Today’s most successful healthcare organizations are fully embracing virtual care as they not only make healthcare more convenient for patients, but also drive better engagement and outcomes. While this trend has been ongoing for some time, the coronavirus pandemic has highlighted the overwhelming need for virtual care and hastened its widespread adoption.
The result is that, during one of the most challenging periods the industry has ever seen, organizations are emerging better informed and better equipped to provide the personalized, proactive care that will carry them through the current crisis and raise healthcare standards for generations to come.
A trio of healthcare leaders shared their experiences and insights during a recent webinar on “The Virtual Health Awakening.”
Virtual care encompasses a broad range of ways that healthcare providers can interact remotely with their patients, extending the options of care management well beyond a specific event, said webinar moderator Reenita Das, a partner and senior vice president at Frost & Sullivan. Telehealth or telemedicine can include live video, intelligent chat, instant messaging, remote monitoring and more. Virtual care “has saved millions of lives,” Das said.
Meeting Patient Expectations
It all begins with meeting patient expectations, webinar panelists agreed.
“Flexibility and ease of use are extremely important for the patient,” said internist Nick Patel, MD, chief digital officer and vice chair for innovation at Prisma Health, South Carolina’s largest not-for-profit health organization. “It’s a hybrid experience. It’s not that we are going to exclusively see patients virtually. Mobility is key.”
“In many respects, the patients are much further ahead than the healthcare infrastructure to actually leverage those technologies,” added Zenobia Brown, MD, vice president of Population Health and medical director for Northwell Health Solutions, the care management organization of Northwell Health, New York’s largest healthcare provider. As providers do so, she said, they must “keep the humanism in healthcare.”
Conversa Health CEO Murray Brozinsky stressed the importance of truly engaging with the patient in striving toward the healthcare system of the future: “How can we understand where they are in their health and their care and then use the technologies to determine what is the right venue for that particular patient? Do they need a live chat with a physician? A phone call with a nurse? A telehealth visit? And when they need an in-person visit, how do you have a patient experience platform that understands the patient and incorporates that information into the workflow?”
Focused on the ‘Quadruple Aim’
Innovative healthcare provider organizations have long gauged their population health strategy’s success against four critical pillars:
- Improving population health outcomes
- Reducing the total cost of care
- Improving the patient experience
- Enhancing and optimizing the clinician experience
During the coronavirus pandemic, “We also added a fifth leg of the stool, which is helping people stay connected without getting infected,” Brozinsky said. “It’s for the patient as well as for the provider. So when we think about outcomes, we think about those five areas of outcomes. And it’s all about outcomes.”
For Northwell Health, Brown said, COVID-19 has highlighted the challenges of regularly connecting with patients—particularly those affected by a rapidly changing disease—to achieve the desired outcome, avoiding readmissions while scaling interactions to a large number.
Patel noted the ongoing shift to value-based care, a system intensely focused on delivering better patient outcomes while reducing costs. “Having skin in the game for healthcare systems is going to change things. Those digital interactions between visits—staying in touch with a chatbot, with remote patient monitoring that monitors your sugars, blood pressure, exercise and overall wellness—are going to be key to improving outcomes.”
He added: “We have to stop looking at them as just patients but truly consumers and customers.” Patel quoted Prisma Health CEO Mark O’Halla: “We are in the people business, and that business is about improving patient experience, improving access, having frictionless access points throughout your system.” To that end, the Prisma Health GO app provides patients with easy access to digital health services.
As for the clinician experience, Brozinsky stressed the threat of burnout, with a looming shortage of 2.5 million providers. “COVID-19 laid bare the capacity issues in the health system. There are times where an automated interaction is the lowest-cost, highest-frequency interaction you can have. That allows you to determine whether you need a higher-cost intervention.”
So how do providers begin to integrate these new elements into the system?
“The thing that works for me (as a patient) is not necessarily the thing that works for someone else,” Brown said, adding that providers need to hear from patients to understand what works for them as individuals.
While electronic medical records capture extensive data, Brozinsky said, talking to patients is essential to helping them, and “the digital platform of the future” must accomplish that.
Personalization and Insourcing
Patients’ demand for personalization has driven another change: Providers are increasingly insourcing telehealth services that previously had been outsourced. “I would like to see my doctor,” Das said. “I don’t want to see any doctor.”
In-house telehealth was once considered unwieldy, Brown said. But “for Northwell Health, COVID-19 solved that problem very quickly, with lots of doctors who had nothing to do but learn how to use telehealth visits.”
This development presents the need for “a new skill set,” she acknowledged. How do you connect with people digitally when you can’t see their body language (which is possible with videoconferencing but not with some other forms of virtual healthcare)? How do you respond during a digital interaction when a patient becomes angry or dangerous or suddenly requires an elevated level of care?
The coronavirus overwhelmed third-party telehealth companies, Brozinsky said. Conversa was able to work with all of its health system partners to develop a virtual COVID screener and triage tool that screened out 90% of patients, identified the 10% who needed assistance and directed them to local resources.
Virtual health enables high-quality, personalized care at a scale that previously was neither affordable nor practical. It involves the use of synchronous technologies like telehealth and asynchronous technologies like intelligent chats—in harmony with traditional care models—to dramatically expand the efficacy and capacity of the healthcare organization while also delivering more collaborative, continuous and proactive care.
“We at Conversa are a team of caring, data-driven, passionate, proactive problem solvers,” Brozinsky said. “Those are our values. Our team wakes up every day and we build solutions that harness the wisdom of patients for the purposes of improving access and health outcomes.” That means, in part, continuing to provide the comfort, security, human touch and reassurance that patients expect from their healthcare providers―despite the physical separation.
It also means treating the individual person rather than the average patient. Effective virtual health is able to personalize what a patient needs and treat him or her as a whole person. It allows providers to think about patients the way they think about themselves, by considering factors such as social determinants, behavioral data and genetics in conjunction with the individual’s input. “You can’t understand where a patient is in their health journey or their care journey without talking to the patient,” Brozinsky said.
Prisma Health has done more than 170,000 virtual visits since March, Patel said. “Prior to the pandemic, driving provider engagement and buy-in was very hard because reimbursement for virtual visits was very restricted. Now that CMS and other payers have lifted most of those restrictions, everybody’s on board.”
Social Determinants of Health
Access to technology is a social determinant of health. Technological literacy also can present a challenge. That’s where community outreach comes in.
In rural South Carolina, about a quarter of homes lack acceptable internet speeds or broadband access. Just recently, Patel drove by a school and saw a line of people going in to get lunch—the only daily meal for many students. So Prisma Health worked with school districts to tap into their Wi-Fi, allowing students to have telehealth visits while there for lunch.
Northwell Health used off-duty EMTs to visit older people and set up Wi-Fi-enabled tablets in their homes. “In every instance where there is a roadblock to technologies,” Brown said, “there are really inventive ways to make sure that we can do this in a universal way.”
Brozinsky added: “Personalization really means: How do you address a particular person’s needs to drive better health outcomes?
Today that question is increasingly being answered through virtual health technology, a development whose adoption has been greatly accelerated by the COVID-19 pandemic. In fact, if there is one silver lining to the onset of the coronavirus, it would have to be that this public health crisis has highlighted the value of virtual health as not just a nice-to-have offering but rather a need-to-have component of the “new normal” care model. And those organizations that are best at continuing on this path will be the ones primed for the greatest success moving forward.