Improved access to care is the most significant value associated with telehealth services, this new chief physician officer says.
Telehealth services deliver value for health systems and patients in several ways, according to the new chief physician officer of MultiCare Health System.
Todd Czartoski, MD, was named chief physician officer of MultiCare in June. Prior to being named chief physician officer, he served as president and CMO of the health system's Neuroscience Institute and virtual health service. Before joining MultiCare, he served as chief executive of telehealth and chief medical technology officer at Providence.
First and foremost, telehealth has proved its value in improving access to care, according to Czartoski.
"In the early days of telehealth, there was concern that people of lower socioeconomic status would not have access to a device that could support a telehealth visit," Czartoski says. "But there is data that shows this population may not have much money, but they still have smartphones that can conduct telehealth visits."
Telehealth is helping health systems cope with a growing physician shortage across the country in multiple specialties, including neurology, psychiatry, and primary care. Czartoski uses stroke care as an example.
"If someone has a stroke, having access to a board-certified neurologist or vascular neurologist via telehealth is incredibly important," Czartoski says. "So, telehealth can take specialized expertise and spread it across a geography."
There are more nuanced ways that telehealth delivers value, including patient satisfaction, cost savings, and a better experience for clinicians, according to Czartoski.
"With telehealth, clinicians often do not need a patient to drive two hours for a follow-up visit to collect information, then they can move on to the next patient," Czartoski says.
Traditionally, physicians have seen patients in a sterile environment at a clinic without any context of what is going on in their life. Telehealth generates value by allowing clinicians to get insights into their patients by conducting visits in a patient's home, Czartoski explains.
For example, if a physician sees a patient with gait instability or cognitive decline during a telehealth visit in their home, they can see the status of the home, such as whether there are rugs on the floor or stairs that have to be climbed.
"A physician can see what real life is like for the patient and see whether there are risks in the home," Czartoski says.
Todd Czartoski, MD, is chief physician officer at MultiCare Health System. Photo courtesy of MultiCare Health System.
Identifying and addressing healthcare inefficiencies
CMOs and other leaders can play a pivotal role for healthcare organizations by identifying and addressing inefficiencies and friction points. While identifying inefficiencies, healthcare leaders should rely on frontline caregivers. Czartoski explains that executive leaders should be cautious about weighing in on operational challenges at a healthcare organization.
"I'm a big fan of listening to people who are in the trenches doing the work," Czartoski says. "There is no substitute for talking with as many people as possible about the experience of providing care and any inefficiencies that may be present."
Listening to patients is also important.
"Patients can tell you what is working and what is not working," Czartoski says. "You need to get patient feedback."
In addressing inefficiencies or friction points, there are two initial steps to follow, according to Czartoski.
"First, I try to quantify the size of the problem and the impact that it is having," Czartoski says. "Is a friction point adversely affecting the performance of team members such as doctors and nurses? Is it adversely affecting patients? If we fix a problem, is it going to improve the experience of our staff and patients?"
"Second, you need to look at the level of effort that is going to be required to fix a problem," Czartoski says. "Is the solution going to require a whole new process or new technology?"
With these two steps in mind, CMOs and other healthcare leaders should focus on fixing inefficiencies with solutions that generate high value and require manageable effort, according to Czartoski.
Once the impact of addressing a problem and the level of effort required to fix it have been assessed, there are three steps to take if pursuing a solution is desirable, Czartoski explains.
The first step is to identify a place to launch a pilot program.
"You want to start small," Czartoski says. "For example, if you decide to fix a clinic process, you should pilot the solution in one clinic."
The second step is testing the results of the solution and looking for opportunities to improve it.
"In most cases, the first attempt at a solution is not going to be perfect," Czartoski says.
The third step is scaling the solution once it is working effectively, and the outcomes such as clinical outcomes and quality outcomes have been documented.
"You take the expertise you developed at one site, and you spread the solution to the entire enterprise because you can show that the solution is better for staff and patients," Czartoski says.
Measuring the success of a solution is crucial to scaling it, according to Czartoski. After a pilot is complete and the solution moves to new sites, CMOs must be able to tell the story of how the solution worked.
"You need to be able to show that the solution benefits providers and patients," Czartoski says. "You need to learn from the pilot, then articulate the results to the new sites where you want to apply your solution."
Operating a successful hospital at home program
Czartoski helped lead an effort to design and implement Providence's hospital at home program. The foundation for the program was established with the health system's COVID at Home program during the coronavirus pandemic. The program was so successful that the health system decided to launch a hospital at home program for other high-acuity conditions.
"For us, it was a matter of increasing capacity in our hospitals at a time when we were overflowing with patients," Czartoski says. "We also wanted to create value by finding a less costly location for care, and allowing patients to recover from an acute illness in their home made sense."
Most of the patients enrolled in Providence's hospital at home program came from emergency departments, and the program gave emergency medicine clinicians a new option to care for patients, Czartoski says.
Prior to the hospital at home program, an emergency room clinician had two pathways for patients. If the patient was very ill, they were admitted to the hospital. If the patient was not very ill, they were sent home with a care plan that could include medication and a recommendation to see their primary care provider within a few days.
"Hospital at home introduces a third pathway for patients," Czartoski says. "You may be sick enough to be in the hospital, but we are going to send you home and bring the hospital to you."
Czartoski emphasized that the most important factor for a successful hospital at home program is ensuring that patients are safe, which addresses skepticism among emergency medicine clinicians, patients, and families about treating acute illness in the home.
"We had to be very thoughtful about creating a hospital at home program from a change management standpoint and doing it safely," Czartoski says.
In a hospital at home program, patient safety starts with enrolling patients selectively, according to Czartoski.
"You want to be thoughtful about who you are choosing to be admitted to the program, [because] it is not for everyone," Czartoski says. "You need to select patients depending on the severity of their condition and their medical history."
The Providence hospital at home program promoted patient safety by having at least one nurse visit for the patients in the home on a daily basis as well as having physicians available to visit patients in the home in person or virtually. Patient monitoring was also a key component, Czartoski explains.
"You can measure patients' oxygen status, blood pressure, and heart rate," Czartoski says. "For congestive heart failure patients, you can monitor their weight to make sure they are not taking on too much fluid."
Patient safety for a hospital at home program also includes having a mechanism in place to get patients to a hospital quickly if necessary, according to Czartoski.
"We had rapid ways of transporting a patient back to the hospital if hospital care was required, which was relatively rare," Czartoski says. "Over 95% of the time, patients did fine at home."
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