Ready for E-Visits? How clinicians can make their practice more efficient, effective

On-demand E-Visits were first introduced at Michigan Medicine in June 2017 through a pilot program involving two primary care locations. Within six months, all Michigan Medicine adult primary care patients had access to E-Visits, with pediatric patients joining the wave in February 2019.

Since that time, the number of E-Visits at the institution has grown significantly, from less than a handful/day to an average of 10 daily visits — a 139 percent volume increase from Fiscal Year 2018 to 2019.

That number may grow even more in 2020, as care teams across the organization realize that E-Visits can make their practice even more efficient and effective.

The virtual care market

The market standard for E-Visits has seen a dramatic shift over the past few years, from strictly a primary care-based, on-demand service to including a range of specialties and follow-up care. Some organizations offer E-Visits in dozens of specialty areas, while other health systems such as MidMichigan Health tout their post-operative E-Visit option.

Michigan Medicine is ramping up efforts to increase E-Visits and other Virtual Care opportunities for patients by asking its clinical departments to identify clinical activity that could be translated to virtual care with significant impact on access. E-Visits will be a part of the FY21 virtual care access metric with clinical departments asked to convert 1, 2, or 3 percent of total clinic volume to virtual care services (E-Visits and video visits).

“E-Visits offer us an opportunity to directly affect patient access, ensuring all patients have timely access to our world class medical care,” said Michael Mulholland, M.D., Ph.D., senior associate dean for clinical affairs and executive director of the U-M Medical Group. “It is because of this that UMMG is committed to changing how we deliver care swiftly and systemically.”

E-Visits are becoming a covered benefit by insurance companies, signaling a cultural shift in the way “standard care” is perceived and delivered. Out-of-pocket costs for E-Visits are budget-friendly for patients — E-Visits not covered by insurance range from up to $25 for primary care visits and from $25-$45 for specialty care visits.

Specialty visits — the future of Michigan Medicine E-Visits

As demand for virtual care increases, specialty visits present an opportunity for growth at Michigan Medicine.

In early 2017, Dermatology began to utilize E-Visits for recurring follow-up appointments, becoming the first specialty department within Michigan Medicine to offer them.

For example, patients taking certain acne medications are able to answer condition-specific health questions online and share photos with their dermatologist to receive the same level of care as they would with an in-office visit, but with less hassle.

Benefiting patients and providers

The Virtual Care Department began collecting and measuring patient satisfaction data in January 2019. Patient feedback consistently shows that they select E-Visits because they save time, are easier to fit into their busy schedules, require no travel and may have a shorter wait to receive treatment.

One patient elaborated: “I probably would have waited a few more days to see my regular physician or have gone to urgent care after hours as my schedule wouldn’t have allowed me to go into an office.”

Looking at the numbers, more than 6,000 E-Visits have been conducted since 2017, saving patients over 80,000 miles in travel… which amounts to well over four trips around the earth!

For providers, E-Visits can increase clinic efficiencies by translating in-person visits to virtual encounters, taking a fraction of the time to complete.

For example, a Primary Care Urgent Return Visit clinic slot may be regularly allotted 15 minutes, whereas a follow up E-Visit can take a minimum of five minutes. This means making use of E-visits for eligible patients will better utilize provider schedules by treating more patients in less time, freeing up access for future patients and reserving clinic exam rooms for patients who truly need to be seen in person.

What next?

The role of E-Visits and other methods of virtual care play a major part in the future of health care delivery. It has the potential to positively impact patient satisfaction and clinical efficiencies and has become a priority for Michigan Medicine.

As departments understand the importance of E-Visits and other virtual care options, they should begin (or continue) to assess the department’s ability to deliver them by considering appropriate opportunities within their area. E-Visits are designed for cases with clinical assessments not requiring hands-on care or consistent back-and-forth conversations.

The Virtual Care internal website houses resources and tools to help departments assess their E-Visit and virtual care delivery options here: https://virtualcare.i.medicine.umich.edu/programs/e-visit.

Additionally, the Virtual Care Department is offering two sessions that will help clinicians kick-off E-Visits and other Virtual Care programs in their area of the organization. Click here for more information.

Ready to start? Contact the team at TelehealthTeam@med.umich.edu — they will work closely with each department to set up and implement E-Visits and other methods of virtual care.