Telehealth and LTPAC
Part 2: Leading Geriatric Practice Uses Virtual Care to Overcome Delays in Treatment

Part 1 covered how LTPAC organizations can use telehealth and virtual care effectively to improve
access to care and the health of the individuals they serve. But what does employing telehealth and
virtual care look like in the “real world?”

Let’s take a look at how a leading geriatric practice turned a COVID-19 necessity into a core element of
their approach to care.

Mobile geriatric medicine, value-based contracts and telehealth

Genevive is the largest geriatric practice in Minnesota, and half of its patients are in value-based
contracts. Before COVID-19, 100% of its providers were in the field. In March 2020, care teams were
pulled out of the field, and the organization had to figure out how to support and care for patients
remotely.

Genevive had already implemented GEHRIMED, which is part of the Netsmart CareFabric®, prior to the
onset of the pandemic. It’s a cloud-based, mobile EHR that uses iPads and allowed the organization to
adapt fairly quickly to expanded virtual/telehealth options as soon as the Centers for Medicare and
Medicaid Services (CMS) approved them.

Although reliance on telehealth began as a necessity, Genevive now sees it as an effective tool for
overcoming delays in treatment. The organization is currently looking at how to balance the need for in-
person connections and the ease of access with virtual care.

Clinicians have noted it’s particularly helpful in dealing with acute situations. Here’s a recent example
offered by Kelli Petersen, clinical integration manager at Genevive:

1. A nurse coordinator was deployed to the home of a patient experiencing exacerbation of COPD, an acute situation
2. A preliminary assessment was conducted by the nurse
3. Current medications were reviewed
4. Treatment options that could be delivered quickly to the home were evaluated
5. The physician provider was brought up to speed by the nurse
6. The nurse facilitated a virtual visit with the physician provider and patient via iPad
7. The physician provider completed the assessment virtually, ordered follow-up treatment and the patient
            was able to remain in the home

Wound care was cited by Petersen as another area where telehealth has been effective. Instead of
relying on a description over the phone, providers can actually “put eyes” on the wound to determine if
there’s an infection and initiate the appropriate treatment.

The fact that the patient and family members can also see the clinician via teleconference fosters
confidence, increasing trust and satisfaction with the care provided, according to Petersen.

To summarize, these are the ways telehealth benefits Genevive, staff members and the patients they
serve:

• Removes barriers to care and reduces delays in treatment
• Decreases hospitalizations and readmissions
• Allows providers to assess patients and intervene before their condition requires care in a higher acuity setting
• Lowers the cost of care and supports value-based contracts while upholding the quality of care and outcomes
• Allows Genevive to deploy higher cost providers in acute situations but without the time and cost of travel

What lies ahead

COVID-19 forced many providers to adapt their services to include virtual care and telehealth. However,
the growth of virtual care is forecast to continue even as the restrictions caused by the pandemic have
eased.

According to analysis done by McKinsey & Company, April 2020 saw a surge in telehealth usage for
office visits and outpatient care that was 78 times higher than in February 2020. A year later, demand
has leveled off, but telehealth usage is still 38 times higher than before the pandemic.

McKinsey estimates that up to $250 billion of U.S. healthcare spending could eventually shift to virtual
care. Reaching that level of usage, however, will require changing care pathways and continued
acceptance and adoption by consumers and clinicians. Continued consumer acceptance of telehealth
looks promising, with 76% of consumers are interested in using telehealth and virtual care options.

Forecasts also point to a large portion of Medicare, Medicaid and privately insured office visits becoming
virtual in coming years. This is due in part to the previously mentioned value-based and risk-sharing
reimbursement models. According to the Centers for Disease Control and Prevention, chronic disease
care, which requires frequent and ongoing management by clinicians, accounts for almost 75% of all
U.S. healthcare spending. It’s obvious, telehealth could offer payers and providers strong benefits if
widely adopted.