On June 17, HC3 hosted the second of a two-part event series focusing on Safe Return to Care as part of HC3’s ongoing Transformation series. During this Navigating the New Normal event, organized in collaboration with Jarrard Inc. and Radiology Partners, local health care leaders discussed how they are examining and applying data to organization and business strategy; developing solutions to consumer access challenges; deploying telemedicine, home-based, and micro-site models of care; and adopting other solutions to navigate care delivery and rebuild patient trust in a post-COVID world.
David Shifrin, Content Marketing Manager, Jarrard Inc
Julie Blankenmeier, MD, Senior Medical Director, Oak Street Health
Sasmita Misra, MD, University of Chicago Medicine and Radiology Partners
Stephanie Willding, MPA, CEO, CommunityHealth
Watch the Recap | Link to YouTube
David Shifrin: Where are organizations are today. What is the state of your clinical teams?
Sasmita Misra, MD: I work in the breast cancer center with both inpatient and outpatient services. Burnout was really exacerbated early in the pandemic. Emerging from the pandemic, there is a boost in morale and vaccinations have made everyone feel safer. Listening to staff and continuously asking what will make them feel safe in the workplace has been important to increase morale and decrease burnout.
Stephanie Willding: The care teams at CommunityHealth dealt with the most from about December to the end of May. In the late winter and early spring, we really had to recognize the burnout setting in and plan for time to reset. Acknowledgement of and addressing it as “one-time” burnout was helpful. Clinicians had to sprint through a hard time but are now more optimistic on the other side of the worst COVID times. We offered more paid four-day weekends and started summer hours (leaving at 3pm on Fridays) early. It’s been important to acknowledge the burnout and we are starting to see a shift in moral and improvement in attitudes of our staff.
Julie Blankenmeier, MD: The stress levels for everyone was very high at the start of the pandemic. The pandemic asked our 90+ primary care clinics across the state to live their best mission. It became exhausting mentally and physically. The organization incorporated flex hours and other benefits to help people find childcare. Primary care providers helped each other, and the collaboration between executives and physicians across the organization made the switch to telehealth more seamless. Being so mission-focused really helped Oak Street Health and its providers thrive.
DS: How do you take the challenges of the past year and adjust operations? What operational opportunities and innovations have come out of the past year?
SW: CommunityHealth has emerged as a different organization. We have had to be nimble and flexible. And, we decided early on to document every time we learned a lesson, so we could grow and evolve. As we evolved, it became obvious that things wouldn’t go back to the way it was before. We had to pivot to virtual medicine and found that we reduced barriers to accessing care. Before the pandemic, patients struggled with taking off work, missing paid worktime, transportation, and so on, which was not patient-centered-care at all. We just opened a telemedicine microsite in the Belmont Cragin community – a community that was particularly impacted by barriers to care – so patients can access the site, utilize the technology, and have a staff member present during a virtual care visit. By reimagining space and place, and taking it to the next level, we are now seeing that we have hundreds of patients of whom it used to take 1.5 hours to get to an appointment and now it’s a 10-minute trip. CommunityHealth is meeting patients where they are, and not asking patients to come to them.
JB: We have all taken advantage of telemedicine, and for health care in general this has been a huge leap forward. Oak Street has a dedicated team who focused solely on telemedicine. We now have three different ways for patients to access care: 1) Patients come in-person on their own, 2) Our vans go out to pick them up and take them to and from the appointment in-person, or 3) A telemedicine appointment is provided at home. Additionally, we already had the vans taking people to their appointments, now those vans take devices (eg. ipads) to people’s home so they can have a virtual visit and stay in touch. Oak Street is one hundred percent value-based care, so that means wrap-around services. The behavioral health and social workers called patients during the pandemic to see if they needed food or someone to talk to. We were proactive and not waiting for patients to call in when they needed assistance. We used our fleet of vans to send out supplies to patients – Gatorade, medicines, thermometers, and so on. “Patient care isn’t just coming to the office” and we had to truly flop the model to get the care to the people in need. It was great lesson to repurpose existing resources to address our patients’ needs.
SM: For radiology things were different because we cannot bring the services to the patients. We saw a decrease in screenings by about 85 percent. As we learned more about the virus and opened facilities up again, we had to adjust the flow of patients and minimize patient interaction due to COVID, but also had to increase points of access to care. Pre-pandemic, we had many facilities that were just for mammogram screenings, and we had to add diagnostics to those sites to increase access to care for patients. And, we used telemedicine to follow up and discuss results.
DS: We have heard many patients experiencing challenges with privacy doing telehealth from home for mental / behavioral health sessions. Have you all seen this barrier and/or other barriers, and what strategies have you found to address mental/behavioral health access during this time and going forward?
JB: Oak Street’s patients are older and often need assistance from a relative or loved one to help them get online for a virtual visit. This was actually very helpful, because the children (their caregiver) could join the visits. Many patients now prefer telehealth instead of coming in and a phone call is another option that is more private. In general, we haven’t heard too many having any privacy issues.
SM: Phone calls haven’t had many issues for us (in Radiology) either.
SW: Our patients have absolutely adapted and evolved, and they schedule their visits for when they can have a private phone call. CommunityHealth’s microsite offers telehealth services which helps with privacy because they can go there for a virtual visit and have access to private room.
DS: How have patient expectations changed over the past year? What are you seeing as far as patient expectations, existing patient knowledge?
SM: There’s been a drastic change between the doctor/patient relationship. Early on, physicians had most of the knowledge, but now patients come with many tools at their disposal, and they come with questions rather than coming uninformed. As clinicians we must embrace this and adapt what the patient has read and integrate it into the clinical context. Medical misinformation is a growing public health issues, and as physicians it’s important to disseminate scientific health information in every visit. I will ask patients about their vaccines even though they are there for imaging because it helps patients to hear explanations from their doctor on all things. There is a huge change in the patient’s attitude about receiving the vaccine just by having a simple conversation about the science behind it. We must explain everything in a deliberate manner and not dismiss anything that they may be coming forth with in the interaction.
SW: Having to pivot overnight to a virtual model accelerated the new doctor/patient dynamic. Providers have shared that in virtual visits the dynamic has changed – the patient isn’t in a space that is intimidating and they are asking more questions. The virtual visits take longer because patients are in their safe place, where they feel comfortable. CommunityHealth sent out a lot of at-home monitoring – asking patients to log their own information which increases their empowerment in their own health.
And, there also have been challenges, especially with vaccine hesitancy. Early on people that were somewhat hesitant about the vaccine didn’t need much to influence them to decide to be vaccinated. Now we are at a point where people that are still hesitant need a lot more to feel comfortable. CommunityHealth doctors must really listen and take in these concerns seriously. CommunityHealth has provided doctors with scripts, sent out videos, and continue to seek ways to provide vaccine education and promotion to patients.
JB: Thirty years ago, it was “doctor knows all,” now it’s more of a team relationship between doctor and patient. As a primary care provider, Oak Street Health’s team would share strategies that worked. When patients would say there was no way the vaccine would be safe because it was developed so quickly, they used the metaphor of building a house by working 24/7 and contracting with the best contractors around the world. “No means no,” means don’t push patients to do something they don’t want to do, but “no also means not yet,” so don’t give up, keep the conversations going overtime and continue to give them the choice. At the end of the day, “Be proactive but patient at the same time.”
DS: How to apply lessons learned to help people receive general care?
SM: Several models have been put out in recent months that investigate what the pause in screenings will do to early detection and patient survivability. One model shows that a six-month disruption in care will result in 10,000 excess deaths over the next 10 years. We can’t stop medicine when we have our next global crisis. We have to work on finding ways to increase access and points of care for imaging modalities. We also need to go out and let patients know that we’ve made changes to make the imaging centers a safer place to come to.
JB: It is truly Important to keep communication with patients and figure out a way to keep in touch with them. Being more proactive to ensuring patients can access appropriate care, even if they don’t come into the office is critical. At Oak Street Health, we finished 2020 with more screenings than we did before, because we were so focused on the mission and trying to be innovative to get everyone taken care of.
SW: At CommunityHealth, most of the providers we have are volunteers, so the clinic tries to make it very easy for those providers to have all the info they need for each visit, and they are prompted to have intentional conversations with patients about what screenings they need.
DS: How are your organizations navigating all these changes (e.g., burnout, new modalities of care) and continuing your mission?
SW: We are getting to a point, where you really need to think about the sustainability of operations that have established and how you build to keep these things in place. Now we have the space and bandwidth to start thinking about sustainability moving forward. It has been important for staff to understand the why behind changes that were being implemented. Our key takeaway from all this that CommunityHealth will continue to be, “be nimble, flexible, evolve and grow to keep meeting patients where they are.”
JB: We all feel a greater appreciation for each other as colleagues and teams. Patients are coming in so much happier. We all just ran a marathon and are in recovery phase, but we can’t totally back off. The danger is that we might feel like we are safe now, but we need to keep innovating. There is a lot more focus at Oak Street on work/life balance, a lot more resources in place (e.g., childcare and access to mental health services). Those benefits and support services have been ramped up, but it is still going to take some time to recover while keeping the same sense of innovation.
SM: The pandemic highlighted problems in the health care system. We put band-aids on a lot of things and now we need to go back and fix things from top down. We must continue to progress in our innovation of care. Early in the pandemic, one hospital was full of COVID patients, and the other was empty. We need to continue to allocate resources appropriately that will allow access for our patients (e.g., internet, build digital infrastructure).