Posts

Medical University of South Carolina Helped Patients with Free Virtual Visits During Hurricane Florence

Medical University of South Carolina logo

At Zipnosis, we talk a lot about clinical efficiency, quality, and reducing unnecessary visits to the ER for simple conditions. And these are all valuable outcomes of launching a virtual care platform. What is incredibly meaningful, however, is hearing how our customers deploy virtual care to help people in communities where there are particularly challenging situations. This is exemplified by one of our newer customers, Medical University of South Carolina (MUSC). When hurricane Florence was recessed out in the Atlantic, MUSC made the swift decision to offer South Carolina residents free virtual visits during the storm.

Free online visits in the aftermath of natural disasters aren’t a new thing – for big companies. Many of the major consumer-facing telemedicine service providers have offered free visits following some of the big hurricanes that left people stranded and unable to reach their doctors. But I believe MUSC’s fast actions signal a new phase in how virtual care can be used for disaster relief.

During the storm, patients who needed assistance with common conditions had access to care from their trusted, local providers. And providers could easily care for patients with common conditions in a fraction of the time, leaving them free to care for more complex or urgent cases face to face. MUSC even used their newly-deployed phone service to help current patients receive medication refills. And, because the virtual care platform is integrated with the EMR, patients’ records remain complete.

During the course of the storm, approximately 80% of MUSC’s more than 150 virtual visit patients throughout South Carolina used promo codes to receive free online care. These patients had health concerns ranging from upper respiratory infections and bronchitis, to bladder infections, to asthma inhaler refills.

According to Dr. Ed O’Bryan, Chief Medical Officer, Business Health at MUSC, “Conditions like bladder infections or bronchitis don’t wait because there’s a hurricane. Patients who weren’t able to come in due to flooding – or even evacuation to other parts of South Carolina – could get treatment easily.”

This deployment of MUSC’s virtual care platform highlights why many of us at Zipnosis come to work everyday. As our CMO, Dr. Lisa Ide says, “We are about more care for more people.” I’m proud to support and work with an organization like MUSC that is so clearly dedicated to supporting their community.

Healthcare’s STD Infection Crisis – How Virtual Care Can Help

Last week, the Centers for Disease Control and Prevention announced that rates of chlamydia, gonorrhea and syphilis in the U.S. climbed for the fifth year in a row. The newly released data prompted a call for federal intervention at the 2018 STD Prevention Conference. This begs the question, how did we get here? And more importantly, what can we do about it?

STD Infection by the Numbers

In 2015, the American Sexual Health Association noted that rates of chlamydia, gonorrhea and syphilis reached a record high. And they’ve kept growing from there.

Preliminary CDC data from 2017 shows a 31% growth rate in diagnoses of these three common STDs since 2013. Individually, diagnosed cases of gonorrhea increased 67% and syphilis 76%. Chlamydia didn’t see quite the same rate of increase, but it remains the most common of these conditions with more than 1.7 million diagnosed cases in 2017.

Candy Hadsall, RN, MA, a prevention nurse specialist with the Minnesota Department of Health was at the conference and noted that the data wasn’t particularly surprising. “The CDC’s announcement that STD infection rates climbed again in 2017 just confirmed what we’re seeing in the field,” she said.

These numbers present a concerning – and initially, more than a little baffling – trend. After all, each of these infections is curable with appropriate antibiotic intervention, and the long-term effects of going untreated can be serious. So, why are infection rates continuing to grow?

The Root of the Problem

The factors influencing the increase in infections are complex and varied. A 2007 study in Sexually Transmitted Infections found an abundance of socio-demographic influences on infection rates, including race, income, gender, state of residence, age and history of incarceration. It also notes that attitudes toward sexual behavior and STD testing are prime factors in the diseases’ spread.

In the CDC’s recent announcement, Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention noted, “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

At its core, the STD infection crisis is driven by this combination of attitudinal, demographic, economic and healthcare infrastructure influences.

Virtual Care’s Role in Fighting STD Infection

One of the best ways to stem the tide of STD infection is by reducing access barriers to testing and treatment, and here is where virtual care shows its value. The ways that virtual care can help patients overcome common barriers to care like geography, time and cost is well-documented. When it comes to sensitive issues like sexually transmitted diseases, virtual care can help mitigate emotional barriers, as well.

In an interview with MedCity News, Geri Lynn Baumblatt (then of Emmi Solutions from Wolters Kluwer Health) noted that patients tend to “engage in impression management” when seeing their doctor. What that means is, they try to paint themselves in the best possible light – consciously or unconsciously – in an attempt to avoid judgement and shame. While Baumblatt was speaking specifically about addiction concerns, this concept translates to sexual behavior. A solution that doesn’t require a face-to-face discussion can often produce more honest answers about sexual behavior and STD risk.

Hadsall concurs that the feeling of anonymity could help patients overcome the shame and stigma associated with STD infection. She also notes that adequate resources are a challenge in STD screening. “It’s just not possible to effectively screen everyone who should be screened,” she said. “Even at very high infectivity rates of 10-15%, that’s still 85-90 out of 100 people who are screened and test negative. With an online screening option, we could do a lot more and potentially make a real dent in STD infections.”

A Virtual Solution

Image: Stop STD Infection

Understanding the value of lowering barriers to STD testing and treatment, we developed evidence based protocols to support health systems as they work to manage steeply climbing STD rates for their patient populations. Our expedited partner therapy protocol enables patients whose partner has been diagnosed with chlamydia to get treatment. As the most commonly diagnosed STD across the country, and the one that is most frequently asymptomatic, this facilitates quick, discreet care for patients – without even requiring a test. By lowering barriers to receiving care for known chlamydia exposure, health systems can help reduce the continued spread of chlamydia.

We also recently created an evidence-based virtual care STD testing protocol that gathers risk assessment data and enables patients to access lab tests for chlamydia, gonorrhea and syphilis. This protocol leverages lab integration workflows to capture patient information and seamlessly route them to a lab location for testing. Our aim is to help health systems use the asynchronous patient interview to overcome the embarrassment patients feel talking about STDs, potentially increasing the likelihood of individuals to seek testing.

The continued rise of STD infections is a complex issue, impacted by everything from socio-cultural norms to poverty rates and education to healthcare access. It may feel overwhelming, but looking at individual pieces can still make a sizable impact. There are many factors virtual care can’t impact. What we can do is help take the strain off of the systems currently unable to manage this growing health crisis and lowering barriers to STD testing and treatment.

What Does Access Really Mean?

Working closely with our customers, I hear over and over that patient access is a key strategy and reason for launching virtual care. Taking a cue from our health system customers, we talk a lot about virtual care’s ability to expand and facilitate access to care. But what does that really mean? Who benefits from the expanded access that virtual care provides?

Meet Kate

One of the things I find really refreshing about working at Zipnosis is that we don’t stop at thinking about what our health system customers need. What I mean here is we’re also thinking about tMiddle Aged Telemedicine Patientheir patients. Who is using their virtual care platform? Why are they using it? What can we do to improve the experience for them?

We actually have well-realized personas covering several known users. The flagship persona is someone we call “Kate.” Kate is in her mid-30s, married with two kids who she chauffeurs  around in a late-model SUV. Kate works full-time and has insurance through her employer. She’s also the persona who drives our standard product demo – if you’ve ever seen the Zipnosis platform in action, it’s probably through the lens of Kate.

Recently, I began to think about Kate because access for her means something different than it does for a lot of the population. It’s really about convenience more than need. Kate could take time away from work, she could drive to see her primary care doctor for care, it’s just inconvenient to do so. But what it we took away Kate’s SUV, her employer-sponsored insurance, even her full-time job?

Meet Katie

Katie looks a lot like Kate on the outside. She’s also in her mid-30s with two kids, but instead of Kate’s SUV, Katie relies on public transportation. Instead of Kate’s employer-sponsored insurance, Katie has a high-deductible health plan that means she pays for most healthcare costs out-of-pocket. Instead of Kate’s full-time job, Katie works two part-time jobs and doesn’t have paid time off. What does healthcare access mean to Katie?

To answer that question, I gave myself an exercise: Put myself in Katie’s shoes and understand the decisions she needs to make when looking at where—and whether—to seek care for a common condition like a UTI. Here’s what I learned:

In-Person Care Options

I looked at 4 in-person care delivery options: A primary care clinic, an urgent care center, a retail clinic, and the emergency room.

Work Schedules

Working two part-time jobs without PTO, Katie needs to find time to go to the doctor. That may mean determining if she can afford to take time off of work, coordinating shift coverage with co-workers, or finding an option that’s open when she’s free. That means the hours of operation and when an appointment would be available are major factors in decision making.

Primary care: 8 am – 6 pm; appointment availability “tomorrow”

Urgent care: 7 am – 7 pm most weekdays

Retail clinic (average): Weekdays, 9 am – 7:30 pm; weekends, 9 am – 4 pm*

Emergency room: 24 hours daily

*Lunch hours: Practitioners take a daily, required lunch break each day. Please note that lunch time are approximate and may vary.

Transportation

Part of managing schedules is figuring out the impact of public transportation. Katie needs to factor in schedules and routes. Then, she needs to determine how much time she’ll need to spend in transit. Using my house as a starting point, I determined that transportation would take anywhere between 15 and 45 minutes each way, most of which required walking about ½ mile in addition to the bus.

Child care

If Katie needs to seek care outside of her typical working hours or when the kids are not in school, she needs to consider what to do with her children. Does she haul them along to the doctor’s office? Does she get a last-minute babysitter – and is that practical from a financial standpoint?

Cost

Finally, with her high-deductible health plan transitioning the full cost of care to Katie, how much will she have to pay out-of-pocket for each of her options? The data shows costs varying widely for services, but the following are pulled from a Blue Cross Blue Shield (MA) fact sheet on typical costs for common services and Consumer Reports:

  • Primary care: $130 – $180
  • Urgent Care: $120
  • Retail Clinic: $55 – $75
  • Emergency Room: $400 – $700

Access with Virtual Care

Imagine the impact a virtual care offering could have on Katie. Access to a virtual care service effectively eliminates the need to balance her competing priorities.

Work Schedules – With virtual visits available via any internet-connected device, Katie doesn’t have to worry about missing work.

Transportation – Katie can access virtual care anywhere, so transportation ceases to be a concern.

Child care – Katie can complete a virtual visit while her kids do their homework at the kitchen table, or while they’re playing at the park.

Cost – Unlike the more costly in-person options, most of our health system customers charge between $20 and $40 for a virtual visit, making it far and away the most affordable option.

With virtual care, Katie can quickly, easily, and affordably receive care for her UTI – without the stress and worry. Virtual care may well be working to bring convenience to the Kates of the world – and that’s no small thing – but our greater impact is in the benefit we bring to the Katies.

When it Comes to Virtual Care Technology – Think Twice, it’s Alright

More and more, health systems are looking to telemedicine and virtual care technology to improve access by connecting patients with clinicians. It’s no secret that providing care online is critical to remaining competitive and meeting patient demand. With online healthcare hitting the mainstream, health systems are moving faster than ever into the direct to consumer market. Sounds easy, right?

Don’t Get Stuck with Betamax

Let’s take a walk down memory lane to the early 80s. Video was busy killing the radio star, and two competing technologies were vying to be the king of video: VHS and Betamax. Ultimately, VHS won the videotape format wars, and Betamax technology (and tapes) disappeared from store shelves. The people who purchased Beta machines and video libraries were left with a choice: forgo video entirely until the next big technological advance comes along or purchase a whole new system and video library.

There was no real way for consumers in the post-disco era to hedge their bets about video technology. VHS and Beta were both expensive new technologies and were wholly incompatible. Fortunately, health systems moving into online care aren’t in the same boat.

Telemedicine is Today; What’s Tomorrow?

Traditional telemedicine tools, including video consultations, have been around since the 60’s, though they’ve only been available to patients for the past 10 years or so. Those tools definitely have their place. They enable patients and providers to connect in real time and are typically embraced by today’s high-value patients – people over 65 and those with chronic conditions. A recent Deloitte survey showed that those high value patients were significantly more likely to only use digital health tools to connect with their regular healthcare provider. But less than ⅓ of millennials would put the same restrictions around online care.

Similarly, baby boomers and the older members of generation X are more inclined to want a real-time, personal interaction with a healthcare provider. Overall, younger generations are less interested in a personal interaction and more interested in making the whole healthcare experience quicker and more efficient. That means that the high value patients of tomorrow aren’t as interested in video consultations or phone calls with their providers. So, how is a health system supposed to meet the needs of today’s patients and tomorrow’s?

Where do We Go from Here?

The optimal option for health systems looking to make a safe online healthcare bet is combining traditional telemedicine with transformative virtual care technology. This pairing gives health systems and their patients the best of both worlds: personal interaction through a real-time consultation and efficient virtual care. Working together, these access points create a digital “front door,” making it easy for health systems to provide the care individual patients need, when and how they need it.

Just like investing in a Beta machine was a safe bet for 1980 (it was developed by Sony, after all), investing in a traditional telemedicine solution alone is a safe bet today. It means you’ll be able to effectively help today’s patients with today’s needs. But true safety doesn’t lie exclusively in what consumers want right now – the safest choice is preparing for what they’ll want tomorrow, too.

Best Practices Guide to Virtual Care

Virtual Care in a Trump America: Making Care Great Again

So, there was this election last November. You might remember it or you might be trying to forget, but either way a new president was sworn in January 20th. Ever since the results were tallied, I’ve been inundated with a barrage of predictions for what the new administration means for the healthcare industry – in particular, for virtual care and telemedicine.

The one thing everyone can agree on is that with Trump in the White House, healthcare policy is going to change. So, what place does virtual care have in a Trump America?

No One Really Knows the Future

OK, it might seem kind of counterintuitive to say that after I just wrote about my forecasts for virtual care in 2017, but bear with me. Speculation about how lawmakers at the federal level approach healthcare policy can be well founded. It can be based on campaign promises (we all know how those go), party politics and previous voting records. But, our democracy is complex and unpredictable. And despite speaking Russian, I have no real insight into the policy direction the Trump administration will take with regards to healthcare.

Here’s What I do Know

While I can’t tell you precisely what legislative changes will come with the new Congress and President, I can tell you that there are macro-level trends in the healthcare industry that will continue to influence digital healthcare, telemedicine and virtual care, regardless of who’s in office. (Tweet)

And that’s where I can effectively make predictions. Like tiny snowballs starting downhill, the following trends have become avalanches in the healthcare mountainscape. Their momentum – more than federal policy – will be the major influencers of virtual care over the next several years.

The Transition to Value-Based Care Will Continue to Gain Momentum

Value-based reimbursement is here, and it’s here to stay. You can check out my post on Becker’s Hospital Review for a primer on value-based care and its impact on virtual care. Suffice to say, virtual care offers health systems a real means to cope with the changes the shift to value-based payment is producing.

Right now, value-based care is still gaining traction, but a number of factors make this shift inevitable. For one, healthcare costs are continuing to rise. Value-based reimbursement can help curtail those costs while supporting high quality care. A recently published study in JAMA found that using bundled payments for joint replacement decreased Medicare costs between 13% and 21% and produced fewer readmissions, emergency visits and prolonged hospital stays.

With insurers seeking to improve the bottom line and the move to high deductible health plans (HDHPs) and health savings accounts (HSAs) leaving patients paying more out-of-pocket, the transition to value-based care is only going forward.

Predicted Primary Care Physician Shortages and Patient Access Remain Challenges

Back in 2013, the Health Resources and Services Administration predicted a primary care physician shortage of more than 20,000 by 2020. Just this past year, the American Association of Medical Colleges issued a report projecting a shortfall of between 14,900 and 35,600 PCPs. This report went further and noted that if all barriers to care were removed, the U.S. would need an additional 96,000 doctors to meet patient needs – today.

All signs point to the population expanding relative to the number physicians available, meaning that improving patient access to care is only going to be more important going forward. I anticipate virtual care – with its increased clinical efficiency – is going to be a critical piece to solving these challenges.

Patient Demand for Virtual Care isn’t Going Anywhere

In our infographic, Virtual Care by the Numbers, we outline how patient demand for virtual care is impacting the industry. Some of the highlights include 76% of patients rating access over in-person care, and 62% of patients stating they’d be willing to replace an in-person visit with an online visit.

This demand is only going to increase as technology becomes more embedded in people’s lives.

People are Increasingly Spending Their Time Online

So, show of hands: Who has a Facebook account? Twitter? LinkedIn? Instagram? How about Netflix or Hulu? The world is more digital than it was even a few years ago. We shop, access entertainment, and even build and maintain our friendships and business relationships online. According to the Pew Research Center, 38% of all adults’ primary news sources are online – a number that goes up to 50% between the ages of 18 and 49.

This shift to a virtual world is only going to grow as more and more resources are available via digital channels. And, this holds true for healthcare, as well.

Virtual Care’s Place Going Forward

These trends may have started as a tiny shift in the snow cover, but they’re full-blown, unstoppable avalanches now. While I can’t predict policy, I feel confident that moving forward, virtual care has an important role in helping health systems and patients deliver and receive care as the landscape changes.

You Say Access, I Say Convenience

The big argument for telemedicine is that it will improve access to care. But is access what consumers really want?

If providers think about telemedicine as just another channel for giving patients access to their services, they’re missing the bigger picture. When it comes to meeting consumer expectations, traditional health systems and physician clinics aren’t competing against other providers, they’re actually battling Amazon, StubHub, Netflix and every other service that customers already love and rely on.

Amazon just launched “Amazon Prime Now” in the Twin Cities where I live. Do I need day-or-night two-hour delivery for household items and groceries? Probably not, but the convenience blows my mind. I had a similar feeling when I discovered recently that I can use an app to feed my parking meter by our downtown Minneapolis office. Whether it’s the ability to binge-watch entire seasons of TV shows on Netflix or listen to almost any album ever recorded on Spotify, consumers are now primed for (nearly) instant gratification.

Healthcare still operates under a different set of expectations. Patients are viewed as a fixed population with few options for seeking care. Telemedicine and other virtual technologies theoretically expand those options. Coming from a traditional system in which access is tightly controlled, many providers I meet still see new technologies like telemedicine or virtual care either as a threat to their existing delivery model or a cumbersome add-on. I argue that they should view consumer-facing technology platforms as an opportunity to access patients in ways that those patients already expect in other areas of their lives and will increasingly demand from healthcare, too.

Here are three benefits healthcare providers can realize when they leverage a workable telemedicine strategy to do a better job providing patients with service they will value.

  1. Add new patients

If you ask people what telemedicine looks like, they describe a patient sitting in front of a computer screen talking to a doctor. When’s the last time you ordered anything on Amazon that way? Never. We do it by app when the need arises.

What would that sort of convenience look like in healthcare? It may be hokey but I picture a parent in his or her minivan initiating a doctor visit for the kids while waiting for them to finish some after-school activity.

Telemedicine strategies that force patients and doctors to meet through a screen are awkward interruptions of our lives. But if you can devise a system where patients can initiate a visit by app, and then direct them to a physical healthcare location, e-visit, or virtual diagnosis as needed, you’re helping them manage their care conveniently like they manage every other aspect of their lives.

In our data, we’ve observed that over 50 percent of patients who use this sort of approach are new to that particular health system or provider network. In other words, technologically savvy patients are migrating to convenient access points. And once they’re hooked on that ease, they tend to rely on that healthcare provider for the plurality of their care.

  1. Provide care in the right place at the right time

As value becomes a priority over volume, providers are being forced to develop strategies to steer patients away from higher cost locations like urgent care or primary care facilities. We’ve noticed that around 60 percent of patients who use virtual care services would have gone to urgent care or primary care facilities instead if they hadn’t had a virtual option.

Employers love virtual care because their employees can receive care when and where they need it without undue expense or disruption to their work lives. Patients love it because it puts an end to the age-old waiting room question, “Why am I here?” We’ve all experienced the frustration of sitting endlessly in a waiting room for a diagnosis or course of treatment when we already know exactly what we need.

And physicians appreciate the opportunity to have meaningful visits for challenging problems rather than cramming their day with patients who could be treated faster and easier elsewhere.

  1. Avoid “stealage”

The big retailers and pharmacy chains are making a major competitive push for the patients of traditional health systems and provider networks, and they have some big advantages on their side. They already understand customers well and are used to delivering compelling value. What’s more, nearly everyone in the country lives only a few miles from a Walgreens, CVS, or Walmart making it very convenient to shift toward those pharmacists and walk-in clinics.

Providers can combat those advantages if they move quickly. Patients still see health systems and traditional physician clinics as the best source for care. If you counter the convenience factor with a robust virtual care strategy rather than just building e-visits into an EMR, you can retain or recapture patients otherwise inclined to stray. Patients would still prefer to meet the totality of their needs in one system.

The future is fast upon us

Consumers and clinicians expect technology to make things easier and faster. Healthcare is lagging in providing people what they need and want when it comes to convenience, ease and value, not because the technology isn’t there but because managing change is hard. Yes, traditional processes and payment models are burdensome legacies to fight through but customers and clinicians are going to gravitate quickly to better options. You really have a limited time to figure out the right strategy to keep them happy and committed. Start by thinking like a consumer and find partnerships and services to build the capabilities you need.

Resources

Calculator: Patient Acquisition Revenue

  • Offering virtual care can help you add new patients to your health system, where allowed by regulations. Answer a few easy questions and discover your potential revenue impact of patient acquisition through virtual care!
  • Enter a number between 1 and 100 - no % necessary. Independent research indicates a 25% conversion rate of virtual care users to health system patients.
  • Logic

    Back End Calculations

Webinar: Launching and Scaling Virtual Care with Ascension Wisconsin

Ascension Wisconsin Webinar: Launching and Scaling Virtual Care

William Brazeau, Virtual Care System Director at Ascension Wisconsin, shares Ascension Wisconsin’s first-hand experience launching and strategically growing their virtual care service line. William provides insight into why and how Ascension Wisconsin launched virtual care, optimization of their virtual care service offering, and Ascension Wisconsin’s virtual care service results.

    (Don't worry–we hate spam, and won't send too many emails.)

eBook: Best Practices Guide to Virtual Care

Best Practices Guide to Virtual Care

Health systems across the nation are increasingly deploying virtual care strategies to complement current access points to care. But why? Research indicates that virtual care and telemedicine services will continue to grow as patients increasingly choose online and mobile delivery for their healthcare needs.

Through our years of working with leading health systems across the country, we know the questions a crowded marketplace can raise. We’ve developed a guide to help you understand the different virtual care models and illustrate the impact of these services on your health system.

  • Understand environment and define strategic objectives
  • Determine business model and mode of care delivery
  • Identify organizational stakeholders and assemble team
  • Create an internal cadence of accountability
  • Ensure ongoing training and support mechanisms are in place
  • Craft a continuous marketing and communications plan for new and current patients
  • Develop roadmap for technology integration and service scaling

    (Don't worry–we hate spam, and won't send too many emails.)