A Practical Guide to Expanding Home-Based Primary Care with Telehealth

The current need for comprehensive medical care in the home, allowing frail older adults to age in place, outpaces the supply many times over. This disparity will continue to grow as our population ages. The necessity to increase the number of individuals served through high quality home-based medical care programs that deliver services when and where they are needed led to our collaboration between Northwell Health and the Gary and Mary West Health Institute. This collaboration has allowed us to pursue extensive process improvement work with front line staff and to develop and implement telehealth innovations with the goal of reducing cost of care delivery, all while maintaining best-in-country outcomes.

Proving telehealth interventions at scale to a population who is homebound and of advanced age has been a winding journey. We started with a direct to consumer telehealth pilot to test the feasibility of video conferencing to address the social needs of homebound older adults. It resulted in many lessons learned as our patients and caregivers sought to utilize “out of the box” HIPAA-compliant video conferencing technology. We recognized both the barriers to this approach as well as the potential impact of telehealth on our population. After collecting extensive feedback from patients, caregivers, and our staff we looked to innovate in a manner more likely to drive patient-important outcomes.

Ultimately, this led to the development of a care model utilizing telehealth facilitators, in our case EMTs with additional training, to connect individuals with acute care needs via two-way video conferencing to our program’s primary care providers located remotely: The Mobile Telemedicine Technician (MTT) model. MTT visits provide our patients a new way to access their care team in their homes and has allowed our providers to see twice as many patients as their usual daily workload permits. After completing several hundred visits, the overwhelmingly positive response from patients and caregivers encourages our pursuit for expansion into a larger geographic area with additional participating providers.

We sincerely hope that lessons learned through our process improvement and telehealth journeys that are shared in this document will inform the growth of similar models of care in other programs around the country. We are proud of the accomplishments described in this guide and believe it will empower you to develop innovative solutions that address the needs of our nation’s senior population. We would like to thank the entire Northwell House Calls team as well as our colleagues from the Northwell Office of Clinical Transformation for their hard work and dedication to our mission of helping our frail elderly community members access top quality care where it is most needed and desired: in the home.

Sincerely,

Kristofer L. Smith, MD, MPP

Karen A. Abrashkin, MD

Zia Agha, MD