A Weitzman ECHO presentation on October 7 2020

1. Data Driven Telehealth:
Understanding the Impact & Measuring
Satisfaction
October 7, 2020

2. CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The
Bridgeport Hospital Yale New Haven Health designates this live activity for a
maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only
credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential
Areas and policies of the Accreditation Council for Continuing Medical Education
through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and
the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited
by the Connecticut State Medical Society to provide continuing medical education
for physicians.
• The content of this activity is not related to products or services of an ACCME-
defined commercial interest; therefore, no one in control of content has a relevant
financial relationship to disclose and there is no potential for conflicts of interest.

3. Data Driven Telehealth: Understanding the
Impact & Measuring Satisfaction

4. COVID-19 in the United States
7,500,964 cases on 10/7/20 up from 7,186,527 cases on 9/29/20 210,616 deaths
https://coronavirus.jhu.edu/map.html

5. • “We’re in very bad shape, never having achieved any sense of
containment, never gotten below 20,000 new confirmed cases
per day”
– Dr. Eric Topol, Director Scripps Research Translational Institute
• “Things can only get worse on this course”

11. “I can’t say anything about this…”

12. News UpdatesAirlines: 32,000 employees furloughed
– Law makers/WH fail to agree on pandemic relief
– Airlines losing $5 billion/month

14. Resources
• Nuvance health ~1250 articles reviewed:
https://spark.adobe.com/page/zvcnKS4bcZAHR/
• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Others
https://www.thelancet.com/coronavirus
https://covidactnow.org/

15. Family Health Center’s
Response to COVID 19

16. About the
Family Health
Centers

17. The Family Health Centers (FHC) at NYU Langone is a community-based program that
provides high-quality primary and preventive outpatient care to adults and children regardless
of their ability to pay or health insurance status
Founded in 1967, FHC has grown to become one of the largest
Federally Qualified Health Center (FQHC) networks in the nation
Our network of Brooklyn-based community health centers includes:
8 primary care and specialty sites
Dental clinics are co-located at 5 sites
23 School-Based Health Centers
(12 Primary Schools, 3 Middle Schools, 8 High Schools)
10-site Community Medicine Program serving 4,700 homeless New Yorkers
Behavioral Health
Rehabilitation Physical Therapy
HIV Services
340 B Drug Assistance Program
Teaching Health Center
Post-Doctoral Dental Residency Program
Social support services and Community-based programs for
adults, children, and families.
Who We Are and Services We Provide

18. 18
FHC Patient Characteristics
 (UDS CY 2019; Excludes Sub-grantees)
 Total Population: 102,796 with over 600.000 visits
o 75% live at or near poverty level (income is <200% of the
Federal Poverty Level)
o 61% at or below FPL
o 41% are best served in a language other than English
o 12% are in SBHCs for primary care
o 2,430 prenatal patients
o 5.6% teenage pregnancies

19. Virtual Visits Launch
in Primary Care

20. In preparation for a potential surge in COVID 19 cases we took the immediate
action:
o Centralized a PPE stock inventory and supply ordering
o Tracked patients presenting with fever or cough
 Determine when cases began to increase
o Formalized a Surge Plan in preparation for seeing a significant increase in:
 Patients presenting to practices/sites
 Staffing challenges
 Employees becoming sick
o Instituted a daily communication call with all FHC employees to review:
 COVID-19 Data
 PPE Supply
 Screening protocols
 Testing and treatment guidelines
Preparatory Phase

21. Standalone site designated to evaluate and test patients suspected of COVID-19
Nursing trained by Medical Directors regarding obtaining a nasopharyngeal swab
Patients presenting at the sites were screened for fever/cough. If screening was positive,
patients were given a mask and flyer with instructions to schedule an appointment
 April 1st, screening was expanded to employees
FHC Respiratory Screening Center (March 19th)

22. As the number of COVID-19 cases increased the FHC started transitioning from
in person to virtual visits. This process included consolidating sites
o Designated sites for COVID suspected patients
o Designated sites for non-COVID suspected patients
Clinicians are able to evaluate and manage patients with non-acute symptoms
using a video visit.
Technology for remote evaluation includes:
o Webex – interactive Audio and Video. Preferred method
o Webex- Audio only. Use only if unable to set up video connection.
o Telephone only – Use only when Webex is not an option
Virtual visits began in March with Behavioral Health visits and on March 23th,
expanded to Medical/Specialty visits
Virtual Visits

23. Workflow and Visit Criteria Established

24. Most medical and behavioral health patients could be seen via an FHC Virtual Visit following current
protocols
If determined that the patient needs to be seen in-person for either COVID or non-COVID symptoms the
following centers are open for an in-person visit
Clinic hours: Monday through Friday, 9am-5pm, all locations
Visitors are not allowed to accompany adult patients in the clinic unless the patient has mobility limitations.
Pediatric patients are allowed 1 visitor
All patients/visitors will be screened at the front door of the COVID negative centers for COVID symptoms
and their temperature will be taken. If a positive screen, the patient will contact the FHC call center to make
an appointment for the FHC Respiratory Screening Center (ADULT) or 5610 Pediatric FHC (PEDIATRIC)
FHC In Person Access

25. Virtual Visits
Behavioral Health virtual visits were easily adaptable and in place
Not all medical visits lend itself to a virtual visits. Those visits are being converted to June
recalls. Current conversion ~75%
Pediatric patients are being scheduled for in person nurse visits for immunizations to assure
timeliness of vaccine

26. Use of Different Technology Platforms to
Conduct Virtual Visits

27. Expanded Use of Virtual Visits

28. Utilization of Recalls
for Patient Care
Management

29. Utilization of Recalls for Patient Care Management
EPIC’s Patient Recalls is a systematic way to proactively outreach to patients
for:
o Preventive care services
o Chronic care services
o Abnormal labs
Benefits include:
o Avoids reactive care by engaging patient in continual care
o Avoids mad rush at the beginning and end of the year to close gaps
o Avoids lost revenue
o Provides a mechanism to track and report outreach efforts
o Consolidates outreach to one worklist in EPIC

30. Phase 1 – October 2018 Automatic Annual
Based on current visit types: Physical, Well Child >2 years, GYN Yearly Exam, GYN New Patient, New
Patient
10 months from current appointment, customized FHC recall letter batch printed automatically for site
to mail or sent electronically if MyChart enrolled.
If no appointment made, front desk will outreach after one month of letter being sent
Phase 2 – July 2019 Automatic Pediatric Recalls for Patients 0-23 months
Phase 3 – August 2019 Manual Recalls entered for
Established Managed Care patients with specific gaps in care Ie: cancer screenings, eye exams
Established High Risk uncontrolled Diabetic and/or Hypertensive patients
Historical Phased Approach to Proactive Recalls

31. Scope of Project: Population Management
FHC 2019 Recalls in EPIC
68% of patients
with Primary
Care Visits had
at least one
recall

32. 2019 Healthfirst Performance – Progressive
Improvement Year Over Year

33. 2020 Efforts to Close the Gap of Missing Recalls
33
In 2019, with 68% of patient being seen in primary care having recalls, attention
was given to assure all a greater compliance with the recall process.

34. Key To Continuous Care
Follow Up Instructions after Each Primary Care Visit
 The communication tool for staff scheduling appointments is the
follow up instructions written in wrap up before patient is checked
out
 Providers indicate follow up instructions during the encounter so
front desk staff can either make follow up appointment or create a
manual recall
If the next visit time
frame is not written
here, the patient
may be lost to care!

35. FHC Visit Volume Activity – FY20 Virtual Visits
35

36. THANK YOU

37. 37
Data Driven Telehealth:
Understanding the Impact & Measuring
Satisfaction
Community Health Center, Inc.
Meredith Johnson, MBA, MHA; Chief of Staff,
Community Health Center,
Tierney Giannotti, MPA; Senior Program Manager, Population Health,
Community Health Center

38. • 82,269 unduplicated patients seen March 15, 2020 – October 1, 2020
• 81% of visits by either phone or video
• 261,472 telehealth appointments
o 183,395 phone (78%)
o 57,734 video (22%)
38
Patients Seen via Telehealth Since March 2020
Behavioral Health Medical
Phone 55% 76%
Video 40% 7%
In Person 5%
(forensic interviews)
17%

39. 1. Real Time (video visits only)
• Send patient a text with survey link day after appointment
• Utilize data as a ‘canary in the coalmine’ to track trends
• Technical issues
• Concerns about quality, providers, changes we’ve made
39
2 Types of Patient Feedback

40. 40
Patient Satisfaction Results: Text Survey
82% of patients are interested in using telehealth for future
appointments (n= 786)
4.3 4.4 4.5 4.4
1 2 3 4
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Please answer the following on a scale from 1-5
(1= Strongly Disagree, 5= Strongly Agree)
Series1

41. 41
Patient Satisfaction Results: Text Survey
(n= 773)
1 2 3 4 5 6
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
How much time was saved today by having a telehealth visit?
(Please include travel, wait time, time off work, etc.)
Series1

42. 42
Patient Satisfaction Results: Text Survey Dashboard
• Comments are incorporated into our established patient experience process
o Shared with leadership and Operations Managers
o Part of service recovery efforts

43. 1. Real Time (video visits only)
• Send patient a text with survey link day after appointment
• Utilize data as a ‘canary in the coalmine’ to track trends
• Technical issues, concerns about quality, providers or changes we’ve made
2. Weekly Telephone Surveys (all visit types; results reported quarterly)
• One to two weeks after medical, behavioral health or dental appointment a
random sample of patients receives a call from independent survey vendor
• Service recovery reports enable timely follow up on specific issues
• Data disaggregated by appointment type and discipline to identify trends
43
2 Types of Patient Feedback

44. n=886

45. 45
Patient Satisfaction: Phone Survey
In person
visits
only
Telehealth
& In person
visits

46. 46
Patient Satisfaction: Phone Survey

47. 47
92.4
87.5
91.7
88.3
0
20
40
60
80
100
Overall quality of care by provider Ease of connecting with care team
AverageScore
Phone Video
Phone and Video Comparisons, 3Q 2020
n=503

48. 48
Connected with care team within 15 minutes of appointment
time, 3Q 2020
88.8%
95.8% 94.1%
0%
20%
40%
60%
80%
100%
In person Phone Video
PercentreportingYES
n=495

49. • Positive Comments
• The video encounter is good. It is almost like you are in the room and can point to
the location of where you are having the problem.
• I would like the encounter in person but due to the coronavirus we had had the
encounter by telephone or video, and I have not had any issues with either of
them.
• The service was good via telehealth. The video call dropped and not even within
a minute [name]a called back.
• I had an excellent experience with the zoom encounter…Zoom is more effective
than regular phone encounters.
• Opportunities for Improvement
• I would like in person visits better then video. The audio wasn't working on my
video call, and it also took about 30 minutes to connect.
• The Wi-Fi during the video encounter was difficult to hear the nurse and doctor.
• Seeing someone in person is very different than seeing them on video.
• I was entering an extra number for the ID password, and I couldn't connect easily.
49
Patient Satisfaction - Phone Survey: Comments

50. 50
Telehealth Clinician Satisfaction
24%
13%
59%
56%
13%
21%
3%
10%
0%
2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
1
2
Opinions
ZoomFeature
Series1 Series2 Series3 Series4 Series5
The Zoom Video audio / picture quality is good.

51. July 2020 51
Telehealth Clinician Satisfaction
Considering the circumstances, my patients receive the same
quality of care during a video/phone visit as an office visit.
10%
12%
31%
30%
25%
22%
21%
22%
13%
14%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
1
2
Opinions
TelehealthTechnology
Series1 Series2 Series3 Series4 Series5

52. July 2020 52
Telehealth Clinician Satisfaction
Post COVID-19, what percentage of all visits would be you prefer to
be telehealth visits (phone and video)?
0
10
20
30
40
50
60
70
80
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
Count
Suggested Percent

53. 53

54. 54 * This initiative is supported by

55. Thank You!
To learn more about The Path Forward series
WeitzmanLearning.org/the-path-forward
To view previous COVID-19 sessions:
WeitzmanLearning.org/coronavirus