Jason Tibbels, MD, Chief Quality Officer, Teladoc Health
One of the priorities for our Quality of Care & Patient Safety Committee in 2019 was to earn accreditation from the ClearHealth Quality Institute (CHQI), the only program approved by the American Telemedicine Association to accredit virtual care organizations. We achieved that goal late last fall when Teladoc Health received accreditation in not just one, but two categories: Consumer-to-Provider services for acute care needs and Provider-to-Consumer services, which focus on the ongoing provider/patient relationship when treating specialty and chronic conditions, including mental health.
We pursued CHQI accreditation because it reassures clients that they’ve selected a virtual care partner that has withstood robust scrutiny of an unbiased third party. Accreditation also benefits patients and their families by providing ease of mind, as knowing they are receiving the highest standards in quality care reduces stress.
Defining Quality Care
What does it mean when we talk about quality care? Quality care begins with patient safety and a focus on effective outcomes regardless of a patient’s health status, level of coverage, socioeconomic background, or where they live.
Clinical studies demonstrate that the zip code in which patients reside contributes to the quality and level of care received. This health inequity is of particular concern given the recent closures of more than 102 U.S. rural hospitals. Nearly 25% of rural residents state that access to good doctors and hospitals is a significant problem in their community.
That doesn’t mean those who reside in major cities always receive better care. Even in cities where patients live a half-mile from a top-ranked medical practice or hospital, barriers such as race, gender, income, and level of education can preclude some of those patients from receiving quality care.
Fortunately, virtual care helps address many of these challenges, offering a cost-effective, highly convenient quality care solution when delivered with the necessary quality protocols and oversight.
Virtual Medicine Crucial to Quality Care
Virtual care improves delivery of quality care because patients no longer need to put off seeing a doctor because they can’t get away from work, have transportation or childcare issues. It also benefits patients living in communities which suffer from a dearth of primary care providers as they no longer must wait weeks or even months to schedule a wellness exam.
Virtual care, when provided by the right partner organization and in collaboration with the plan sponsor, also better allows for the management of chronic illness as physicians, patients and patient caregivers have access 24/7 access to all electronic medical records as well as the most current information on prescribed medications, so the right treatment decisions can be made based on a full medical history regardless of who provided the care.
Raising the Standard of Virtual Care
As Chief Quality Officer, I oversee the level of care provided by our clinicians, as well as our quality improvement and quality vigilance initiatives. We deploy a variety of tactics to ensure that our providers in 450 subspecialties regularly meet or exceed standards of quality care, including:
- Physician training including webside manner and how to effectively evaluate a patient remotely.
- Chart audits and peer review
- Surveys to evaluate the patient experience and outcomes
- Data analytics to evaluate physicians and patient outcomes
- Evaluation of various prescribing metrics
- Duration of the patient-provider visit
We provide regular personalized feedback on several quality measures to our physicians monthly, more often than most doctors receive from the “live” healthcare organization or hospital with whom they are affiliated.
All of this is built around a strong quality infrastructure, based on a well-established framework that supports all domains of healthcare quality, as the following graphic illustrates:
Teladoc Health is also establishing new virtual quality care standards. Thanks to a grant from the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, we are leading the first large-scale five-year study to assess and refine antibiotic prescribing practices in virtual care, together with the University of Southern California and Northwestern University. By studying existing prescribing behavior, our researchers can then adapt and develop further processes and use novel behavioral economic interventions with physicians to further improve prescribing practices.
In May 2019, we created The Institute of Patient Safety and Quality of Virtual Care, the first and only Patient Safety Organization (PSO) in virtual medicine. PSOs offer a safe legal environment where clinicians and health care organizations can voluntarily report, aggregate, and analyze data to further improve quality and patient safety. Teladoc Health’s Institute is one of just 87 PSOs commissioned by U.S. Congress to conduct quality and safety projects with and on behalf of key stakeholders.
Why does all this matter? Engaging through virtual care often leads to earlier diagnosis and treatment of conditions across the spectrum of care, resulting in improved outcomes and less costly treatments. But this only occurs in virtual care environments where patient safety protections and quality protocols have the same rigorous oversight as care in traditional settings. Teladoc Health is poised to continue to be a trusted partner for our clients and assure all members trusted care delivery.
Jason Tibbels, MD, chief quality officer, Teladoc Health, is board-certified in general medicine.