real challenges provider groups are facing in a COVID world, trends in tech adoption, and how the future lies in a yet-to-be-built hybrid model of care.
When COVID-19 hit at the beginning of 2020, healthcare providers of all sizes were presented with a dual challenge. How do you care for patients safely during a pandemic without going out of business? Some healthcare systems easily pivoted to telehealth solutions, but for many, the transition was anything but smooth. In this StartUp Health Expert Office Hour session, Terri Seppala, CEO and Founder of consulting firm Telehealth Associates, shares her cross-market insights on the needs and pain points of providers, hospital systems, and health centers as they navigate the landscape of digital health solutions.
Q+A
You spent a lot of time listening to and talking with providers and payers during COVID-19, about how they can augment virtual care. What have you heard and learned from these conversations from providers over the last few months about their needs and pain points?
The impact of COVID really changed the game. It put a spotlight on providers’ practices. The real questions for patients became: Where are you? What are you doing? What are you doing for me now? In terms of survival for providers and healthcare systems, it turned a walk into a race and changed the definition of sustainability. At this point, no healthcare organization could continue with revenue stream or continuity of care unless they got into telehealth and they had to do it very quickly. The need to pivot to telehealth represented a massive change to healthcare systems — just like the change moving from paper to EMR. EMRs represented this large change where it affected everything in a practice: workflow, processes, and HR. Telehealth is the same thing.
From our conversations with our clients, there are four new rules for survival that we hear:
- “I have to keep my patients in my ecosystem. I cannot lose my patients because they are not coming into the clinic.”
- “I have to find revenue and sustain my revenue flow.”
- “I have to get my providers on board.” Telehealth requires massive and significant provider buy-in to virtual care and the integration of virtual care with on-site care. The two are not separate systems, they must operate in a hybrid model.
- “I have to remain sane for myself, my patients, and my practice. I have to make sure that we can be calm and telehealth on.”
Can you share a specific example where a client has lost patients or had to get creative about keeping patients and sustaining revenue?
Here is the foundational idea: If the patient or the caregiver won’t use the technology, your goose is cooked. We had to learn this the hard way. We launched with a remote patient monitoring hypertension program with just a blood pressure cuff and a tablet. We thought that one page of instructions would be sufficient and easy for patients and providers, but we discovered massive resistance and handholding. People needed to be handheld every step of the way. From being reminded to take the blood pressure reading to having access to the wifi. From putting on the blood pressure cuff to taking the reading, there were many hiccups with this first launch.
When patients could not connect, they became frustrated with the equipment and they quit. I truly thought this would be so easy. Then we said, let’s go to the patient’s house, do the reading with them, and have hotlines for troubleshooting and phone call reminders. But if we wanted to roll this out to thousands of people, this was not scalable. So we took a step back. And we created a remote patient monitoring assessment to evaluate the likelihood of patient compliance with our program. We are very familiar with patient activation measurements, to see how accountable the patient will be to adhere to the treatment plan. We can assess their level of digital competency and assess any physical impairments by taking the readings. For example, some developmentally disabled patients shake so it’s hard to get a reliable blood pressure reading. We also looked into residence type and connectivity issues. Finally, we had to evaluate the technology, and here is what is important: We needed technology vendors that met the following criteria:
- It has to be simple for patients to use. For example, you put it on and press a button or you download an app and press a button. We turned to an RMP vendor that could incorporate 4 different measurements: blood pressure, pulse, heart rate, and thermometer all at once, at low bandwidth.
- The technology must consume a very minimal amount of time and fit well into patients’ daily schedules.
Understand a patient’s pain points
You have to understand how comfortable the patient is with learning and how motivated they are to learn. Performance is a combination of motivation and competency. If someone is really motivated to want to learn. You can present them with educational materials that can fit their needs. Some people learn better with audio. Some with video or by reading. But, you need to do that assessment. It is important to have an assessment of the end-user before you actually launch the product. If you have someone that is motivated and have tech experience, that makes it a lot easier to provide a user manual. But if you have someone that is not motivated, then that is tricky. I’ve seen a doctor tell me: “I don’t want to use this stuff. I just want to go back to the way it was before, I don’t want to make a fool of myself in front of my patients.” Sometimes it is the simple things that the patients or providers don’t understand that could be presented in a more compelling way for them to learn but you have to know what those things are and you don’t get that understanding without serious beta testing.
For example, I was just on the phone with a tech vendor who wanted me to sell their RPM equipment without having done a beta test on it and asked, “Is this product reliable in a real practical environment?” I said no. I cannot present this product to my clients and customers without having an understanding if it works reliably while consuming a minimal amount of time or not. If we understand how to transfer the knowledge to a person that is motivated but not competent, or a person that is scared of digital technology, we have to collect the data and get into the patient’s mind. I think that smart providers and vendors should put themselves in the patient’s shoes. Vendors have to ensure these technologies are quick, easy, and intuitive. Vendors need to provide multiple educational approaches and provide readiness assessments designed around the product. “The end goal is comfort, competence, and confidence. That is what you want your providers and patients to feel with your technology.”
Let’s anchor the discussion around where we are with COVID. The market is shifting. What are you seeing right now in terms of provider’s and buyer’s response? What are they responding well to? What they are looking for in a partnership?
This whole COVID tragedy is an exercise in change management. How do we change what people do? They have to understand and believe in it; they have to participate it in and accept it internally. When COVID hit, one of our clients, the CEO of a community health center, categorized his providers into three buckets. The first bucket is the type of provider that says, “I think telehealth is too much change; I’m overwhelmed by obstacles. I want to go back to the way things were before COVID.” The second bucket of providers says: “I know I need telehealth. I started doing phone calls and video visits but I have to take this to the next level and I don’t know how.” The final, third bucket says: “I’m ahead of the curve. I was already doing telehealth and I need to integrate it into my daily workflow.” In order to address all three buckets, the CEO first tackled their fear. He helped them understand the financial picture, that telehealth was reimbursable. He reassured and encouraged providers to not lose the skills they are good at but instead use the skills to learn new workflows.
As a vendor, we all need to be a partner in helping our client’s leadership team keep providers on-board. If we motivate providers to use our products and help them develop the competencies to do that, we will be so much more valuable to providers.
“The end goal is comfort, competence, and confidence. That is what you want your providers and patients to feel with your technology.”
What is an example of a client that really embraced telehealth, made that big change early, and now they are seeing the fruits of that labor?
I had a client in the Bronx. The clinic was in the worst part of where COVID hit and she elected herself to immediately get on board with telehealth. She prepared to do video visits through her EMR that already had the capability of video visits. She brought patients into a separate part of her clinic that was sanitized and separate from the main clinic. She then taught patients how they were going to remain with her and have access to her providers immediately. She was not afraid to tell them that they were safe here. The key was that she used the same systems and structure for in-person visits but she extended it into virtual care.
A lot of providers have made the mistakes of going into telehealth and utilizing a completely different infrastructure and scheduling system. My recommendation for healthcare providers is to keep their brand the same: keep patients in the ecosystem, keep providing the same level of service for in-person and telehealth visits, and use the same process that created loyal patients before.
With regards to the role that vendors and entrepreneurs can have in the equation, what are some of the secrets to success for hybrid models?
Incorporating telehealth into your clinic means offering the same caregiving experience that patients expect from you whether it is virtual or onsite. The goal is to minimize interruptions of workflows and scheduling. If patients love a certain scheduling software, use the same scheduling workflow; if they love their doctor, keep that doctor. We’ve seen health centers operate telehealth operations with a different triage staff, software, and scheduling and it just did not work. It only creates more resources, expenses, and confusion for patients and providers. If vendors can help minimize disruptions in service that is a huge service to providers. If you can help providers create this integrated model of care, you can help them retain their loyal patients.
What advice do you have for telehealth entrepreneurs trying to introduce their product or platform into healthcare facilities?
I have a couple of points. First, assure people that you’ve tested your product and taken all the necessary steps for commercialization. This way, when the provider rolls the product out, he or she is not surprised by anything that could have been prevented had you did more rigorous beta testing with end-users. For example, a hospital system that I’ve worked with went through three RPM vendors in the last two years. The problem was that the hospital system did not know enough to ask the right question to vet the vendors. As a vendor, you have a responsibility to help the buyer understand what questions they need to be asking you to make them feel comfortable, confident with the technology. Second, many vendors have hidden costs with warranties or upgrades. You can help your clients gain confidence by being very upfront about your knowledge about how your product operates in the field and about your costs. The battleground is in the field. The implementation is more important than the product. Being able to understand the factors in successful implementation is going to be key.
About Terri Sepella and Telehealth Associates
Telehealth Associates is a certified women-owned business located in New York. We are a telemedicine integrator that is focused on helping payers, providers, physicians, clinics, and health centers design, develop and implement virtual care programs using software and hardware. We are agnostic about technology which allows us to remain objective when recommending the right technology match for clients. With 12 years of experience singularly focused on digital health solutions, Telehealth Associates has a deep understanding of providers, caregivers, and patients. Our work aims to assist both providers and patients in feeling comfortable and competent in using digital health and other kinds of technology.
With a wide range of clients, we work with vendors to develop patient and provider specs for products and devices, vet and test products, and provide training to providers and patients alike. Over the past 12 years, Telehealth Associates has worked on a variety of projects across healthcare. When working with community health centers, we have been writing state and federal funded telehealth grants to the New York Department of Health and FCC, which has just given hundreds of millions of dollars for telehealth equipment. We were asked by a consortium for 60 agencies in NYC, who serve developmentally disabled individuals, to create a telehealth-enabled urgent care program where we could bring telehealth equipment into the homes of these patients for diagnostic virtual assessments. With hospitals, we’ve helped incorporate patient activation measurements and coaching for hospital-based AOCs. Additionally, we have created workflows and protocols for integration into clinical and virtual care for healthcare centers during COVID-19. We helped a children’s hospital select the right type of technology for their remote patient monitoring program. We’ve also created and launched a mental health telemedicine program for a Medicare payer. These are just some examples of the work and impact that TeleHealth Associates has made.
I decided to create this company because I’ve worked for corporations for years. I started my career at 3M, where I was involved with programmable hearing aids and at that time people were just getting into what programmable technology would look like. I then moved to Oracle to manage the North America Oracle education and services business. Then, I moved to MedTronics, where I was responsible for remote monitoring for the cardiovascular division. While working at Medtronic, I realized that I really liked the telemedicine space. Upon that realization, I decided to settle in New York and start my own company where I will be singularly focused on telehealth and it has been a real adventure since then.
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