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Automated Virtual Care and Accountable Care Organizations

Feb '21

By Phil Marshall, MD, Founder and Chief Strategy Officer, Conversa Health

Accountable care organizations (ACOs) face a daunting challenge: effectively managing care across settings, ensuring the best care delivery and lessening the likelihood of expensive readmissions. To illustrate why this is such a challenge, let me offer an anecdote:

For hundreds of years, the healthcare profession has known that patients with heart failure will start experiencing breathing difficulties when they’re retaining more water. Difficulty breathing is an early sign of what eventually will be a readmission: a person on a ventilator or on an IV drip to get his or her heart pumping efficiently again. Yet less than 5% of heart failure patients after discharge from the hospital are routinely and systematically asked if they’re having problems breathing. That’s more than just a 95% missed opportunity. It’s a potentially life-threatening gap in our process.

This is just one example of why we need automated virtual care―across the board, but particularly within ACOs. In any arena of healthcare, value-based care means getting in front of situations: anticipating, predicting and using patient profiles proactively in order to deliver better outcomes while saving money. This is particularly important in ACOs, which are tasked with efficiently managing populations by providing coordinated high-quality care to the patients they serve.

According to the Centers for Medicare & Medicaid Services (CMS), “The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.”

Unfortunately, we still are not doing this consistently, with enough of a concerted effort, to overcome the challenges of a fragmented healthcare system in severe need of system-level coordination. ACOs can fulfill their mission by providing care teams the tools to better manage their patient populations. When they succeed at this goal, unnecessary, avoidable care is avoided, thus eliminating unnecessary costs and ensuring better outcomes.

Among the specific challenges for ACOs are:

  • Attribution logic. The various parts of an ACO―hospitals, doctors, medical practices and other providers―must determine whether a particular patient is attributable to a particular provider. That’s called attribution logic.
  • Care coordination. Once attribution has been determined, are the various providers who are accountable for that patient on the same systems? Are they able to coordinate care, effectively overseeing what happens with that patient? If so, how?
  • Bundled care. At the most basic level, ACOs function to some degree within a capitated model, wherein the provider is essentially are paid a lump some for the holistic care of patients, requiring better systems of care coordination.

Within this framework, the vision of ACOs is clear: fully accountable and coordinated care, and staying in touch between visits. This model lets providers know how a patient is doing so they can mitigate issues early and avoid complications—consequences of uncoordinated care—and unnecessary and costly care. But a formidable question remains: How do we accomplish this?

The Necessity of Automated Conversations

How do we know how patients are doing between visits, unless we staff a care management population health call center? And even with such a center, the problem is twofold: 1) It is prohibitively expensive and 2) most people no longer answer calls from unknown numbers

The solution is to automate the conversation, using an automated virtual care platform. This allows care teams to systematically reach out; gather patient-generated health data; analyze the data in real time; and understand whether the patient meets any of the risk criteria that would escalate into a phone call, telehealth visit or in-person visit. When patients start to get off course with whatever health issues they might have―chronic care, post-acute care, pre- or post-procedure, new symptoms or concerns ―we can determine whether they need more support, and if so what kind, to stay healthy or get healthy.

In many cases, such as with patients who have chronic conditions or are in postoperative situations, this requires high-touch continuous contact. That’s how you deliver better outcomes while saving money.

A virtual care and triage platform such as Conversa could be a valuable addition to any model of care. But when you have a value-based or at-risk financial arrangement, you have no choice but to know how your patients are doing between visits. You have no choice but to try to mitigate any issues early.

How Automated Virtual Care Is Working

Northwell Health in New York and University Hospitals (UH) in northeast Ohio are two providers that are successfully using automated virtual care to manage chronic and post-acute care.

At Northwell Health, Conversa has been an essential tool in the centralization of care management and population health functions to support both Medicare ACO and commercial ACO populations.

UH has deployed Conversa in a variety of areas, including post-hospitalization for heart failure, post-coronary artery bypass, acute myocardial infarction, pneumonia, stroke and COPD, as well as chronic diseases, hypertension, diabetes and asthma.

As soon as patients’ diagnoses and issues are known, these providers deploy Conversa’s automated technologies, which serve as an extension of their call centers. This allows the providers to proactively reach out and escalate these patients into a call when needed, thus reducing outbound telephone calls by about 50% and doubling the nurse capacity to be able to respond as patient needs arise.

Patients therefore have a virtual concierge that coordinates their care―systematically reaching out, staying in touch through automated chats, getting to know them better and better over time. This system triggers just the right topic at just the right time, based on the particular illness or issues that the patient is managing, and the medications that he or she is taking. It keeps the patient on track, closing any gaps in care to keep him or her healthy. This automated virtual care becomes an extension of the physician’s brand and relationship, delivering efficiency, engagement and outcomes.

Managing Coronavirus Volumes

Conversa has been extraordinarily active in helping healthcare systems manage their coronavirus volumes. Northwell Health is using the platform to manage all of its coronavirus-positive patients through regular outreach. Conversa is the exclusive electronic delivery mechanism for all COVID-19 test results and antibody test results at Northwell Health, the biggest health system in New York. Talk about an epicenter of activity!

In addition to delivering all test results, Conversa is enabling quarantine-oriented chats or monitoring chats for those who have tested positive. These chats educate the patient about what to do next and what it all means. They also can channel the patient into automated monitoring, as well as help with scheduling vaccines. Because nobody wants to receive care in person these days, the coronavirus has elevated the prominence of, and need for, automated virtual care.

Triggering Outreach

By helping ACOs turn their process into one that’s continuous and collaborative and proactive, automated virtual care closes gaps in care, helps patients prepare for procedures and then assists them throughout their recovery. Whatever the topic―orthopedic procedures, colorectal surgery, bariatric, heart failure, COPD, hypertension, diabetes, asthma, coronary artery bypass graft surgery, comprehensive joint replacement and more―Conversa has specific pathways that address it. When a person is identified as needing a certain kind of outreach, that outreach is triggered to stay in touch, surface the patient’s signals early, get the provider involved early to mitigate any issues and avoid costly complications.

As a result of such outreach, Conversa has demonstrated a 32% reduction in readmissions for situations like the ones I just mentioned and, as an example of preventive care, a 50% reduction in colonoscopy no-shows. Those are just a couple of ways that skyrocketing costs can be avoided through continuous contact with patients.

Changing How Care Is Delivered

As the healthcare industry steadily moves toward accountable and value-based care, whether in full or in part, it is impossible to imagine how these aims can be accomplished without an automated mechanism for staying in touch with patients. Without automation, you need too many people to deliver service adequately. Automated virtual care is the mechanism that changes how healthcare is delivered.

Going back to the example of heart failure patients at the top of this post, in order to systematically take advantage of opportunities like this, the process must be mechanized and automated. When we take the knowledge that we have at our disposal, apply it, systematize it and automate it, we can change the way heart failure patients―or any type of patients, for that matter―are taken care of. And it is our duty to do so.