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Introduction

Updated June 30, 2021

The FQHC Telehealth Consortium Telehealth Playbook is a “how to” guide to support the adoption and sustainability of telehealth at health centers. Like telehealth, it is evolving, seeking to incorporate “best practices” and tools as they become available. It consists of the following chapters:

  • Introduction
  • Strategy & Leadership
  • Clinical Integration
  • People
  • Technology & Tools
  • Reimbursement & Policy

Each chapter includes the overall strategy and approach to improving telehealth performance, as well as supplementary documents and resources.

Notice: This Playbook should not be considered legal advice and should be adapted for each community health center, based on the needs of the population and updates to federal, state, and local policies. The materials are intended for informational purposes only.

Telehealth Definition

The term “telehealth” includes telemedicine services but encompasses a broader scope of remote health care services. Telehealth is the use of electronic information and telecommunications technologies to support patient care through remote clinical and non-clinical audio and video services, patient and professional health-related training and education, mobile health applications, asynchronous communication via patient portals and text messaging, and home-monitoring/self-care digital communication technologies.

It can be used as a complement to in-person care delivery when clinically appropriate and when a patient has access to broadband, a device such as a phone or computer, and education on how to use telehealth modalities to support their health and wellness.

Improvement Approach

The FQHC Telehealth Consortium has developed a long term strategy in the form of a Maturity Model, which demonstrates the capabilities needed to advance telehealth performance. The model represents “what” we hope to achieve.

The Consortium has also created a Driver Diagram, which demonstrates the key drivers needed to advance performance. The diagram represents “how” to improve performance, and it will be updated as Consortium health centers continue to test the drivers and identify new drivers.

Maturity Model

In general, a maturity model is a tool used to demonstrate capabilities needed to achieve improved levels of performance, in a holistic manner. The model is the basis for assessing each health center’s telehealth strengths and opportunities.

The Consortium Maturity Model provides high-level guidance for advancing telehealth capabilities. It answers the question, “Where should we go (or where could we go) in building sustainable and equitable telehealth at the health center?”

Long-Term Value to Suppliers and Buyers

This framework is Michael Porter’s Five Forces approach to understanding the nature and intensity of industry competition. We utilized this approach in discussions with health center senior leaders in Spring 2020 as a tool to develop a sustainable, long-term strategy for telehealth. The curves diagram below illustrates potential trajectories for telehealth and is the basis for the dynamic levels, or “curves” in the Maturity Model.

Diagram of Michael Porter’s Five Forces approach to understanding the nature and intensity of industry competition.


Sustainability – Which Curve Will We Be On?

Diagram of Sustainability Curves


Telehealth Consortium Maturity Model

Curve 1:
Covid-19 Response
Curve 2:
Care integration
Curve 3:
expansion & Sustainability
Strategy & LeadershipAll-consuming focus; critical to patient care and revenue needed to surviveCEO and entire C-suite champions the change; integrated in strategy, budget, and executionTelehealth embedded in health center clinical models; drives financial, quality, and health equity goals
Clinical IntegrationCOVID and non-COVID workflows; telehealth substitutes for some in-person visits to health centerIntegrated into delivery of care across all health center disciplines and for all patientsOn-site and virtual specialty care integration; optimization of community-based care with remote monitoring, in-home testing, and portal use
PeopleRapid adoption of phone/video visits by health centers; variability in digital access for patientsCare teams competent in using telehealth for patient care and engaged in ongoing innovation; all patients able to access telehealth modalitiesProviders routinely utilize access to specialty consults; patients engage in tech-enabled community-based care
Technology & ToolsRapid deployment for phone visits; some videoEHR-integrated, HIPAA-compliant, video-enabled; patient devices, data plans, and remote monitoring deployedSpecialists integrated through eConsults and synchronous patient visits
Reimbursement & PolicyLiberal to support COVID-19 delivery of careFFS reimbursement supports phone and video; partial patient enablement support; HRSA, FTCA, other regulatory flexibilitiesSustainable reimbursement HRSA modernization

Driver Diagram

A driver diagram is a performance improvement tool used to visualize all the factors that contribute to the achievement of an initiative’s aim (goal). It maps the theory of change, from the aim statement to the primary drivers of what contribute directly to achieving the aim, and then to the secondary drivers that represent specific tactics that support the primary drivers.

Our Telehealth Driver Diagram demonstrates the key components needed to advance performance, and answers the question, “How will we mature our telehealth capabilities?” The diagram aligns the primary drivers with the Maturity Model domains and includes secondary drivers that provide guidance for testing out new approaches of delivering virtual care. Our diagram will be updated as Consortium health centers continue to test improvement ideas and identify new tactics for adopting and sustaining telehealth.

  • Partner Resource

    Telehealth Consortium Driver Diagram

    Develop a sustainable, patient-centered, and equitable telehealth model and achieve an advanced level of maturity at Consortium FQHCs

    PDF

Primary & Secondary Drivers of Success

Strategy & Leadership

  1. Board of Directors engagement
  2. Designated Team: Executive Sponsor, Provider Champion, Support Staff
  3. Virtual care built into health center budget
  4. Established measures of success
  5. Maturity Model assessment, gap analysis, and improvement plan

Clinical Integration

  1. Redesigned care team roles
  2. Scheduling guidelines and workflows for virtual visits
  3. Clinical pathways for virtual care and hybrid models
  4. eConsults for specialty referrals

People

  1. Provider & staff training
  2. Patient education
  3. Digital equity
  4. Satisfaction/Engagement surveys: patients, staff, providers

Technology & Tools

  1. Telehealth platform, integrated with EHR
  2. Accessibility to smart phones and data plans for patients
  3. Remote patient monitoring

Reimbursement & Policy

  1. Expanded reimbursement guidelines at state and federal levels
  2. Advocacy for HRSA and other regulatory agencies to support sustainability

FQHC Telehealth Consortium Members

FQHC Telehealth Consortium members serve over 700,000 patients from 35 locations across Massachusetts. See our full list of members.

Map of Massachuetts showing location of Consortium members

What Patients Prefer about Telehealth

“It was faster, my child had allergies and I sent a photo to the provider and they sent me my prescription the same day.”

“Since I don’t have a car, it’s better for me to have the encounter with the provider by phone. If I have any kind of worry or doubt about my baby, I can simply call the center. They have always answered kindly.”

“For me, I do not have transportation. Since losing MassHealth (and their ride assistance), being able to make appointments that someone can take me to is VERY difficult.”

“I like it better because my job is very demanding. I work 5 to 5 every day so telehealth makes it easier… I can step aside for 15 minutes and take the call.”

Acknowledgements

The FQHC Consortium was established to create a robust and sustainable telehealth platform to support high-quality, team-based primary care to improve health, reduce disparities, and provide a national telehealth model for under-resourced populations. It is a collaboration of 35 Federally Qualified Health Centers (FQHC’s) led by:

  • Community Care Cooperative (C3), an Accountable Care Organization (ACO) and MSO/Business Operations company made up of 18 FQHCs located across the state, and the largest MassHealth ACO
  • Massachusetts League of Community Health Centers (League), a Primary Care Association (PCA) that promotes population health equity for all through leadership and programs supporting community health centers in achieving their goals of accessible, quality, comprehensive, and community responsive health care

Funding

Funding for the Phase 1 Initiative of the Consortium was made possible by sources of C3 and League funding, as well as generous support from:

  • A lead gift from The Patrick J. McGovern Foundation
  • FCC administered COVID-19 Telehealth Program funded by the CARES Act
  • CareQuest Institute for Oral Health (formerly DentaQuest Partnership for Oral Health Advancement)
  • The Paul and Phyllis Fireman Charitable Foundation
  • Harvard Pilgrim Health Care Foundation
  • The Klarman Family Foundation
  • Landry Family Foundation
  • MA Executive Office of Human Services
  • Barbara and Amos Hostetter