Electronic Health Reporter

By Matt Henry, senior manager consultant, Denver, Point B; Talia Avci, managing consultant, Chicago, Point B; and Ashley Fagerlie, managing consultant, Phoenix, Point B.

As the COVID-19 crisis disrupts traditional care delivery, digital tools such as telehealth are making it possible to deliver care outside your facility’s walls. Here’s how to prepare your organization both now and in the future.

Amidst the COVID-19 pandemic, healthcare has literally left the building. With millions of Americans under orders to stay home, in-person care delivery and elective procedures have been effectively shut down, elevating the need for alternative care delivery options.

Health systems are in a crisis, balancing heroic action to ramp up and support their communities through the COVID pandemic with existential threats to established service line revenue and cost structures.  The importance of using technology to extend reach and effectiveness of your mission has never been greater.

While other industries have spent years disrupting traditional operating models to deliver online engagement to meet customer needs, healthcare has lagged due to many practical, economic, regulatory, cultural and quality of care reasons.

As health systems prepared for a surge in infectious patients, many have leveraged their digital front door as a way to deliver credible information, guide care, and deliver safe and effective services to patients.

Taking lessons learned, the time is now to plan for your post-COVID plans and how your digital front door can extend your mission as you intentionally re-open your care facilities.

Re-imagine access: As you build your strategy, consider how new front door solutions are being offered by non-traditional ‘providers’, like Anthem, Walgreens and CVS/Aetna, to address gaps in the primary care landscape.

These gaps include inaccurate online health information, lack of access to personal health information, long wait times for appointments, lack of price transparency and other issues that impact patients along their care journey.

Barriers can be addressed by tools that assist in triaging, medication adherence, capacity management as well as two-way patient communication via websites, patient portals and apps.

Anthem has partnered with a digital health start-up, K Health, to offer symptom triaging to their 40 million members to provide care guidance and access.  Members provide their symptoms to an AI-enabled algorithm and can text directly with providers for advice.  Walgreens, with locations that are accessible by 78% of the U.S. population, has launched Find Care, which offers everything from lab tests to virtual consults.

CVS/Aetna has spent nearly 10 years building out digital health tools, focusing on medication adherence, with the power to leverage data as a pharmacy, payer and retail clinic to connect with their patients.  Other organizations are launching chat bots for assessments and triage or more deeply leveraging remote patient monitoring for care.  Each of these digital front door tools is changing how patients access care.

First and foremost, consider the purpose and utility of a digital front door from your patients’ perspective as you leverage these tools to inform and guide care, connect with both episodic care and ongoing health management, and enable patients to complete administrative tasks.

Inform: It is imperative to closely manage and deliver consistent, up-to–date crisis management information to both your patients and employees across the organization.

Large health systems that have grown through acquisition struggle in the best of times to integrate their clinical and patient-facing systems. The COVID pandemic only amplifies the need and challenge. A few immediate steps to take:

• Meet your patients where they are and identify both push and pull opportunities for engagement. The crisis can provide an opportunity to collect preferences for digital engagement through your patient portal, mobile apps and website to make sure they have current care information.
• Learn from voice of the customer. Make sure you have feedback loops to incorporate patient experience into your messaging campaigns that can be sourced from digital surveys as well as from patient services.
• Build clear pathways and expectations for digital/telehealth care delivery tied to a long-term strategy for enabling digital options. You’re moving quickly, but that doesn’t mean all shortcuts should be taken.
• Establish a Communication Command Center. Set clear communication expectations and points of contact by identifying a digital rapid response communication team to single source crisis management messages. This includes establishing internal service level agreements (SLA) to set expectations for response timelines and inviting cross functional decision-makers to expedite action.
• Quickly define a cascading process for posting and disseminating critical information organization-wide based on communication platform architecture. This includes considering how messages will need to be published across regions that run on different platforms and have local communications teams and may require a temporary matrixed reporting responsibility to coordinate efforts.

Guide care: Triage tools need to provide actionable insights for patients grappling with incomplete information on COVID-19. Recognize that people will try to self-diagnose. Overall, 65% of Americans try to diagnose themselves via Google, leading to 74% feeling stressed out, primarily because over half of self-diagnosis are wrong.

With this misinformation in mind, make sure tools provide localized and updated information for next actions since COVID test and treatment processes are fluid. First responders are overwhelmed as well, so posting generic guidance to call 911 for emergency dispatch is not guiding care.

Share information about how facilities are managing emerging COVID patients versus ‘normal’ patient volumes. Again, since information changes quickly, implement processes for regular updates.

Finally, coordinate internal training for new patient care processes and set expectations for changes in staff behavior that reflect digital front door guidance. Patient services, scheduling, and referral teams all need current information on how the pandemic changes their normal services.

Connect to care: Telehealth is a natural solution and the scope of services is expanding rapidly, with increasing payment parity with in-person visits.  Make sure your digital front door provides a clear entry point for your telehealth services, including options for virtual and eVisit, urgent care and primary care as well as capacity for services like behavioral health.

Immediately focus on freeing capacity or augmenting capacity of those staff most impacted by COVID while keeping an eye on your long-term strategy and how your organization will capture revenue from these services.  As for staffing, assess and engage providers that are comfortable practicing medicine via telehealth modalities.

One simple way to do this is to survey providers on their comfort engaging friends and family in casual digital texting and/or emailing regarding health questions.  Finally, look ahead and plan for how the evolution in telehealth can support patients and providers to coordinate care.

National standards for telehealth like provider flexibility, the ability to practice and see patients across state lines, greater reimbursement of family practice care, routine specialist appointments, and more flexibility with modality of choice may become standards in the future. Make sure your digital strategy takes this new omni-channel approach to care delivery into account.

Administrative support: Beyond extending access, there are many key moments of engagement with the patient journey that your digital front door can and should support.  In the short term, many health systems redeployed teams to support expected surges in clinical functions, leaving a need to backfill existing administrative roles.

Further, the effectiveness of patient service teams is diminished as they work remotely and are dealing with their own professional and personal life disruption.  Now is the time to double down on self-service tools of your digital front door and support the patient along their journey. Examples of opportunities that will pay off now and after COVID-19 include:

• Appointment reminders to limit no shows are more important than ever given the demand on providers’ time and the revenue shortfalls.
• Refill reminders can keep patients that are missing important maintenance visits stay current with their therapies
• Simple web and mobile payment options can support collection performance, especially for revenue cycle management teams that are dealing with the distractions and technical challenges of working remotely.
• Enhanced digital communications for after visit summary and health maintenance actions. As mentioned before, take this as an opportunity to collect preferences for how you deliver these communications.

Once this crisis ends, one of the lasting impacts across industries will be the rise in the digital delivery of services.  In healthcare, the growth and adoption of digital front door tools are an opportunity to expand and optimize how you engage and maintain the health of your communities.

With these solutions and programs in place, you can diversify care delivery options for your patients and insulate your organization from future disruption.