Gabriel Perna | March 13, 2020
The coronavirus pandemic may force health care organizations to face a crisis that will feel unprecedented in terms of scale and overcapacity. This isn’t verbiage meant to scare people, it’s a reality in Italy and could be an American problem very soon. For health care organizations, this means long-term innovation plans are becoming immediate strategic initiatives.
As they say, necessity is the mother of invention.
Interestingly, for leaders at Providence St. Joseph Health in Washington state, which was the first system to treat coronavirus patients in the U.S., it’s an example of history repeating itself. The Catholic Sisters who founded and operated St. Joseph Health vastly expanded the health care organization in response to the Spanish Flu pandemic of 1918, which killed 50 million people worldwide.
“They built hospitals all across California. That’s when they started, during the Spanish flu epidemic, because there was no other service for those patients,” says Sara Vaezy, chief digital strategy and business development officer at Providence St. Josephs Health (PSJH). Aaron Martin, chief digital officer at PJSH, adds that the organization is once again expanding its capacity to reach patients, this time through virtual innovation in response to coronavirus. “We’re drawing inspiration from the stories of heritage. Pioneering woman who did incredible work,” he says.
PSJH, like any health care organization right now, is figuring out how to deal with the coronavirus pandemic as it changes in real time, innovating in rapid speed and trying to keep patients and the public at large as safe as possible. Martin, who spoke with Health Evolution a few weeks ago about its massive plans for AI, says that many of these technologies have been moved from long-term business plans to immediate implementations. From a multiyear strategy to a 10-day plan.
Across, the board—providers, payers and other stakeholders—are working to immediately meet the increasing demands and capacity that is being caused by coronavirus. Health Evolution spoke to a few organizations who shared strategies. Here’s what they had to say.
Providence St. Joseph Health
At PSJH, Martin and the digital team leveraged its investments into chatbot capabilities to create a self-triage tool. This technology helps potential coronavirus patients give a self-assessment that will determine next steps to take if they think they have the virus. The system also has reoriented and scaled up its virtual telehealth platform, Express Care Virtual, to be able to accommodate an increasing demand.
Both these platforms aim to treat patients without having to expose them to the virus in the hospital and potentially increasing the problem, particularly if there’s no need for them to come in. It also aims to ease the anxiety of patients. In a short time, it’s become clear that patients are responding to the need, says Martin.
“When we deployed the [telehealth] technology on Monday [March 2nd], we saw a 6x jump day-over-day in the usage of it,” he notes. The chatbot/triage tool has seen a heavy increase in usage as well, since it was made available on Sunday [March] 8th.
For PSJH, it’s a matter of fortune that the organization was willing to invest in AI and these technologies a few years back. This isn’t what the organization expected, but it’s glad to have the capabilities regardless.
“These investments were made to mitigate disruption. We were always thinking about business model disruption with respect to the new entrants into health care and the competition for a better consumer experience. That was what this technology was built for. It turns out an even bigger disruptive force is coming in and that’s Covid-19,” Martin says.
Working the round clock
For the past two weeks, Martin’s digital team has been essentially working around the clock to rapidly iterate this technology and support caregivers on the frontlines. It’s been important to have a solution that can not only scale fast, but change and adapt quickly, says Maryam Gholami, Chief Product Officer at Digital Innovations at PSJH. As information and workflows around the coronavirus change, the self-triage and virtual care tools must adapt as well.
“The objective is to get as many patients as possible reliable information about their health status as quickly as possible. How are we configuring the technology to reach that objective? The objective is not to increase the number of virtual visits, we want to increase the number of virtual visits to yield someone who has a problem. We’re trying to conserve capacity. The function of a triage process is when someone needs to be seen, in a clinic or the ED, we got them there correctly and their health status justifies that,” says Martin.
The technology, especially the triage tool, is a work in progress. Gholami says there is a structured chat format that they are working to make it a more open chat functionality, where patients don’t have to ask specific questions to get answers. She’s also looking at how to improve the technology and user experience. “The lesson for me is that it can come and we have to be better prepared. How do we think ahead of these epidemics? From a tech and product standpoint, I’m thinking about how we can be better prepared for a disaster,” she adds.
Martin says being proactive and having technological capabilities isn’t the only lesson he has learned from this experience. He also has seen the benefit of investing in top-tier talent as well. “We’re really lucky we have the technical and clinical teams in this region where this thing unfortunately started in the U.S.,” he says.
In Michigan, Spectrum Health is also relying on virtual care to treat patients and preserve capacity for the coronavirus pandemic. Darryl Elmouchi, MD, CMO of Spectrum Health System, and President, Spectrum Health Medical Group, says the organization has had a virtual care program for years and realized it would be a good way to deal with the likely increasing onslaught of concerned patients. Like PSJH, Spectrum wanted to ensure those not seriously ill were not exposing themselves to coronavirus by needlessly going to the hospital or an urgent care clinic.
Aaron Martin, Providence St. Joseph Health
“Within a matter of days, we were able to stand up a virtual screening program where a person can call a hotline and get instructions on how to download our app and set up a virtual appointment, usually shortly thereafter. Then one of our providers would have a virtual visit can screen them for symptoms and screen them for exposure that would put them at higher risk. And then after that, we can refer them to the appropriate level of care,” Elmouchi says.
The screenings are free for the public, which Elmouchi says was one of the biggest potential barriers they saw occurring—they foresaw many patients not wanting to pay for the service. One of the lessons they’ve learned in this crisis is the virtual screenings program is a safe, effective way to care for patients and could be used for future issues.
“We have had this virtual capability for many years and we’ve recently, in the last six months, began planning a significant expansion to convert a huge percentage of our primary care and outpatient visits to be virtual. But we never anticipated this. Some people may say, ‘No good crisis should go to a waste.’ Within a matter of days, we went from thinking this is a good idea to standing it up. It never would have been done as quickly if there wasn’t such a huge need,” Elmouchi says. “Obviously we never would have wished this situation was here, but it helped us to do this quickly.”
As for the role payers play during an outbreak such as coronavirus, Blue Cross Blue Shield Association Executive Vice President and CFO Bob Kolodgy said they all should be working to supply timely and accurate information to members, employees and the general public.
“That means removing any barriers to care and working hand-in-hand with federal, state and local governments on a daily basis,” Kolodgy said.
Kolodgy explained that the 36 BCBS entities comprising Blue Cross Blue Shield Association’s network waived prior authorizations and increased coverage for “appropriate medically necessary diagnostic testing for COVID-19,” at no cost to members,” when it is not covered as part of the Public Health Service response.
“We will also support the broader health care ecosystem to assure sufficient capacity to handle what might be ahead” Kolodgy added.
Ricardo Johnson, senior director of Healthworx at CareFirst BlueCross BlueShield, said that the payer—like Kolodgy and others have advised—is removing barriers to care, ensuring there are no fees related to testing. He also said they’re educating employees and members about protecting themselves from the threat of infection.
Virus shines a light on virtual health
The first week in March was a record-setter in terms of the numbers of people accessing services from the on-demand mental health company Ginger, to say nothing of the rise in COVID-19 related searches the firm found, according to Ginger CEO Russell Glass.
“it’s hard to differentiate the causes specifically of the uptick we’re seeing, between COVID-19, the financial markets, and the 2020 election cycle, but all of that has led to significant increases of 16 percent for sessions and 10 percent for daily users,” Glass said.
Glass added that Ginger has seen similar spikes in the past, such as the day after the 2016 Presidential election, and high-profile suicides of Anthony Bourdain and Kate Spade.
Although Ginger does not — at least not yet — have a dataset with which it can compare COVID-19 to previous pandemic outbreaks and forecast a likely course for this one, Glass said the CEOs should recognize the significant physical and mental stress and anxiety loads the novel disease is putting on employees. CEOs and other leaders should also be vocal about supporting their workforce and community. And as more and more organizations practice social distancing, working from home and reduced travel, it’s equally important to be aware of the additional stress and isolation those tactics can cause.
“I suspect we’ll continue to see increased outreach,” Glass said. “This one feels more sustained and more universal.”
Tom Sullivan contributed to this article