Not-for-profit UCHealth includes 10 hospitals, one of which is an academic medical center, and more than 150 clinic locations throughout Colorado, southern Wyoming and western Nebraska. The system serves about 1.4 million unique patients each year, 30% of whom are covered by Medicaid. That patient population has increased 86% since 2013. Colorado as a whole is booming, with an estimated 100 new residents moving in per week. Since taking over UCHealth in 2014, CEO Elizabeth Concordia has focused on strategic partnerships, expansion of the system's footprint in the region, developing new models of care and addressing consumers' demands. Tackling the opioid epidemic has also moved front and center for the system. Heroin overdoses spiked 500% over the past decade in Colorado. In recent months, Concordia took the unusual step of instituting random drug testing for the system's 21,000 employees. Modern Healthcare Editor Aurora Aguilar recently talked with Concordia about that move. The following is an edited transcript.
Modern Healthcare: How did you engage your workforce to get behind something that could be misinterpreted as an invasion of privacy?
Elizabeth Concordia: Let me start by saying this is part of a bigger focus on drugs and addiction. Our physicians prescribe opioids online and we place limits on how many days' worth they can prescribe. As a result, the system has seen opioid prescribing in its emergency rooms drop by 30% to 40%. We did that at the same time we started the random testing and there's been no change in the number of employees who want to work for us. In fact, we've had a lot of our employees thank us because it's well-known that there are various drug diversions and challenges within the workforce, and these professionals are very comfortable being tested, because they have nothing to hide.
Obviously when we first did this, because you have to test the person within the hour of them being randomly selected, we spent a lot of time engaging the workforce. We wanted them to know this was a fair process, and it's been successful. The fact that physicians have agreed to participate is significant in that they're not being treated differently. So I think, culturally, it sends the message that we take opioid use very seriously and that we have zero tolerance for our own workforce.
MH: Were there areas within the system that you identified as being more vulnerable?
Concordia: Pharmacy, anesthesia and the operating rooms were big areas. We wanted our staff to buy in, so our human resources people engaged high-use areas or high-risk areas, and those staffers helped craft the policy and helped with the rollout. This way they didn't feel like it's something being done to them, but really something that they authored.
Secondly, because it's complex in how the testing works, meaning if you're, for example, an OR nurse, and you get randomly pulled and you're doing a case right at that moment, how do you meet the one-hour guideline? How do you get to the testing location? So another lesson was that you have to do dry runs and identify potential problems. When we say dry runs, you pull the name and you have the employee go to the testing location but you don't do any testing. Then you look at how could this process have gone better, or not, before you actually implement it.
MH: Your organization has invested heavily in innovations, $50 million to be exact. What benefits has that reaped for you?
Concordia: At one of our newer hospitals, every inpatient has a wearable so that we can monitor all of their vital signs at all times. We're getting continuous information on the patient; we don't have to wake them and that data is imported into our electronic health record, real-time. So from a cost perspective, a medical assistant doesn't have to go in and do that. That will be rolled out across our system.
We also have a robot eye that serves as a sitter for patients. It's a high-tech centralized area that can monitor multiple patients across our system at once, so if the patient is about to get out of bed, the person who's monitoring says, "Miss Concordia, can I help you? Can you wait for assistance?" Because when you think about the number of patients in a hospital on any given day—and that number is unpredictable and they all need staffers to watch them—it can be costly and inefficient. So that's the type of advanced technology for inpatient care that really does drive innovation.
From a patient satisfaction perspective, we're a national center for cancer care. Patients come in for chemotherapy, which is typically a couple of hours for infusions. We give them virtual reality headsets, so they can take a vacation to the beach or other places that they can choose. Another example is a company that we've invested in called LeanTaaS that uses advanced computational algorithms to figure out the start and stop times for all the patients, so that we can schedule to avoid peaks and valleys. That prevents patient wait time and staff overtime because we're scheduling more efficiently.
MH: Patient engagement and satisfaction is a big goal for UCHealth. How does price transparency fall into this?
Concordia: First, we are very clear when a patient comes to one of our facilities, of deciding where that patient should go, facility-wise. And then, we wholly believe that patients are happy when they get no surprises. So if patients want to know what the specific charge is, it's oftentimes that we need to direct them to their insurance company because the insurer needs to tell them how much they've paid on their deductible and what their specific benefit plan is, with regard to the cost. So we help the patient as often as we can, but many times we have to work with the patient to direct them back to the insurer to get the specifics of the benefit plan.
In general, when you look at where healthcare is, we have to become much more transparent in how care is delivered—that there are no surprises. But it's not always easy and it's not as though we don't want to tell the patients that information, but depending on their health plan design or what their specific situation is, we can only assist them.
We have launched a virtual urgent-care option through our UCHealth portal and we make it very clear that it's $49.95. So wherever we can tell our consumer what the price is, that doesn't differentiate by payer, we do that.
MH: What are you doing to make sure technology doesn't negatively impact the patient-provider relationship?
Concordia: Our fundamental philosophy is to give the patient choice. So an orthopedic patient who comes in to have surgery has the option of, "Would you like your follow-up visit virtually, or would you like to come in for your visit?"
When you think about it, oftentimes in orthopedics, they're not driving themselves, so if they choose virtual, they are not making one of their relatives bring them in, they're not in a crowded waiting room. So that's one example.
Another example is when someone makes a virtual urgent-care visit, we're letting the patient know about the various services we have, as well as saying, "This one costs this, versus this." From the patient experience perspective, we're seeing a lot of positive feedback, because we're not forcing anyone into any certain venue.
We also know that when patients are calling us, or trying to get through to their primary-care physician on a Saturday, we say to them, "Here is an urgent-care center that is near where you live," because we don't want them to go to an emergency room if they don't need to do that. We're training our staff to make sure they offer these options to our patients, but want to always make it be the patient's choice.
MH: What do you see as the biggest challenge for UCHealth moving forward?
Concordia: I think the challenge is that we are still, as an industry, nowhere near where we need to be, with regard to the patient experience and how we provide care, meaning utilizing all the various technology that's out there. The big challenge is how do we move, organizationally and as a country, into the future, while we still are burdened with this old-school regulation? So when we look at what we want to do, is this the right thing for the patient? How do we implement it? How do we use that technology to get us there? And what do we need to do to overcome the various regulatory challenges?
A decade ago you had to use a travel agent. Now everyone goes online and uses Expedia or whatever, and schedules their flights online. We don't need to talk to anyone. We can schedule it and book our flights when it's convenient for us.
The healthcare industry still doesn't make it that easy to schedule appointments. So when you look at where we need to go, this is a major focus for us this year. How do we give a much higher percentage of our patients the ability to schedule their appointments online? And that's just one simple example of how far we have to go.