AMP News Arkansas Hospital Association

Population Health and Telemedicine: The Intersection of Caring

The following article is from Arkansas Hospitals magazine, a custom publication of Vowell, Inc., which also produces Arkansas Money & Politics.

by Nancy Robertson, Senior Editor

Like many hospital systems in Arkansas, Baptist Health was an early adopter of telemedicine. Long known for its electronic intensive care unit service, Baptist Health eICU® care, the system also is expanding telemedicine initiatives as part of its focus on population health. Kourtney Matlock, Associate Vice President for Patient Services, is a key player in this work.

Matlock is a woman on a mission to expand health care access in Arkansas. And she sees offering telehealth programs as a way to expand both access and the long-term health of Arkansans. “Everyone knows Baptist as home of the eICU,” Matlock says. “But our outreach goes far beyond the ICU.”

With her work specifically focusing in the area of Population Health, she has daily opportunities to work on expansion of health care in the state.
“Population Health means many things to different people,” Matlock says. “For some, it’s completely centered on costs, and for others, the focus is on the quality of the health care provided.” To Matlock, population health means increasing access to health care for all Arkansans and providing that care to all Arkansas communities, both urban and rural.

“We need to make it easier for people to adhere to their care. If they can ‘see’ physicians and nurse practitioners via telehealth when they can’t see the provider in person, they will still have that one-on-one experience that guides them to better health. The more people have easy access to health care, the healthier they will be. And that’s what we want for ALL Arkansans!”

Matlock says telehealth appeals to all ages, but that connecting people to telehealth networks when they’re kids or in their early adult years will lead to better long-term health. Working with other hospitals and providers is key to making these connections. “It’s our goal at Baptist to increase health care access in tandem with other hospital systems, physicians, a variety of providers…working across corporate lines to make patients the center of Arkansas health care.”

Matlock started her personal focus on population health seven years ago, when she became involved with the state’s first attempt at establishing the “medical home” concept. From that initial project came the Comprehensive Primary Care Initiative (CPCI) sponsored by the Centers for Medicare and Medicaid Services (CMS).

CPCI was a national program that launched in 2012, essentially inviting primary care practitioners to join with commercial, state and other federal insurance plans to give more Americans access to quality health care at a lower cost. Under the CPC Initiative, CMS paid primary care practices a care management fee – initially set at an average of $20 per beneficiary per month – to support enhanced, coordinated services. Arkansas Blue Cross and Blue Shield (doing business as Health Advantage), QualChoice, Humana and the Arkansas State Medicaid program also offered an enhanced payment to these primary care practices.

In order to receive the new care management fee from CMS and insurers, primary care practices agreed to provide enhanced services for their patients including: offering longer and more flexible hours, using electronic health records, delivering preventive care, coordinating care with patients’ other health care providers, engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and other needs.

“For that type of system to work, Care Coordinators are pivotal,” Matlock says. In fact, at the outset, she hired a cadre of more than 20 Care Coordinators to assure that all patients were connected with their caregivers, who were working together across traditional medical silos to increase population health and help grow access to care.

At CPCI’s launch there were 69 Arkansas practices participating in the program, 15 of which were Baptist locations; now, there are 120 Arkansas provider units taking part in phase 2 of the program, CPC+, 21 of which under the Baptist umbrella. Matlock, through her role at Baptist, offers case management input and oversight over the CPC+ clinics.

“Now, we’re engaged in CPC+, with double the number of states, and double the number of practices per state participating in the widened concept of the medical home. I’m pleased to see the government saw value in putting money into care coordination.”

A significant reduction of ED utilization has occurred as patients experienced care through their own primary care physician; patients are discovering that their own PCP’s office offers a better place to be seen. Care is coordinated, and other benefits abound.

“After hours care is a big component,” Matlock says. “The care cost per patient went down significantly when we opened after hours clinics.”
And with the CPC+ network, specialty telemedicine is becoming readily available.

“Many times, physicians and patients can be connected via iPad, phone, or simply by computer. Telehealth carts are not always necessary,” Matlock says. “And through our telehealth network, we have lots of opportunity to do a better job with psych patients. Let’s face it; we simply don’t have enough providers. There are not enough advanced practice registered nurses (APRNs) or physicians coming out of school wanting to do psych. Telehealth allows us to stretch our providers. We reduce travel time between locations for our doctors and increase the number of people who can be seen each day. We also integrate Behavioral Medicine into the PCP office, which is where we should be identifying the needs initially.”

Like others in the industry, Matlock agrees that the new telemedicine law enacted at this year’s General Assembly will increase the ability of Arkansas providers to participate in telehealth/telemedicine. “In the rural setting, outpatient telehealth can be billed the same as face-to-face encounters,” she says. “The hosting clinic can bill for its special telecommunications use, and the physician can bill as normal. It’s a win-win-win for patient, facility and physician.”

Matlock sees health care delivered through telehealth channels as growing exponentially in the coming years. “We’re going to need a whole team of APRNs doing nothing but telehealth. Again, it’s a win-win; patients ‘see’ a caregiver, and access can be immediate.”

“To me, eCare Coordination is like a group of coaches calling plays from their box seats above the field,” Matlock says. “Our centralized care coordination team are the health coaches assessing gaps in care and cost opportunities. And each of us as patients? We’re the ones playing the game on the field.”

Her ideas are only growing as telehealth expands. “My goal is that we offer specific eHealth programs through telehealth channels throughout the state, and that all Arkansans achieve the easy access to health care, including psych treatment and medical specialties, no matter where they live.” These goals have become part of Kourtney Matlock’s mission – a mission that will result in better, more accessible care for our friends, neighbors and ourselves.

The Baptist Health Care eHealth Services

Around the clock, instant access is offered to an experienced team of Critical Care physicians and RNs supported by clinical decision support software to watch over a facility’s sickest patients.

Supported by critical care physicians, experienced eICU RNs provide continuous surveillance in the emergency department to rapidly identify severe sepsis and septic shock for early intervention, best practice adherence, and improved outcomes.

Supported by an acute care team, the service provides monitoring and virtual rapid response to support patients in a skilled nursing facility in order to reduce readmissions and improve outcomes.

Emergency department, inpatient and outpatient clinical consults are provided by mental health providers.

eCare Coordination
Care coordination is offered through an interdisciplinary team (Care Coordinators, Social Workers & Nutritionists) for clinics wanting to improve population health efforts for patients.

eNutrition Services
Nutrition services are provided in the clinic or hospital setting, including the emergency department.

Cardiologists provide emergency department, inpatient and outpatient clinic consults Monday through Friday.

eTranslation Services
Translation services are offered via telehealth for 12 languages, with 48 additional languages offered by telephone.

Through this service, a lactation consultation can be done electronically with an RN IBCLC certified lactation consultant to help new mothers overcome the barriers to successful breastfeeding. Consultations are offered in the inpatient and outpatient setting, as well as from the patients’ homes.

NICU Live Streaming
The Baptist Health NICU Live Streaming system uses a camera placed at the baby’s bedside so that parents and other family members who can’t be at the NICU can view the baby 24 hours a day by logging into a secure account from their laptop, tablet or smartphone. This system helps promote bonding between parents and their premature babies, who sometimes have to stay in the hospital for weeks or months.

Remote Monitoring
Offered to patients suffering from congestive heart failure and to those with diabetes, this service provides real-time ongoing monitoring of vitals, as well as face-to-face telehealth consults via an integrated tablet with the focus of reducing patient costs and improving compliance.

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