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Virtual care innovators from El Camino Health and Prisma Health describe their journeys in building the Hybrid Care Delivery Model

Mar '22

All the challenges that faced health organizations before the pandemic have only been aggravated over the past two years. Total spending on healthcare in the United States nearly reached 20 percent of Gross Domestic Product in 2020. Shortages are projected over the 2020s for physicians and nurses, with staffing now the top concern among health system CEOs

Innovative leaders are focusing their organizations on the Quadruple Aim—reducing the cost of care, improving clinical outcomes, enhancing patient experience and enhancing clinician experience—as the best way to meet these challenges.

A hybrid care model uses virtual care to “leverage the wisdom of the patient, a data set that has been missing: everything that we all carry around with us on how we’re doing on our health journeys and our care journeys,” Brozinsky said. This data set includes biometric data captured with sensors and patient-reported outcomes offered in answer to simple questions delivered by an automated chat.

In a session titled, “Unlocking the Quadruple Aim with Automated Virtual Care” at the recent ViVE 2022 event, Conversa CEO Murray Brozinsky discussed these themes with two leaders in building a hybrid care model:

  • Deborah Muro, Chief Information Officer of El Camino Health, Mountain View, Calif., and
  • Nick Patel, MD, Chief Digital Officer, Prisma Health, headquartered in Columbia and Greenville, S.C.

Automated virtual care is proactive

Virtual care is central to El Camino Hospital’s efforts to differentiate itself from competitors in California’s Silicon Valley region, where expectations for virtual options are especially high, Muro said. The two-hospital system links digital transformation of care delivery directly to pillars of its strategy, such as building a high-reliability organization with the goal of zero defects and reaching out to patients more proactively, Muro said.  

Readmissions is a focus of these efforts. “We have people coming back to the hospital who shouldn’t be coming back, because we weren’t able to watch over them after  they left. Are they taking their meds? Do they have food? Do they have housing? All the social determinants of health play a role.” Muro said. “How are they doing? We found that when we check on our patients, they’re not doing well, post-discharge. They’re usually in a bad place.” The health system is combining Conversa programs with a physician dedicated to checking in virtually with patients post-discharge to root out these problems as soon as possible.

Instead, El Camino is now automating proactive outreach to vulnerable patients. For example, El Camino has worked with Conversa on a program to enhance monitoring of patients with chronic obstructive pulmonary disease (COPD), Muro said. Clinicians need regular updates on these chronically ill patients regarding any difficulty breathing they are experiencing or if they are feeling fatigued. The Conversa program prompts patients to report on their conditions and alerts care team members to patients who are struggling, she said.

The health system is integrating bio-stickers that track patient vital signs with a Conversa monitoring program. El Camino also is using Conversa programs to stay in touch with maternity patients, before and after delivery and to ensure patients are completing all the necessary preparations for surgery.

Frictionless, always-on access

Prisma Health, based in South Carolina, is building a seamless virtual care continuum to wrap around its 18 hospitals and 330 outpatient care sites, Patel said. Automated virtual care provides the entry point to guide patients to the right level of care, such as enhanced video visits or an in-office appointment, and then follows up with automated check-ins and home monitoring, he said. 

This hybrid care delivery model provides patients with frictionless, always-on access and automated monitoring that enables clinicians to intervene sooner and more effectively, Patel said. “Care shouldn’t only happen when you walk into my clinic and see me for 15 minutes, if you get 15 minutes at all,” he said. “Care should happen when and how you want to do it. It should happen where you live most of the time, which is 99.9 percent not in my hospital or my clinic.”

For example, Patel said, a clinician can give a home blood pressure cuff to a patient with hypertension. Automated chats can prompt the patient to use the Internet-connected cuff daily to track blood pressure. If the readings from the cuff are high three days in a row, the chat asks the patient a series of questions: Have you missed a dose of your blood-pressure medication? Are you feeling any side effects of your medication? Are you taking any new medications? Are there any other changes in your health?

Conversa’s automated virtual care platform analyzes the responses and escalates patients in need to Prisma’s dedicated virtual care center or a call center. This virtual care infrastructure takes pressure off physicians and their clinic staff, Patel said.

Prisma has relied on several programs in Conversa’s COVID-19 suite of solutions. Adopting Conversa’s COVID-19 Screener & Triage program cut calls to Prisma’s overwhelmed call center by 40 percent at the outset of the pandemic, Patel said. Prisma also has deployed Conversa to provide vaccine information to the communities it serves and to automate return-to-office letters for patients to relieve physicians of that burden.

Beyond COVID, Prisma uses Conversa for total joint replacement patients, post-discharge follow-up care and pediatric wellness.

Virtual is hard-wired into hybrid care models

As mentioned above, El Camino ties automated virtual care and other digital transformation efforts directly to strategy. Muro, a registered nurse, spends time with front-line clinicians and nurses to understand their technology challenges first-hand to inform implementation and ongoing improvements.

El Camino is using automation to allow patients to self-schedule appointments and answer their patient history questions online before their appointments, along with other elements that shift from reactive to proactive, Muro said. “If you could be in a wellness world where you’re preventing (disease), you’re using things we have, like genomics, to help guide patients for how they can stay as healthy as they can be and reward them along the way,” Muro said. “We don’t use rewards in healthcare, and we should think about that.”

Similarly, Patel draws on his experience as a practicing internist. New digital tools must fit existing physician workflows without adding a significant number of clicks to be widely adopted, he said. Crafting a hybrid delivery model requires operating guidelines that make virtual care options a normal part of the decision tree for guiding patients to care. For true digital transformation to occur, automated chats and virtual visits must be part of the regular mix of care options, not a pilot program siloed off from most care, he added.

“We have to make sure we are thinking of our providers, and making sure we are not making work harder for them, we’re making work much better and easier for them,” Patel said.

Automation expands capacity, and in particular, it reduces the burden on providers by doing repeated tasks at scale to find the small number of cases that need their intervention, Brozinsky said. “We’re trying to virtualize and automate a healthcare professional coming out to your home, asking you questions, taking your vital signs—increasingly, those will be ambient vital signs—and then making a decision right then and there,” Brozinsky said. “Hey, you’re fine, keep doing what you’re doing. Or: you’re not fine, here’s some recommendations of what you can do and we’ll check back tomorrow. Or: that’s a problem, we’re going to get you to your provider.”

To watch the full length live panel discussion, click HERE.

 

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