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How Healthcare Leaders Adapt to the Evolving Front Door to Care

by Chilmark Team | October 19, 2018

by Brian Eastwood and Paul Nardone

When today’s healthcare consumers have questions about their health, they are no longer limited to phone calls to the doctor’s office or visits to the emergency room. Technology has enabled and supported the creation of numerous new “front doors to care” – including but not limited to telehealth, chatbots, digital therapeutics, retail health, urgent care, and community-based clinics – that threaten to disrupt traditional care delivery models.

We recently interviewed two leaders at organizations leveraging telehealth to meet patients where they are and complement existing clinical workflows:

  • Joseph Brennan, Senior Director, MedNow at Spectrum Health
  • Chris Johnson, Vice President and General Manager, Landmark Health

Excerpts of these interviews appear below. They have been edited for clarity.

Briefly describe the solution or service you offer and how it opens a new front door to care for patients.

Brennan: MedNow is Spectrum Health’s direct to consumer (DTC) telehealth program. It has been in place for four years. It lets patients see a provider on their device for low acuity primary care conditions. Custom-building a mobile app that integrates with the EHR enabled us to enhance the patient experience and complement all of the other digital tools that Spectrum Health offers.

Johnson: We describe Landmark Health as a leading-risk medical group. We contract primarily with payers but can also contract with anyone who takes on risk. We focus exclusively on patients with 6 or more chronic conditions and are available to them 24/7/365 telephonically or in their home. We have physician leaders who take care of patients and are supported by interdisciplinary teams: Case management, behavioral health, pharmacists, dietitians, social worker, and non-clinical healthcare ambassadors who help build relationships with patients in between clinical visits and help them with education.

Was the motivation to adopt a solution that would open a new “front door to care” driven by clinical, financial, or operational needs?

Brennan: All of the above. The primary driver for us creating a great patient experience is that it is quickly becoming an expectation of patients who want convenient access to care. In addition, as healthcare transitions to value-based care (VBC), cost reduction is paramount.

Johnson: The hospital business model isn’t designed to provide longitudinal care of patients with complex conditions. We designed a model from the group up that could provide care for patients when they need it (24/7) and where they need it – in the comfort of their home. Patients with complex chronic conditions have a generally steady high medical spend year-over-year, so intensive longitudinal models to improve their long-term health work well. There are also psychosocial elements, including depression, dementia as well as addiction. This can be impacted by the interdisciplinary approach – specifically the incorporation social work and behavioral health – of our clinical model.

Hospitals state outwardly that they don’t want inappropriate hospitalizations. We are not taking away their core business treating patients in need of acute care.

How did you make the case for implementing a front door to care that has the potential to adversely impact another part of the business?

Brennan: Throughout development of our program, we were very conscious of cannibalization. Telehealth takes visits out of the emergency department and replaces it with something much less expensive. In preparing our health system for the future, we would rather get ahead of reducing healthcare costs than react to it. We need competencies in virtual care for the future and chose to build it now, rather than trying to catch up later.

Johnson: Hospitals state outwardly that they don’t want inappropriate hospitalizations. If there’s a readmission, they don’t get paid the second time, so we partner with them on discharge planning. Conceptually, they’re aligned. We are not taking away their core business treating patients in need of acute care.

Which stakeholders did you need to engage when first making your pitch – and who was the hardest to convince?

Brennan: We emphasized both clinical and operational benefits. Many health systems focus on one or the other; our strategy was to focus on both. The primary resistance came from physicians who were not convinced this was an appropriate standard of care. Four years into our telehealth journey, some physicians still don’t believe that virtual care is part of the future. We can attribute much of our success to the buy-in and support of executive leadership.

Johnson: We’re something that not a lot of people have seen before. It takes a bit of time to explain who we are and assuage fears that we will be competing for members with primary care physicians. We’re not a PCP, and we encourage strong relationships with a PCP. When we enter a market, PCP visits stay the same, or even increase a little bit. Once PCPs see the effects, they realize it’s really only a small number of their panel – and it’s usually the ones they find the hardest to manage, who have a lot of barriers to care.

When we are measuring the growth of our encounters, we are thinking of it as a convenient front door to the system, so it makes sense to measure how many people come through that door. Other important metrics include new patients to the system, cost savings to payers, avoided ED and Urgent Care visits, and patient miles saved.

What KPIs or other metrics are most important to measuring the success of your front door to care initiative? Are you focused on raising awareness, boosting business, or adding revenue?

Brennan: For us, it’s the number of encounters. With virtual care, the only way to scale is through increasing volume. When we are measuring the growth of our encounters, we are thinking of it as a convenient front door to the system, so it makes sense to measure how many people come through that door. Other important metrics include new patients to the system, cost savings to payers, avoided Emergency Department and Urgent Care visits, and patient miles saved.

Johnson: Our service significantly reduces the medical expense reimbursement for a patient and improves the medical loss ratio for that covered population – from north of 100% to something quite profitable. Health plans can take a segment of members that used to be challenging and bring it in line with the rest of their book of business. This allows our plan partners to keep premiums lows and invest in additional services for their members.

How does your new front door to care reduce the friction that often makes it difficult for patients to seek the care they need?

Brennan: First and foremost, it’s access. Our average wait time for a visit is 12 minutes and we are available 24/7. MedNow sees patients regardless of having a relationship with a Spectrum Health provider and we are available to everyone in the state of Michigan.  We have created a patient experience that is easy to use so that we can provide care where and when a patient needs it.

Johnson: The patients we serve often have frequent inpatient stays, or discharges to skilled nursing or post-acute care facilities. It’s often inappropriate and ineffective care; patients leave in worse condition than when they came in. If we can manage or control these patients more effectively prior to an incident, working with their existing PCP and specialists, we may prevent a hospital visit and stabilize longitudinal health.

What do you think will be the most disruptive front door to care in the next 3-5 years?

Brennan: It’s the digital health ecosystem. Similar to Google’s digital ecosystem, it is a suite of products, not just one tool.  We will get to a point where the expectation of patients becomes that health systems will meet their needs digitally like other industries, such as banking and commerce.

Johnson: For us, it’s literally the front door. Our mission is to bring healthcare to people when they need it, where they need it. It’s simple but profound. It also allows us to bring family in. A lot of the barriers to care are around families and education and getting people on the same team. We have clinicians who can build great care plans, but also think through the barriers to care and how to ensure the patient can follow that care plan. “How can we implement this? What are the barriers? What is the family alignment that we need?” Being able to do it in the evening, on the weekend, allows us to have better conversations.

A version of this blog first appeared on the Convergence 2018 blog on September 27, 2018. 

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