Avera Health Addresses Gestational Diabetes with Obstetrics Telemedicine Program

Avera Health Addresses Gestational Diabetes with Obstetrics Telemedicine Program


In the first installment of our telemedicine blog series, we showcased how Epic e-Visits produced 20% cost savings. In our next segment in the series, I had the opportunity and pleasure to interview Dr. Kimberlee McKay, OBGYN and Clinical Vice President of Avera Health’s OB service line, and Kristin Laberis, MTS who works with a wide variety of Service Lines offered by Avera Health.

At Galen, we are always looking for unique ways to work with our partners and expand our expertise into various industry use cases. Having worked for telemedicine startup, American Well, prior to Galen, I knew going in to our conversation that telemedicine solutions are one of the hottest market offerings in digital health and that there are unique challenges that accompany the wide array of benefits that they offer.

Kim and Kristin should be an inspiration and an example to all Health System’s considering implementing telemedicine, as they have carefully articulated a road map of use cases and put in the much-needed time and resources to execute successful implementations. In part one of a two-part interview, we spoke with them about telemedicine at Avera, their most recent Gestational Diabetes virtual service, the unique challenges presented through solution data integration and their plans for what’s next.

“Telemedicine is how we figured out how to do business because of the distance that patients have to travel within the South Dakota region”

How we got started

Avera Health is comprised of 5 regional facilities, a tertiary care facility, and a network of rural critical access hospitals (9 of which are equipped for deliveries) in the Sioux Falls area of South Dakota. They are no stranger to the concept of telemedicine, as they began with an EICU solution over 20 years ago. Proposed by Dr. Don Kosiak, an Emergency Room Physician who was tired of taking phone calls for non-emergent/low acuity issues, Avera saw the need to become more efficient and began their journey with virtual care. Today Avera eCare has a 24/7 telemedicine hub in San Antonio, TX; has served over one million patients in multiple states, and have recently partnered with NATO to develop a multi-national telemedicine program.

While most hospitals in bustling metropolises adopt telemedicine as a supplemental luxury, it is very much a part of daily operations at Avera. “Telemedicine is how we figured out how to do business because of the distance that patients have to travel within the South Dakota region” says McKay.

Rolling out Telemedicine in Obstetrics

Although many Avera providers have been using telemedicine for almost a decade, Obstetrics is a new use case (launched just last year). Their App, AveraNow, which is powered by American Well launched 3 years ago with urgent care and has since grown to include clinics and OB, specifically focusing on lactation consultation and gestational diabetes.

“We rolled it out really slow, which was the right decision” says McKay. “The thing that we learned is you really need to put some thought into your operational process.”

“I think, people think that implementing telemedicine is putting a camera in front of a patient, but there is a very robust resource assessment, and a lot of process mapping that needs to go into planning a program like this” says Laberis. For Avera, they consider themselves fortunate to have already had people employed who had the capacity to take on the extra work of implementation and support. Without them Avera would have had to staff up to support these projects.

A Successful Year for the Gestational Diabetes Team

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All the hard work that the Avera team put in to rolling out this use case certainly seems to be paying off. For GD specifically, they have realized a decrease in visit times, increased provider and patient satisfaction, rapid referral and medication access for patients in rural areas and are beginning to compile patient specific health benefit data that indicates they’re on the right track.

In the first year, the Gestational Diabetes team has only been able to enroll about 50% of patients in the program due to language and connectivity barriers in rural South Dakota. Patients that are enrolled in the program are part of a comparison group that is compared against patient data from the year before. The preliminary findings show the following improvements:

  • Adherence to protocol (how often a patient checks their blood sugar)
  • Lower rates of Shoulder Dystocia
  • Lower rates of C-Section in labor
  • Lower rates of neonatal hypoglycemia

“For us, the biggest win is access to our patients. They don’t have to drive 100 miles to get the expertise they need” says McKay. “They don’t have to take the full day off of work or play phone tag with the clinic. They can even sit in their car and have an appointment” adds Laberis. “Its consumer focused rather than health system focused”.

The team knows there is much work to be done before a proof of concept case study can be made for more funding, insurance/Medicaid/Medicare coverage, and additional use cases, but these findings indicate a bright future for telemedicine.

One of their strategies is focusing on the full ACO which gives them a better angle with health insurance companies. “When you can reduce down those high-end costs when you’re getting paid to manage a patient’s pre-existing conditions, per patient, per year, that is money very well spent; that’s how you make your economic case” says Laberis.

Part 2

In Part 2 of the interview, we will examine what data Avera leveraged and how they integrated it into the solution; their advice to other hospitals looking to implement telemedicine solutions; and what’s next for the program in 2018.

About Avera Health

Avera Health is a regional health system based in Sioux Falls, S.D., comprising more than 300 locations in 100 communities throughout a 5 state region. Avera serves South Dakota and surrounding areas of Minnesota, Iowa, Nebraska and North Dakota through 6 regional centers in Aberdeen, Mitchell, Pierre, Sioux Falls and Yankton, SD, and Marshall, MN. Avera is comprised of 33 hospitals, 208 primary and specialty care clinics, 40 senior living facilities in addition to home care and hospice, sports and wellness facilities, home medical equipment outlets and more.

Are you thinking about implementing a telemedicine solution but aren’t sure where to start? Galen is here to help by offering project management, process/resource mapping, implementation guidance, and clinical data integration consultation. Contact us today to learn more

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