Introducing virtual care to commercial members
TytoCare serves commercial members across the US. TytoCare partnered with a top-3 national health plan to integrate the Home Smart Clinic into five healthcare programs across 29 states. The virtual care program now serves 16,000 households, reaching over 60,000 eligible members.
Through the virtual care program, the payer successfully reduced the number of member claims and total cost of care, improved the quality of care, access to care, and the care experience.
Lowering cost of care while providing an improved experience
A top-3 national health plan wanted to launch a virtual care program for commercial members, with the aims of reducing cost of care, and improving quality of care, access to care, and member retention.
Health plans are always looking to reduce the cost of care. One surefire way to do this is to reduce unnecessary ED utilization by members seeking urgent care for common complaints when they cannot access a doctor’s appointment in a short time frame.
The health plan wanted to introduce a virtual care solution that would meet members’ needs for accessing urgent care for acute, non-emergency medical complaints while shifting to a more cost-efficient care site (i.e., the home). They sought a virtual care solution that would offer improved clinical capabilities beyond traditional audio/visual telemedicine so that members could get the resolution they needed without an in-clinic follow-up. This would enhance the quality of care and access to care and consequently contribute to the overall reduction of the cost of care. This solution would have the dual effect of improving member retention with a better care experience.
Implementing cost-efficient, high-quality virtual care that members love
TytoCare and the health plan worked together to define objectives for the virtual care program that aligned with the health plan’s business goals.
Cost of care
Shift to more efficient sites of care (home)
Reduce total cost of care
Quality of care
Improve clinical performance
Member retention
Improve care experience
A virtual care solution tailored to the health plan’s business goals
Together with the health plan, TytoCare designed a virtual care strategy and rollout focused on the key business goals they sought to achieve. TytoCare’s Home Smart Clinic, with remote physical exams that can be performed from the comfort of home, would be rolled out to a cohort selected based on best practices from Tyto Engagement Labs™ and the health plan’s business goals. Each family selected for the cohort would receive a TytoHome device to facilitate virtual care with remote physical exams.
The Home Smart Clinic would be integrated into the health plan’s existing virtual care providers to enable more accurate diagnoses and treatment plans for members seeking immediate care with the help of remote physical exams. To maximize success, we optimized adoption and utilization tactics using Tyto Engagement Labs™, TytoCare’s proven framework based on behavioral science methods and years of successful nationwide deployments.
Better care, lower costs, satisfied members
Reduction in cost of care
There was a reduction of 2.7 preventable ER claims per 1,000 members per week in children, indicating that fewer members were ending up in the ER for urgent, non-emergency medical complaints. This translated to a 5% reduction in the total cost of care for the payer.
per 1,000 members per week for preventable ER visits
of care in children overall for the payer
Improved quality of care
Using TytoCare for the virtual care program enabled doctors to more accurately diagnose patients using remote physical examinations rather than just audiovisual telehealth. This allowed for timely resolutions, accurate treatment, and almost no follow-up in-clinic visits.
of ICD-10 costs diagnosed with TytoCare compared to A/V visits
How was this calculated?
- Overview: Conducted a diagnostic capability analysis of ICD-10 codes for large payer population
- Volume: 4,511 captured diagnoses codes
- ICD-10 codes: 573 unique codes scored
- Diagnosis scoring: Scoring rubric was applied to assess diagnostic accuracy by Tyto clinicians:
- Poor
- Fair
- Good
Improved member retention
With an NPS score of 80+, members indicated that they enjoyed their experience using TytoCare to receive care from their providers from the comfort of home. Having happy members increases the likelihood that they will stay with their current health insurance.
to stay with the insurer long-term thanks to TytoCare
Feedback from health plan members
“I was very happy with our coverage beforehand, but this has put a value on it that is extraordinary.”
Leanne, Los Angeles
“I appreciate how easy it was to get started with TytoCare. There were tutorials for practicing vital information collection and sending it to the doctor.”
Chris, Santa Monica
“What stood out to me is that it’s not just a phone call to a nurse or a physician – it’s actually taking the data and measurements and visual information for a real diagnosis.”
Mallory, Palm Springs
Key ingredients for successful virtual care adoption
Integrate a holistic solution that enables successful virtual care adoption
The success of a virtual care program is the sum of its parts. The Home Smart Clinic solution enables payers to introduce virtual care into its existing care delivery framework with ease through careful program design, remote physical exams, workflow integration, and leveraging proven best practices from Tyto Engagement Labs™ for member engagement. TytoCare’s software connectors streamline the integration with its EHR so that the insurer and its provider partners can access and leverage TytoCare’s Home Smart Clinic post-implementation.
Remote physical exams for immediate data-based diagnoses
Tyto’s remote physical exams allow families to manage and get care for multiple conditions.
-
35%
respiratory system
-
6%
eye disorders
-
15%
ear diseases
-
5%
skin
-
35%
respiratory system
-
15%
ear diseases
-
6%
eye disorders
-
5%
skin
The Home Smart Clinic
TytoCare’s FDA-cleared handheld solution enables clinicians to conduct medical exams remotely for accurate diagnoses – e.g., listen to heart and lung sounds, look into the ear canal, throat, blood pressure, blood oxygen levels, weight, and more.
The Home Smart Clinic also includes Tyto Insights™ AI-powered guidance and decision support, provider integrations, and Tyto Engagement Labs™ which include member journeys and engagement frameworks.
Select a cohort that balances behavior, cost, and demographics
Select a cohort based on factors that increase their likelihood of engaging with and adopting virtual care. The health plan, together with TytoCare and based on learnings from Tyto Engagement Labs™, selected the target cohort based on cost of care and factors that affected their probability of adopting the virtual care solution. Factors included family structure, telehealth experience, medical history and ER/UC utilization, and the predicted cost of care.
| Criteria | Values |
|---|---|
| Family avg. size | 3.7 |
| Children ages | 0.5 children between the ages of 0-5, 1.7 children between the ages of 0-18 |
| Parents age | <45 |
| Medical history condition | Ear and upper respiratory tract infections |
| Telehealth utilizers | 1+ a year |
| Preventable ICD-10 codes | Acute upper respiratory infection, rash, unspecified fever, acute maxillary sinusitis, etc. |
| ER + UC usage levels | 1.8 a year |
Plan your virtual care deployment and adoption strategy
Take the time to create a plan that crystallizes the goals and paths to success for your virtual care program. With Tyto Engagement Labs™, you can leverage best practices and behavioral science methods to carefully plan and deploy your virtual care program. TytoCare collaborated with the national payer to build a user journey designed to promote behavioral change and incorporated multiple channels for each stage of the journey.
Tyto Engagement Labs™
TytoCare created a proven framework that includes all the required building blocks for successfully deploying and adopting the TytoCare Home Smart Clinic. This framework is based on TytoCare’s learnings from behavioral science and years of successful deployments with our partners globally. It is designed flexibly, allowing adaptations depending on the audience or the modality being addressed.
The carefully planned user journey created with Tyto Engagement Labs™ drove high adoption rates of TytoHome among members. 53% of the members who completed an enrollment quiz to evaluate whether TytoHome was a good solution for their family went on to enroll in the program, versus 37% who didn’t finish the quiz.
Tyto Engagement Labs™
Promoting behavioral change at every touch point
Leveraging a multi-channel approach
- Product: Unboxing, app and device UX/ UI, in-app & push messages, and user journey’s
- Physical: Mailers, merchandise, physician referrals, and in-clinic collaterals
- Digital: Web assets, email, SMS, and social
In-house execution: A multi-channel approach
- In-house expert marketing team (content, creative, web development, etc.)
- Ongoing monitoring, analysis and user journey optimization
Larger cohorts, more plans
Having seen the success of the virtual care program, the health plan will scale the virtual care program to a larger population of commercial members using the same characteristics identified for the original cohort. They will also use the learnings from this virtual program to expand the virtual care offering to Medicaid cohorts. The health plan will also be able to apply the learnings and strategies to introduce virtual care to other programs.
Read more about virtual care with TytoCare
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