Chat with a Doctor: On-Demand, Asynchronous Physician Advice Session 189: March 7, 2018 Ari Melmed, MD, FACEP Assistant Regional Director for Telehealth, Colorado Permanente Medical Group 1
Conflict of Interest Ari Melmed, MD Has no real or apparent conflicts of interest to report. 2
Agenda What is Chat with a Doctor Why provide Chat? The Quadruple Aim Learnings Q & A 3
Learning Objectives Describe access to care benefits of an asynchronous virtual care program Quantify adoption rates in this unique text-based application of telehealth Identify optimum case use of chat based care, its limitations and advantages 4
Chat with a Doctor Female patient is leaving for a week-long international work trip first thing in the morning Feeling symptoms of a UTI No time to see the doctor in person or wait for an email response 5
Chat with a Doctor Member logs on through kp.org and identity is verified through the patient portal where they can directly access the Chat with a Doctor program. 6
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Chat with a Doctor Prescription entered to treat UTI Patient picks up prescription at convenient pharmacy near their home Ready for a business trip knowing she can always reconnect with a KP doctor through the platform 9
KPCO Chat with a Doctor Launched Nov 2016 in CO KPWA launched Jan 2018 On-demand unscheduled access to CPMG physicians Asynchronous text-based communication Available 8am-10pm, 7 days-a-week No cost to the member 10
KPCO Chat with a Doctor 3 rd party chat platform CirrusMD Web based Able to upload photos Mobile in development 11
Access to EMR Review past encounters labs/radiology studies Physicians manually summarize encounter for EMR Ability to communicate with member s care team Order meds, refills, referrals Backup from Telephone Medicine Center for high acuity chats 12
Integrating Specialty Care Depending on patient needs, encounters can be transferred to the most appropriate provider of care or administrative support. 13
Why offer Chat: Through the Quadruple Aim Lens Service Quality Affordability Sustainability 14
Service: Patient Satisfaction 3.2% 2.0% 3.3% How would you rate your experience? Excellent Good Adequate Fair Poor 14.2% 77.1% Patient survey data: Nov17-Jan18 15
Service: Patient Satisfaction 4.3% 2.0% 2.5% 0.9% How likely are you to recommend this chat service to a friend or colleague? Extremely likely Very likely Somewhat likely Not very likely Not at all likely I don't know 15.9% 74.4% Patient survey data: Nov17-Jan18 16
Service: Patient Testimonials Excellent, not only did it save my time. It also saved valuable time for the resources at the doctors office. Quick and helpful. Thank you. So thankful for the service. THANK YOU! Thank you. That was so easy. I love Kaiser! 17
Quality: Resolution and Bounce Back ED 2.9% 28% referred to brick-and-mortar 72% resolved via chat Routine Appt. 11.7% 3-5% were seen in-person within 7 days Same Day Appt. 13.0% 18
Quality: Disposition Physician A 1% go to the ER 10% go to urgent care 15% go to clinic 74% are resolved on platform Physician B 15% go to the ER 15% go to urgent care 20% go to clinic 50% are resolved on platform Compare providers to the group mean to easily be able to see who manages patient needs best. 19
Affordability: Cost per Encounter 61x A Chat with a Doctor encounter is 48% the cost of a nurse call, 10% of competing video evisits, and 2% of an ER visit. 1x 2.1x 7.1x 9.7x Chat with a Doctor Nurse Call Line Urgent Care Primary Care Visit ER 20
Affordability: Measuring Efficiency Length of Chat 20.4 min* Time to Initiate Chat 1.3 mins** *Average data since launch **Median data since launch 21
Affordability: Market Differentiation Support the Sales team: Featured in worksite telehealth rooms Member retention I think this is a great service that Kaiser offers and is one of the reasons I would want to stay with Kaiser. 22
Sustainability: Chat Staffing Working from home or office Most physicians feel that chat offers a counterbalance to clinic/ed work and helps sustain and enrich their work week Impact on recruitment and retention of primary care physicians 23
Learnings: Staffing Started with generalists: EM & FM Have since added specialty care: Pediatrics Clinical Pharmacy OB/GYN Support Agent Scheduling Experience with telephony resolution rates have pushed use of physicians over RN or MLP 24
Learnings Staffing Physicians can handle up to 4 simultaneous conversations Queuing minimized by setting staffing to 5-7 chats/provider/hour Members willing to tolerate queue if given information on place in line and see movement Tolerance for wait lowered once chat initiated Not well suited for chat High acuity/risk complaints Asynchronous pacing and continuity vs synchronous Duplicative communication Has already entered into communication with PCP High likelihood for face-to-face evaluation 25
Webside Manner Skills for successful interactions Express empathy Demonstrate and verify comprehension -provider and member Refer to the member s medical record, primary care team Be human. Connect emotionally, use humor when appropriate Share resources Invite further questions Review precautions for return/escalation especially important virtually 26
Questions Ari Melmed Assistant Regional Director, Telehealth Services ari.z.melmed@kp.org Please complete online session evaluation 27
Who uses chat? Users by Age Group 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 0-17 18-24 25-34 35-44 45-54 55-64 65+ 28
What issues do members chat for? URI Symptoms 26.74% Gynecological 1.23% Musculoskeletal Pain 5.40% Results Review 1.08% Skin Problem 4.92% Injury 0.84% UTI Symptoms 4.44% Pregnancy Related 0.72% GI Issues 3.72% Dizzy 0.69% Eye Problem 3.69% Chat with a Pharmacist 0.66% Medication Question 2.10% Anxiety 0.63% Headache 1.47% Chest Pain 0.54% Flu-like Symptoms 1.44% Lab Order Request 0.54% Fever 1.38% 29
Present Volume of Chats Encounters by Week 30
Plans for expansion Adding Behavioral Health Expanded hours Additional Specialties Post-discharge management High Utilizer Mobile App Voice recognition Cross-regional coverage? Platform changes 31 Direct import into Health Connect Landing page for selfdirection User permissions Proxy Toggle Smart sets