Background: While there was broad adoption of telemedicine during the COVID-19 pandemic, optimizing the interaction for patients and the clinical team remained a challenge. We sought to optimize delivery of telemedicine services to provide more efficient and effective patient care. Target areas of concern for improvement were scheduling, staffing, communication, technical challenges with operating the platform, a high cancellation rate, and limited copay collections. Methods: A team of 8 virtual Patient Service Coordinators (VPSCs), 8 virtual Medical Assistants (VMAs), and an RN clinical manager was created to work remotely from home to serve Providers at 8 clinics. VPSCs performed check-in duties, demographics, copay collection and technology trouble-shooting with patients. VMAs performed medical intake (medication reconciliation, depression screenings, and vital signs) with real-time EMR input. VMAs stayed in-touch with patients to communicate Provider delays. Standardized communication pathways connected virtual teams with in-clinic teams. The clinics selected to participate in the TMS program were conducting 29% - 50% of E&M visits by telemedicine. The goal of the TMS program was to reduce stress and burnout, as well as relieve in-clinic staff of telemedicine duties giving them capacity to address in-clinic COVID related staff shortages. Results: The TMS Program supported 15,500 visits (11/15/21 – 5/31/22) and increased upfront expected copay collection from 9% pre-program to 100% post program. The program reduced the time for first contact on video from 18 minutes to 1 minute and reduced the telemedicine cancellation rate by 3%. The supported TM cancellation rate was 7% lower than in-person visit cancellation rate. A geographically distributed work from home team was able to support a 66% increase in visits during inclement weather days which allowed visits to be completed that would have otherwise been canceled due to clinic closures. Additionally, the TMS program relieved workload for in-clinic staff and the VPSC and VMA positions proved highly desirable to the eligible workforce. Conclusions: The TMS Program improved patient connectivity and experience, increased upfront co-pay collection, decreased burden on in-clinic staff, allowed continuity of care during inclement weather, and was an attractive work option for staff. Due to its success, the program moved past pilot phase into an operational program.