Almost three years before COVID-19, Fort Myers-based Millennium Physician Group, one of Florida’s largest comprehensive independent physician groups with more than 500 health care providers throughout the state, already was laying the foundation for its telemedicine program.
Expanding patient care offerings through technology was already a core concept, but it took a pandemic to show just how effective the health care delivery model could be. As doctors’ offices across the state closed, COVID-19 effectively shut the health care access door for thousands of Floridians. Millennium’s proprietary platform was ready to launch in earnest.
THE DOCTOR WILL SEE YOU NOW
Consulting before coming on full time, chief innovation officer Jeffrey Nelson has been with Millennium for nine years and started working on the company’s telehealth strategy in 2017. “We look at it more as part of the telemedicine regimen we put into place,” Nelson says of virtual visits.
Technology components providing remote patient monitoring and medication adherence were early additions. From there, Nelson and his team built Millennium’s online offerings, while at the same time incorporating them with the system’s front and back-office functions. When COVID-19 hit, the groundwork paid off. Nelson rolled out the turnkey program to all 120 sites, encompassing more than 520 providers in one week.
By the end of July 2020, Millennium physicians had completed more than 90,000 online visits. “We were very well ahead of the curve,” Nelson says, noting online visits had surpassed the 200,000 mark this February. “We didn’t really miss a beat in providing care for our patients in a remote setting.”
TWEAKING THE TECH
Millennium’s systems weren’t initially designed to operate during a pandemic, and required a few initial adjustments. Nelson’s team completed nine software rewrites between April and July, with each rolling out automatically system-wide. “We wouldn’t have had that agility if we used a third-party system,” Nelson says.
From the beginning, the focus was not just how to put a patient in front of a provider virtually, but how that visit could be incorporated into a patient’s health care plan. At the time, the televisit landscape was bare, with few providers offering virtual visits. Those that did outsourced both the technology and clinical services to third-party providers.
“Building out the ecosystem of tools … it really is an interrupter into the flow of how a provider sees the patient,” Nelson says. “We wanted to make sure it was seamless, completely integrated, and the only way to do that was to build it out the way we wanted based on our own workflow.”
Nelson said the industry as a whole is still struggling with a disjointed system; integrating electronic medical records, scheduling, digital check-ins and the visits themselves often rely on multiple vendors. His phone rings often with questions from those playing catch-up.
Chief Medical Officer Alejandro Perez-Trepichio is a practicing physician-leader in the system. From a provider standpoint and patient access standpoint, he says the technology just makes sense.
“I firmly believe telehealth is here to stay beyond the needs imposed by the current pandemic,” Perez-Trepichio says. “This newly embraced technology, once perceived as low value or too complicated by many, has made doctors and patients re-evaluate the significant gain achieved through this bidirectional communication, allowing real-time exchange of information. In addition, this was a natural form of communication for the younger population of patients already well-acquainted with technology and now finding themselves in need of quick and effective resolution to relatively simple problems, without having to commute or take time off from their already busy schedules.”
The technology was a definite advantage, but the linchpin of success came through the relaxation of many pre-existing regulatory and reimbursement barriers. Early in the pandemic, the Centers for Medicare and Medicaid Services—the federal agency charged with the administration of Medicare—temporarily suspended restrictions on payment for many online visits. Before the COVID-19 public health emergency, only 15,000 fee-for-service beneficiaries each week received a Medicare telemedicine service. CMS added 144 telehealth services such as emergency department visits, initial inpatient and nursing facility visits and discharge day management services that are covered by Medicare.
As a result, preliminary data showed that between mid-March and mid-October 2020, more than 24.5 million out of 63 million beneficiaries and enrollees had received a Medicare telemedicine service. In December, those CMS restrictions were permanently removed by the Trump administration. And the Medicare population is increasing, with more than 10,000 beneficiaries joining the program every day.
“The runway has been opened,” Nelson says. “Right now, we’re in the process of executing the next evolution, which is kind of almost going back to what began this whole thing: What can we do to add to the telemedicine regimen?”