In recent years, the biggest challenge faced by Happy Kids, a six-clinic pediatric practice based in Phoenix, Arizona, was a detrimental loss of business during the COVID-19 pandemic. Patient volume dropped nearly 40% at its worst point.

THE PROBLEM

The practice was on a disastrous path. The situation – having the same overhead and not enough patients – would have forced the practice to close its doors. Staff had all the disposition to see their patients, but many were too frightened to go out in public or come into the clinics.

"The worst part of this situation was that our patients lost access to healthcare, compromising their health as they were not receiving regular care such as the treatment of acute illness, preventative health and managing chronic conditions," said Dr. Jose Francisco Carrazco, founder of Happy Kids.

"Our patients' health was being jeopardized, especially the high-risk population," he continued. "Telehealth technology opened the doors to new hope that we would survive, and that we would have the ability to serve our patients' needs in a safe and convenient way."

Before COVID-19, many of the patients struggled with transportation, among other obstacles. With telehealth technology, they could be attended from the comfort of their own home and not risk getting exposed to illness in the lobby.

"Telehealth technology saved many jobs, as well," Carrazco explained. "We were able to maintain our staff. The demand gained so much momentum that we were even able to grow by increasing our workforce.

"Telehealth provided a more efficient platform that allowed us to invest in other areas, such as our call center," he added. "We were able to focus on filling more care gaps by increasing outreach to our high-risk members."

Telehealth provides the perfect platform to address simple things that are very important, such as lab results, medication refills and follow-up care, he said.

"For example, a member who had recently been discharged from the hospital who does not follow up with their primary care physician within a week has a higher likelihood of being hospitalized soon after," Carrazco noted. "By preventing hospitalizations, we can save the industry the burden of this high healthcare cost. The best part is we can ensure that a patient's treatment plan is reinforced, and that it is followed through successfully.

"The bottom line is telehealth catapults access to quality healthcare efficaciously."

Dr. Jose Francisco Carrazco, Happy Kids

"Furthermore, we can monitor the progress, and effectively make adjustments to a patient's care plan and regimen as needed to ensure a more optimal health outcome," he continued. "The bottom line is telehealth catapults access to quality healthcare efficaciously."

PROPOSAL

Equality Health is Happy Kids' value-based care partner.

It helps the practice with a range of technology and services, including: helping negotiate contracts with the major Medicaid payers; bearing risk and offering pre-payments so the practice does not have to wait on the lengthy remittance process; providing a dedicated performance practice manager who helps the practice gain access to social determinants of health (SDOH) services like housing, food and transportation; and offering the Care Empower tech platform, which helps the practice track patient populations and report for the new VBC quality metrics.

"The Care Empower platform includes a telehealth solution, and that's the technology we used to help us win back our patients and enhance access to healthcare with a virtual care approach that is safe and easy to use," Carrazco said.

"Not everyone has the privilege of owning a computer or access to the internet, but most people do have smartphones nowadays," he continued. "Some people are lucky enough to have tablets. Telehealth technology can be accessed by any of these means at no additional costs."

If anything, telehealth saves time and money by eliminating transportation – not to mention the convenience that comes with telemedicine, he added. The only consumption is bandwidth, which is at a minimum cost.

"Another benefit of telehealth is time," Carrazco noted. "Time is more valuable than money in most cases. Imagine saving time on traveling, waiting in a lobby, and those additional things that set you back time at a traditional visit. In addition, no stone is overturned as the telehealth visit is well-documented.

"Access to healthcare via telehealth would [remove] the fear of being exposed to illness during the pandemic and restore the ability to seek medical care in a safe environment from the comfort of your own home," he added. "It's convenient, it's working, and our patients love it."

MARKETPLACE

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MEETING THE CHALLENGE

The telehealth technology Happy Kids uses is HIPAA-compliant Zoom and is bundled with its Equality Health services. It's connected to the EHR from eClinicalWorks as well as the Care Empower platform.

The technology is accessible through a smartphone or tablet. Once logged into a secure account, patients are ready to go.

"The medical assistants prep the appointments ahead of time via phone call to answer all the necessary questions such as verifying demographics, reconciling medications, taking health history including health concerns, and adding the required templates for the provider," Carrazco explained. "The patient then is provided a link through text and/or email.

"Once the patient clicks on the link from their computer, smartphone or tablet, they are admitted to a virtual waiting room where they then are admitted to the visit by the provider," he continued. "They instantly are connected via videoconference with sound and microphone with the provider where their concerns are addressed."

This enables the provider to deliver treatment, reassurance and supportive care, he added. All medications and orders such as diagnostic imaging or labs are delivered electronically.

RESULTS

The biggest achievement through this new workflow was increased productivity. Most patient visits the practice was missing out on have been recovered. Patients have said they love the convenience and ease of use. Providers can see more patients in less time.

"Telehealth now accounts for about 25% of our visits," Carrazco reported. "Before the pandemic, we averaged between 1,800 and 2,000 visits per week. After integrating telehealth technology, we are seeing closer to 2,600 patients a week, which includes about 600 virtual visits.

"Compliance for taking medications, following up for the management of chronic care, and attending labs have vastly improved, thus enhancing our performance in the value-based model of care," he added.

ADVICE FOR OTHERS

"Be open-minded and embrace the technology," Carrazco advised. "Like anything else in life, we must evolve to succeed and grow. We don't have to suffer growing pains to do so. Technology is developed to utilize and enhance what we are trying to accomplish."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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