In March, Salt Lake City, Utah-based Intermountain Healthcare announced the launch of one of the nation’s largest virtual hospital services, bringing together 35 telehealth programs and more than 500 caregivers to enable patients to receive remote medical care.
The virtual hospital, called Intermountain Connect Care Pro, provides basic medical care as well as advanced services, such as stroke evaluation, mental health counseling, intensive care, and newborn critical care. “While it doesn’t replace the need for on-site caregivers, it supplements existing staff and provides specialized services in rural communities where those types of medical care usually aren’t readily available,” officials said in the March announcement.
Michael Phillips, M.D., Intermountain’s chief of clinical and outreach services, says that a core reason why the health system went in this “virtual” direction was because its leaders saw the evolving healthcare landscape and wanted to get out in front of it. “Our thought process behind this was that the world has changed from the days where you can only take care of people who [physically] make it to you. But literally every person on the planet is pretty much within the distance of a cell tower now. So we feel people should be able to benefit from [remote] care,” says Phillips.
Offering an example of how these services work in the clinical setting, Intermountain officials brought up the instance of an infant at a southern Utah hospital who was being supported via Connect Care Pro services and received a critical care consultation that allowed the sick baby to stay in that facility instead of being transferred to a newborn intensive care unit (ICU) in Salt Lake City. This single avoided transfer would have cost over $18,000 dollars. The parents of this baby were able to remain in their community, surrounded by their support system, instead of traveling what would have amounted to 400 miles and seven hours round-trip every time they wanted to see their baby, noted officials.
Indeed, as Phillips puts it, when most rural hospitals think about big health systems, their vision is a helicopter scooping in and flying away from the rural facility with its complicated patient. “But we believe that many of those patients can be treated locally, and there are clear benefits to that. First off, it’s better for the patient—having their family separated by 200 miles to drive to a major medical center is not good for their care and doesn’t tallow for a good support system. If they can be treated locally, they should be,” he attests.
As of now, notes Phillips, Intermountain’s virtual care services—inclusive of the Connect Care Pro, which is a direct provider-to-provider service and Connect Care, which is a direct-to-consumer service—covers all of the health system’s hospitals and another nine facilities outside of the system. “We are really covering more than 30 ICUs in all, and we have a stroke service, a neonatal resuscitation service, and [other services]. Our tele-ICU services are covering a few hundred beds with this process,” Phillips explains.
Michael Phillips, M.D.
So far, some of the top results from deploying the virtual services across Intermountain have included reduced length-of-stay, decreased ER and urgent care visits, and improved mortality rates, notes Phillips. What’s more, Connect Care leaders wanted to make sure that clinicians were performing in a telehealth visit with similar antibiotic stewardship than if they were seeing the patient in person. “We don’t want the answer just to be that we talked to you on phone, so we will write you a prescription for an antibiotic; we wanted the [prescribing process] to be as rigorous as it would be in person,” he says.
Although virtual health services are certainly catching on more at health systems these days, some physicians who are used to traditional care delivery are apprehensive. At Intermountain, Phillips offers, “Providers have taken to [Connect Care] well. There is a bit of self-selection for the kinds of people who are comfortable with doing this kind of work and who are good at communicating over this medium. But I think [telehealth] will come to virtually everyone in medicine because for a lot of conditions, it’s simply a more efficient way to deliver care,” he says.
To be clear, Phillips does not believe that in-person visits will “go away” by any stretch, but that it is quite difficult to have extensive, expert coverage at every hospital and physician’s office. “But we can certainly bring that expert in with a telehealth format, virtually everywhere,” Phillips notes. “Yes, cultural changes will need to take place, and I would say that the technology is the easy part. Culture is the challenging part,” he adds.
Phillips also contends that issues around the payment portion of telehealth visits—which has sparked much discussion in healthcare and health IT circles over the years—will continue to present challenges to providers, particularly those that still operate primarily in fee-for-service environments. “We have a large at-risk population here, so the payment part might be less of an issue for us because telehealth works better in a [value]-based model than a fee-for-service one. But these are typical barriers everyone is trying to figure out. In an at-risk model, [telehealth] is efficient and if you’re not worrying about having a fee-for-service payment for each individual episode, it becomes less of a concern,” Phillips says.
In the end, Intermountain clinical and IT leaders believe that virtual care is an efficient way to provide healthcare, Phillips offers. “The technology is meant to make all the folks inside our system more productive. If you look at larger sectors in the economy, there’s only two I can think of in which the workers have not become more productive: medicine and education. And that’s about embracing technology,” he says.
Phillips believes that the cost of healthcare is largely based around how productive an organization’s workers are. Indeed, if 70 percent of the costs are “people,” there’s a need to make sure that this area is well invested so that “we can keep costs affordable for people who need to get healthcare,” he says. “You can have the best healthcare in the world but if people can’t afford it, it doesn’t do you any good. We want as many people as possible to lead healthy lives.”