Digital health and telehealth veteran, Christian Milaster, shares more on this topic.
What is the critical set of metrics to measure performance of a telehealth service? The key metrics come from 3 performance areas: service performance, technical performance, and financial performance.
Service Performance examines the acceptance of the service by patients as well as by the clinicians. With a great service experience on both sides, telehealth is sustainable.
Technical Performance ensures that the technology (which includes connectivity) can support a seamless, painless experience, where the technology just fades into the background.
Financial Performance ensures virtual care’s contribution to the bottom line of the organization.
Here are the 5 critical metrics that healthcare leaders need to assess to determine the health of their telehealth services and whether a course adjustment is needed.
Let’s review the nuances of these 5 critical telehealth metrics.
Clinical Satisfaction First
The most critical metric of all (and the one most health systems ignore) is clinician satisfaction. When our organization works with clients we ask the clinicians, for example, “the telehealth visit was as good as an in-person visit” and we repeatedly get 4.3 or 4.4 on a 5-point Likert scale, so high satisfaction across the board is possible. In January of 2021 the Mayo Clinic conducted a nationwide study to explore physician feedback on the recent boom in telehealth. More than 75% of respondents said telehealth enabled them to provide quality care for COVID-19-related care, acute care, chronic disease management, hospital/emergency department follow-up, care coordination, preventative care, and mental/behavioral health.
Patient Satisfaction Second
The second metric under service performance is patient satisfaction. Typically, the acceptance of telehealth across all demographics is very high. Patients love the convenience and appreciate the efficacy with which care can be received. With our clients, we typically ask the patients “How likely are you to recommend telehealth with this provider to your friends and family?” and have gotten Net Promoter Scores (NPS) in the 70s, which is considered world-class service.
Here’s the reality: If the physicians do not like delivering care via telehealth, none of the other metrics matter much. The most prevalent root cause of statements such as “patients don’t like telehealth” is that physicians don’t like it. Even with the slickest technology and full reimbursement, if the physicians’ mindset is that telehealth is not as good as in-person care, they will find self-fulling evidence to support their sentiment.
It is therefore imperative that healthcare leaders measure and address physician satisfaction before working on improving patient satisfaction.
While telehealth is not about the technology (but about the workflows and managing the organizational change), it certainly is about the technology when the technology is not working.
A Few Givens
With regards to telehealth technology, there are a few “givens” that we assume: that the technology is reasonably usable, that it is secure and also, given good internet connectivity, reliable.
The metrics to capture under technical performance should simply be on whether the clinician and patient could easily connect and that there are no audio/visual problems. Any deviation from the targeted goals is mostly the cause of individual circumstances on the clinician’s or patient’s side. Most user experience problems can easily be compensated by workflow or process intervention (such as Pre-Visit TechChecks) and by training and coaching (e.g., on “webside manners”).
Of the 5 critical metrics, the first 3 can be measured intermittently whereas the financial metrics should be measured continuously.
Overall Visit Volume by Modality
This metric is critical in providing a good overall picture of the performance of your healthcare organization. It should include attributes such as date, time, provider, visit type, show/no show, and modality (one of: inpatient, outpatient, video visit, telephonic visit). A semi-automated analysis of this metric can reveal a multitude of insights: seasonal comparison to prior-year volumes, distribution (and shift) across all modalities, adoption by individual providers or provider groups, change in no-show rates, etc.
Overall Reimbursement by Modality
This metric provides critical insight into the financial performance of the organization. It should include similar attributes as the volume metric, i.e., date, time, provider, modality, CPT code, payor/health plan, and actual reimbursement. Here, a semi-automated analysis of this metric can reveal an additional set of insights: e.g., comparison to prior-year revenue, the ROI of telephonic vs. video telehealth visits, average reimbursement per visit, usage by CPT code and modality, etc.
How to Apply the Metrics
All 5 metrics should be reported on a regular basis (weekly first, monthly later) in the form of a telehealth performance dashboard. Each metric must have a target goal along with a predefined action list in case the metric falls short of the goal, meets the goal, or exceeds the goal.
Nobody would think of driving in the dark at 80 miles an hour without feedback on the direction, speed or the fill-level of the gas tank. It is thus equally crucial for healthcare leaders to invest in establishing a telehealth performance dashboard that at a minimum includes these 5 critical telehealth metrics.
Which telehealth metrics are your healthcare leaders evaluating on a regular basis? What predefined actions have you identified to overcome the challenges you are encountering?