– For some time, the business and technology teams at the Southern California-based MemorialCare had been planning a big technology and overhaul in its ambulatory facilities. This project, slated to take about three years, really focused on patient engagement technologies to ease patient access to care and deliver on value-based care priorities.
“As a health system, our big focus has been on delivering value-based care,” Kevin Davidson, the vice president of business development & strategic services at MemorialCare, told PatientEngagementHIT. “We’ve long been trying to look for ways to make sure patients are getting the right care they need when, where and how they need it.”
This approach was largely going to center on technologies outside of video visits, meaning the asynchronous tech interactions patients have with their providers and vertical triage.
That approach makes sense. After all, up until recently, telehealth was only getting a tepid response from patients. In August 2019, two-thirds of patients said they were willing to try telehealth, but only 8 percent were actually following through on that.
But like so many healthcare organizations across the country, the COVID-19 pandemic forced Davidson and his team at MemorialCare to change course. Panic surrounding the disease spread pushed Davidson to consider traditional telehealth video visits as the organization geared up for a massive national response to the pandemic.
In anticipation that patients may be less willing to go out into public — in fact, anticipating similar lockdown procedures popping up in similarly developed nations — the team at MemorialCare stood up their video visits quickly by March 18.
“We knew we needed to be well positioned to be able to take care of our patients and make sure they had timely access to care,” Davidson said.
That quick turnaround ended up coming just in time. By March 19, California Governor Gavin Newsom had announced a shelter-in-place order for the state. Having the telehealth strategy in place by that point allowed the team at MemorialCare to keep its promises to deliver value-based and patient-centered care to its healthcare consumers.
That care included not just primary care or chronic illness check-ins. Importantly, the virtual care model allowed MemorialCare to conduct screenings, an essential service line considering the number of patients growing concerned they may have the virus.
But as much promise as this telehealth program showed, Davidson and his team were still wary of the approach. Like patients, providers hadn’t wholly bought into telehealth, largely because they harbored concerns that in-person care would be more efficient and the technology may be difficult for patients to operate.
“We had a lot of concern. Initially, when we were rolling this out, we were thinking about how we make sure patients are prepared and ready have the technology that they need, but also just have to know how to navigate and troubleshoot on their own,” Davidson said.
In other words, MemorialCare needed to ensure they had the right systems in place and adequate instructions to enable patient use, but they also knew they could do everything right and technology issues could still crop up.
“Sometimes video works out and sometimes you have technical challenges that you can’t quite quickly decipher,” Davidson acknowledged. “So a big part of it is we really thought to make sure that we prepared patients if something went wrong.”
MemorialCare armed its clinicians with a set of strategies to help walk a patient through a technology hiccup, like recognizing if a patient or themselves are on mute. Clinicians were also instructed to try and call the patient if the video froze so they could assist the patient through troubleshooting.
Additionally, MemorialCare worked to avoid care quality issues by first conducting telehealth visits for patient cases that lent themselves particularly to the technology. In doing so, the provider and patient had an easier time adjusting to the care delivery method, which allowed the provider to fine-tune her telehealth communication skills.
“Our staff proactively reached out to patients who we thought were good candidates for a virtual visit,” Davidson said. “We actually started by combing our schedule to identify those things that could be dealt with via video and then reached out to those patients to educate them about the technology and make sure that they were prepared and ready for their visit.”
By and large, MemorialCare providers found that their concerns didn’t manifest. While not every visit has been perfect, the health system has experienced the changing tide of patient experience expectations that offer a little grace to providers working to deliver care.
“It’s been pretty remarkable how quickly people have embraced the technology,” Davidson said. “Sometimes patients will lean on someone in the home or a caregiver who may be a little more tech-savvy than they are but for the most part, our patients have been eager and happy to have this as an option.”
“Patients have been remarkably tolerant of small issues and maybe having to troubleshoot a call if it’s not working correctly,” Davidson added. “There’s a high tolerance when you’re really doing the right thing for the patient.”
And it’s not just the patients who are satisfied with the transition; the providers like telehealth, too. As noted above, MemorialCare clinicians had their apprehensions about the pivot to virtual care, something Davidson largely credited to the normal nerves that come with a widescale change.
In anticipation of that, Davidson and his team were sure to follow the cardinal rule of change management: keeping in touch with those affected by the change. In this case, that was the provider.
“A lot of times when you’re rolling out new technology one of the points of resistance you have is just a general nervousness about changing,” Davidson said.
“A big part of what has helped us succeed is really regular check-ins. During the heightened period of COVID response, we were having daily huddles with our clinical care teams. We had an all-provider call that we held every day for several weeks dedicating time to coaching and reminding our providers how to navigate the care experience.”
All said, MemorialCare went from conducting zero telehealth visits to nearly 1,400 in its first week with the technology; by the end of May, it had completed a total of 25,000 telehealth visits.
And as MemorialCare has continued its telehealth care delivery, it has slowly pivoted away from emergency COVID-19 response and management and more toward chronic disease management and re-engagement.
“Initially we thought telehealth was going to be a way to manage the surge,” Davidson noted. “But we didn’t quite see the surge in Southern California that we were expecting. It’s actually been a really helpful tool for keeping close to the patient and making sure that they have supportive care, even from home.”
Ultimately, this ideally helps keep chronically ill patients, those at highest risk for COVID-19 infection and complications, out of the hospital and the emergency department.
Moving forward, Davidson anticipates utilizing other remote patient monitoring and care management tools as part of the digital care strategy.
After all, that three-year mission toward virtual included far more than just telehealth.
For example, MemorialCare has also rolled out its virtual triage, which uses artificial intelligence to chat with the patient, decipher potential COVID-19 symptoms, and refer that patient to the appropriate cite of care.
This came out alongside the virtual visits to help funnel patients toward telehealth except when serious, acute conditions arose. Moving forward, Davidson and his team plan to expand this use to other clinical conditions.
“The other piece is asynchronous visit,” Davidson added. “Video is a great modality and it’s been really well embraced. Patients really like being able to see their doctor and have that face-to-face conversation, but it’s often not always a preferred method.”
Sometimes a patient may not be able to hop onto a video visit, like if she has returned to work. Perhaps her health need can be addressed through a secure direct message or phone call. Rolling out the technology needed for these asynchronous visits is on the horizon for MemorialCare, as is remote patient monitoring technology.
These plans may seem big, but if there is one thing Davidson and team have learned in the COVID-19 response, it is that healthcare can deliver on these goals when they are forced to.
“We often plan these really intensive, large, detailed technology solutions and put a lot of time and energy into development,” Davidson noted. “One of one thing that struck many of us is we do have the ability to move fast when we need to. That’s been eye-opening in terms of our ability to really quickly deploy technology, even if it maybe isn’t perfect at first.”
In order for MemorialCare to continue down this path, it is going to need support. Reimbursement for telehealth and other remote care options has always been a sticking point for implementation. Although both public and private payers have revamped their payment models for these tools to enable better patient access in the wake of COVID-19, more work is needed to support continued use.
“There have been a lot moving around in the reimbursement landscape and honestly one of the biggest challenges probably for us in the first couple of weeks was just keeping up with all the requirements for payers around,” Davidson concluded. “How to bill and how to submit claims, and there’s there still seems to be a lot of differences in what various payers are asking for. We’re really advocating for more parity across health plans and payers just to make it easier for us and for other providers to sort of be able to navigate that part of the process.”