Engaging patients and communities virtually

Today, ease of access is expected in every aspect of our lives. From the time we wake up each morning, we have immediate access to technology, whether that’s giving a voice command to open the shades in our bedroom, setting a timer to brew our morning cup of joe or simply bringing up news and weather on our smartphones. Why would we expect less in clinical care?

Yet patients are often left wanting more, according to Craig Cordola, FACHE, executive vice president and chief operating officer, Ascension, Austin, Texas. When they arrive at the doctor’s office, “we throw them back 20 years and ask them for a paper version of their insurance card, we give them a stack of paper to fill out so that we can go copy it on a copy machine,” Cordola says. “The dichotomy of what those two worlds looks like right now is real … so how do we accelerate the technology to better impact patients and families?”

That question is what Ascension has been attempting to answer since it opened its Good Health Solutions Center in November 2017 in Austin, Texas. As Cordola expresses, Ascension wanted a single facility where it could expand the reach of its providers to help improve care and access, along with instituting new models of care. The facility has 350 full-time employees, and Ascension is in the process of doubling its physical size, from 30,000 square feet to 60,000 square feet.

Ascension focuses on connection through virtual care with a focus on the Triple Aim of improved individual care, improved population health and lower healthcare costs. To achieve this, the largest nonprofit healthcare system in the United States engaged patients and communities and identified opportunities to reduce waste. According to Cordola, the organization’s scope of work is divided into three buckets:

1. Hospital support services and clinical surveillance: integrated communication platform, eSitter, ePharmacy, telemetry, transfer center.
2. Patient access and experience: clinical call centers, transitions of care, continuity of care, ED attachment.
3. Virtual care and remote care: care coordination/navigation, direct to consumer urgent care telemedicine, telemedicine-neuropsychology, virtual provider office, remote patient monitoring.  

Cordola points out that the three buckets serve to help reduce time patients spend in receiving care while reaching more patients efficiently. “Patients and providers can save time because we are working behind the scenes to coordinate this,” Cordola says. “We have staff who are care coordinators doing all of the prework so that it’s teed up for that patient to meet the doctor as if they were walking into an exam room.”

Through the use of telemedicine, digital clinics and remote monitoring, Ascension can provide additional care options to its patients.

Telemedicine

To take part in Ascension’s telemedicine program, patients have to visit a facility, such as a doctor’s office, hospital, ER or skilled nursing facility. Once there, patients have access to real-time, HIPAA-compliant and encrypted audio-video consultations with specialists, which reduces travel time and time spent waiting. This produces “speed-to-value” for clinics and hospitals.

In addition, Cordola notes that physicians don’t have to do any prework. “It’s where all of the patient registration, the access, the insurance, the payment, the virtual waiting in line happens until such time the physician can engage with the patient in real time,” Cordola says.

Digital clinics

Through a HIPAA-compliant app, Ascension also provides patients access to its digital clinic to address minor illnesses and provide injury care. Patients can upload photos, take part in conference calls with providers and get help throughout the process. For patients, the digital clinic offers:

• Convenience: Patients don’t need an appointment and can access quality care through the use of their mobile device, tablet or computer.
• Affordability: Depending on the patient’s insurance, an urgent care visit could cost twice as much and an ER visit eight times as much than a trip to the digital clinic.
• High-quality care: Experienced providers assess non-emergency medical health conditions and prescriptions are sent directly to the patient’s pharmacy.

Ascension currently offers virtual care programs in such specialties as behavioral health, dermatology, cardiology and urology.

Remote monitoring

Ascension provides patients with an easy-to-use kit that makes it possible for providers to remotely monitor patient health data, receive patient alerts and easily connect with patients through the use of video conferencing. Benefits for patients include: 24/7 monitoring, measurable results, easy-to-use technology, access to care management, better patient experience and affordability.

“We have measurable, actionable results on our patients that we see in real time,” Cordola conveys. “This isn’t pulling data and looking back 30 days; it’s literally sitting at a monitor and seeing what’s happening with that patient right now and being able to intervene.”

Impact of virtual care

Ascension’s virtual care program has been an integral part of the health system’s success. Some key statistics include:

Quality, safety and service

• Reducing the congestive heart failure readmission rate in remotely monitored patients versus non-managed by 90%
• For patients receiving a post-discharge call, 50% improvement in HCAHPS scores
• Medication reconciliation error reduction.

Growth

• 800 patients managed through remote patient monitoring
• 500-plus engaged members in diabetes prevention programs
• 20 active telemedicine specialties
• Six specialty digital clinics
• 7.5% escalation rate to a nurse navigator during care transition calls.

Efficiency

• Thanks to consolidation and centralization, $6 million reduction in operating budget
• $600,000-plus savings through eSitter program
• $400,000-plus annual savings for diabetes prevention program participants
• Technology rationalization and standardization.

Beyond doubling the size of its facility in Austin, Ascension plans to build three or four virtual care centers to support its other facilities throughout the country. As Cordola says, Ascension will “learn, find out what works, find out what’s possible and then expand and scale that in other locations.”