Prior to COVID-19, our healthcare spending was nearing an unsustainable 20% of GDP, while yielding middling outcomes. We had problems with capacity, access and patient experience, and providers were struggling with too-heavy workloads and, in many cases, burnout.
These issues and other “defects in value,” as highlighted in a recent paper published in the New England Journal of Medicine, include hundreds of billions of dollars wasted each year on low-level and unnecessary care; and a reimbursement system that incentivizes episodic—rather than well-coordinated and continuous—care.
When the pandemic struck, these issues were magnified, forcing rapid innovation to cope with the unprecedented strain on healthcare organizations’ resources, while also showing the way for care delivery models that must work harmoniously together moving forward.
A panel of healthcare leaders shared keen insights and examples of how their organizations are leveraging the full spectrum of virtual care to address key healthcare challenges during a recent webinar: “The Next Wave: Automating Virtual Care.”
Pandemic Shows Glimpses of Future Care Delivery
During the pandemic, we saw that the full spectrum of care delivery models—including a wider adoption of virtual care tools out of a sense of urgency—could be used together to deliver compassionate care more efficiently. As we move into a post-pandemic world, better care delivery means augmenting the paramount goal of human care with technologies that optimize its effectiveness, such as automated virtual care, telemedicine, e-visits, virtual check-ins and remote patient monitoring.
The ability for care delivery models to work together in harmony requires the flow of real-time data from a variety of sources—including electronic health records, biometric data collected from the patient and patient-reported outcomes. Although the patient experience must always remain at the forefront, the role of automation is essential to improving system capacity and care team productivity. Personnel and other limited resources can be allocated intelligently, allowing patients with the greatest needs to be triaged to the highest levels of care, while lower-level functions, such as the answering of routine questions and the collection of standard data, can be addressed with intelligent automated chat or other technologies. Often in healthcare there is a trade-off between cost and quality, but the informed use of automation as part of the virtual care spectrum provides both.
Conversa Health CEO Murray Brozinsky detailed how virtual care pairs fully synchronous, in-person care with asynchronous, automated virtual care, in which the provider and the patient’s interactions don’t have to occur in the same place or in real time. The patient’s journey back and forth through these different care delivery models gets him or her to the right place at the right time, with the best outcomes, but at the lowest cost.
“With asynchronous care, if you’re my doctor I can send you a text, and then you get back to me later in the evening,” Brozinsky said. “Or I record a message or take a picture of a wound and send it to you, and then you get back to me at a time that’s convenient for you.”
Ideally, these varied care delivery models “all work harmoniously together,” with data and connectivity as their lifeblood. Most people can be treated at lower levels of care, while those with the greatest needs can be triaged to higher levels.
Dr. Peter Pronovost, chief clinical transformation officer for Cleveland, Ohio-based University Hospitals, quoted the Rev. Martin Luther King Jr.’s phrase the “fierce urgency of now” to describe the healthcare industry’s rapid shift toward virtual care in response to the coronavirus. But many organizations were already moving in that direction, largely because the existing system had become unsustainable. Pronovost was the lead author on a paper for the New England Journal of Medicine that detailed $1.4 trillion in annual waste resulting from defects in value.
“We spent so much time wasting people’s time, bringing them into care and settings that are not convenient for them or for us,” Pronovost said. “If we combine a number of technologies―such as smart chatting, ‘triggering’ to identify at-risk populations, and smart scheduling, where you can schedule visits or transportation, we can eliminate so many of these defects.” To accomplish a goal of zero defects in value, the industry must prioritize “reducing avoidable utilization,” or letting automation handle routine, standard tasks. That will free up providers to, in Brozinsky’s words, “practice at the top of their license.”
COVID-19 Screening and Chronic Disease Management
Two examples of how to do this come from the Center for Digital Health Innovation (CDHI) at the University of California San Francisco (UCSF), which leveraged automated care pathways in response to a San Francisco emergency health order in March 2020 requiring all healthcare facilities to screen their employees for COVID-19 symptoms and risk factors every day before they come to work. Working with Conversa, the team created and deployed, in seven to 10 days, an automated screening tool that allowed tens of thousands of employees to receive a text message every morning, answer some basic questions and rapidly get to work using a tool comparable to a TSA pre-check bar code.
In addition, just weeks after the pandemic-induced shutdown, CDHI’s Product Team, Lung Transplant group and Digital Patient Experience program teamed up to demonstrate how virtual care can be used for chronic disease management, especially when patients are fearful of visiting healthcare facilities. The resulting home spirometry kit transmits data to lung transplant recipients’ smart devices, while a chatbot application powered by Conversa Health engages patients and enables them to share symptom information from the safety and comfort of their homes. Patient education and outreach have led to more than 65% adoption by transplant recipients who are receiving follow-up care at UCSF, and the team continues to make improvements to the process.
“Basic questions need to be routine, standard and automated every day,” said Dr. Aaron Neinstein, CDHI director of clinical informatics. “Person-to-person, expensive, high-touch interactions should happen only when needed and not as the default.”
Taking the Robot Out of the Human
“It’s about taking the robot out of the human,” said Dr. Nick Patel, chief digital officer, Prisma Health, South Carolina’s largest not-for-profit health organization. “We have to get out of this mindset that the only time you get care is the 15 minutes of face time you get with your provider.”
Prisma Health was also forced to respond quickly when the pandemic struck. Because of the constantly changing and often conflicting information about the coronavirus, scared patients began canceling routine office visits, both ambulatory and surgical, and the organization stopped elective procedures as a safety precaution. Almost “over a weekend,” Patel said, it moved to virtual ambulatory care. As a result, Prisma, which did around 22,000 virtual visits in 2019, has done nearly a half-million since March of this year.
Among Prisma’s rapid responses to the pandemic were the creation of an incident command center to standardize all communication related to COVID-19 and, with the help of Conversa, a COVID screener chat that by mid-December had seen almost 200,000 engagements within South Carolina. The chat let patients with virus symptoms or questions find out whether they should be tested and, if so, where, based on their ZIP code. Residents got the answers they needed, “and the contact centers really loved it because they got fewer calls,” Patel said. “They were able to route people without having to call and go over the same symptom questions that everyone has to ask.”
Prisma also developed a “digital badge” to help screen the system’s 30,000 employees so they could come to work; since then, several colleges have adopted it for return-to-school chats.
The panelists also discussed various ways in which automation can be used in the coming months as COVID-19 vaccines are rolled out to the public. It can help educate the public about the differences between vaccines from, say, Pfizer and Moderna, and potential side effects; help individuals decide which one is right for them; schedule vaccinations and direct people to the appropriate locations; provide digital badges indicating who has been vaccinated; and help with tracking. Through all these functions, as in other areas, automation can help provide a combination of standardization and personalization.
With the automation of virtual care, the quadruple aim of patient experience, provider experience, cost and outcomes becomes more attainable, but the human element must never be overlooked. “So much of getting people to use this isn’t tech,” Pronovost said. “It’s economic incentives, it’s sociology, it’s psychology―because it’s literally about behavior change. And we’re going to see innovation accelerate when we put research teams together to think about this from a more holistic perspective.”
A Few Words of Wisdom for Automating Virtual Care
- Start with the problem, not the technology. The technology is a versatile tool that can be adapted to address the problem, or defect in value.
- Find the initial-use cases that drive ROI, and go from there. Investment is a must in solving our healthcare problems and changing the way we deliver care, but it must be done wisely. Home in on what will yield the greatest benefits for all parties.
- Engage either clinicians or patients to test the usability. It is all just theoretical until it is tested and proved to work.
- Get partners because you aren’t going to do this alone. Automating healthcare is all about data and connectedness. It can’t happen in a vacuum.
- Access is the key. Improving access while eliminating waste would also dramatically improve care, outcomes and every other part of the quadruple aim.