Lessons Learned from the MAVEN Project Pilot

Using Physician Volunteers to Increase Access to Care via Telehealth

by Lori Uscher-Pines, Robert S. Rudin

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Research Questions

  1. What were the pilot program's strengths and limitations?
  2. What lessons can this and similar programs apply to improve quality?

The Medical Alumni Volunteer Expert Network (MAVEN) Project was one of the first programs in the United States to create a corps of experienced volunteer physicians to provide consults to providers in rural and inner-city safety-net clinics through telehealth. In the fall of 2015, the MAVEN Project started offering telehealth visits, with the expectation of serving three safety-net clinics in Massachusetts and California for a six-month period. RAND Corporation researchers aimed to conduct a qualitative evaluation of the pilot, describing the program's strengths and limitations to inform quality-improvement efforts within the program itself, and to provide lessons learned for other telehealth initiatives under development in the United States. They obtained data from MAVEN Project administrators on telehealth visit volume and site characteristics. They also conducted 13 semistructured interviews with volunteers, on-site referring physicians, and administrators across the three pilot sites and, for comparison, three representatives of additional telehealth programs that link physician volunteers to underserved communities. They identified themes in the interview data and developed recommendations for addressing program challenges or limitations. They conclude that, although stakeholders involved in the pilot were pleased with many of its features, further formative development and experimentation will be needed to address identified barriers to implementation and to establish sustainable and scalable processes. Because the demand for such services on the part of community health centers, as well as the supply of physicians interested in volunteering, will continue to grow, this model, when fully developed, has the potential to increase access to care for underserved populations.

Key Findings

When Volunteers Were Engaged, Patients Benefited in Multiple Ways

  • Volunteers often reassured patients.
  • Patients could avoid costly and inconvenient travel to an in-person specialist or could be seen by an in-person specialist more quickly.

Volunteers Generally Evaluated the Program Positively Overall

  • Volunteers were very pleased with administrative staff and the improvements made to the pilot over time.

The On-Site Clinicians Had Only Positive Things to Say About the Physician Volunteers

  • They frequently praised their clinical skill and professionalism.

Low Utilization of Volunteers by On-Site Clinic Providers Was a Leading Challenge

  • Some on-site physicians and volunteers identified cases in which referral to MAVEN Project volunteers was inappropriate.
  • Lack of familiarity and rapport between on-site clinicians and volunteers was a major barrier to uptake.
  • The limited hours of MAVEN Project volunteers and the need to track the schedules of part-time volunteers were barriers to greater uptake.

Workflow Issues Are Common in New Telehealth Interventions

  • Each service line required its own unique workflow; there was no one-size-fits-all approach.
  • Both volunteers and on-site staff independently recommended that certain days or blocks of time be fully dedicated to the MAVEN Project and telehealth.

Volunteers Did Not Always Get Information on What Ultimately Happened to Their Patients

  • They were concerned that, given the low volume of visits, there might be insufficient demand to allow them to meet their personal goals with the program and to remain comfortable with MAVEN Project systems and processes.

The Program Can Have Unintended Consequences

  • Certain patients who confront barriers to in-person care might opt to use the MAVEN Project as a substitute for the care of a local specialist.

Recommendations

  • Consider developing standardized criteria for referrals and conducting collaborative training sessions about referral decisions with on-site staff and volunteers.
  • Prior to implementing a particular service at each site, write the goal statement for that unique offering that takes into account patient acuity, the "telehealthabilty" of the service line, and the state of local specialty care.
  • Facilitate more in-person interaction between volunteers and on-site clinicians prior to launching a service line.
  • Consider experimenting with a panel of volunteers in which all specialties or a subset of specialties are available 24/7 for curbside consults via mobile phone.
  • Initially focus on a narrower set of specialties, such as hematology, rheumatology, and cardiology, and develop workflow models for each one.
  • Encourage clinics that are not already doing so to establish a block of MAVEN Project appointments in which on-site providers are fully dedicated to the MAVEN Project.
  • In workflow models for direct patient care, consider integrating some time for dedicated provider-to-provider communication.
  • Consider developing a feedback mechanism or process for volunteers to track patients' outcomes and see the results of their work.
  • Request and monitor that volunteers do a certain number of visits per week or month to maintain interest and competency in the program.
  • Train volunteers on proper conduct in telehealth visits using materials developed by professional associations and telehealth companies.
  • Assess inappropriate use of the MAVEN Project by patients.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    MAVEN Project Description and Evolution

  • Chapter Four

    Findings and Recommendations

  • Chapter Five

    Conclusions

Research conducted by

The research described in this report was sponsored by the California Health Care Foundation and conducted by RAND Health.

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