CEO Power Panel: Strategies for consumer-centered care shift amid COVID-19

Health systems for years have been talking about patient- and consumer-centered care, trying to figure out new ways to meet patients where they are, make their hospitals stays more enjoyable and more strongly engage them in clinical decisions.

But as COVID-19 led more people to seek care from home and decreased touch points with patients even inside of hospitals, health systems needed new strategies to keep patients involved in care and provide them with resources—two core components of patient-centered care, according to Modern Healthcare’s Power Panel, a survey of top healthcare CEOs—even when providers couldn’t see them face-to-face.

While COVID-19 created a new reality for healthcare in just a few months, it hasn’t sidetracked health systems from projects focused on patient-centered care and experience, according to their CEOs. In fact, for many, it accelerated digital efforts focused on patients.

Roughly 87% of CEOs who participated in the Power Panel survey said their organization had implemented new digital tools related to consumerism during COVID-19.

“A lot of what we do in the consumer experience is in person,” said David Entwistle, CEO of Stanford Health Care. “But despite all of that, I still think what we’ve been able to focus on and do has probably propelled us further than what we gave up, so to speak.”

When COVID-19 hit, executives at Scripps Health knew they needed to figure out how care teams could reduce contact with patients who had the highly infectious disease, without losing the personal touch.

“We wanted to be customer service-oriented and patient-centered, but we also wanted to protect our employees from going in and out of the rooms a lot,” said Chris Van Gorder, CEO of the San Diego-based health system.

Their solution? Installing baby monitors in patient rooms.

It proved to be a low-cost way to let nurses communicate with COVID-19 patients—and have patients talk back—without necessarily having to go inside the patient’s room, Van Gorder said.

It’s one example of how systems have developed new processes to keep patients engaged and employees safe.

For ambulatory visits, health systems are overhauling entrenched processes, keeping patients outside of the facility as much as possible.

Scripps Health recently rolled out an option for patients to automatically get checked in when they arrive at a clinic by enabling location tracking on their patient portal app. Then, patients get a text message when the exam room is prepped and the provider is ready to see them—meaning they can go directly to the exam room, bypassing registration and other steps.

Sometimes, patients don’t even have to step foot into the hospital. Dartmouth-Hitchcock Health in Lebanon, N.H., has started drawing some labs while patients sit in their cars.

These types of programs are part of a growing trend that Paddy Padmanabhan, founder and CEO of Damo Consulting, refers to as the “drive-through experience.”

He compared the process to ordering a coffee from Starbucks. Patients schedule appointments, check in from the parking lot and then pay for services online, similar to how customers can place an order for coffee through an app and pick it up at a drive-through window.

“If you have to go into a clinic for something, you go in and you go in for exactly what you need,” Padmanabhan explained, adding that the trend is still just emerging.

But with health systems implementing whole new sets of processes—often with a quick rollout amid COVID-19—organizations are still assessing how well they’re working.

Froedtert Health in Milwaukee launched a project during the pandemic to get feedback from patients about their experiences at the health system. Most data is collected through calling patients and sending emails, said Cathy Jacobson, Froedtert Health’s CEO. There’s a pretty quick turnaround, so executives and managers get that feedback on a weekly basis.

Froedtert had planned to roll out the customer experience project a few months earlier but delayed it and retooled some questions to focus on patients’ perception of infection control and safety—such as getting patient feedback on masking policies.

“We get that (feedback) back to our managers immediately,” Jacobson said. “We’re just now starting to tap the insights from that.”

Carilion Clinic in Roanoke, Va., had been planning to roll out a multipronged digital front door strategy over the next 24 months. But as COVID-19 cases mounted in the spring, executives realized they needed to move faster.

Executives in healthcare for years have been discussing the so-called “digital front door,” wanting to use new technologies to engage patients outside a facility’s walls. But with many health systems compelled to restrict patients from walking into their actual physical front doors at the height of the COVID-19 pandemic, executives had to revisit those plans, pushing out new chatbot symptom checkers and at-home virtual visits.

COVID-19 “hasn’t changed our thinking” about patient-centered care, said Nancy Agee, Carilion Clinic’s CEO. But it has accelerated “how far and how fast” the system moved toward implementing tasks already on its to-do list.

Agee is in good company. Seventy-three percent of CEOs in Modern Healthcare’s Power Panel survey said their focus on consumerism increased amid COVID-19, with the remaining 27% saying their focus stayed the same.

At Carilion Clinic, that included expanding the roster of tools that patients use to connect with the system online, such as rolling out options to self-schedule appointments and pay bills. And Carilion is developing an app, dubbed MyCarilion, which will centralize where patients access those services as well as educational videos, directions to facilities and on-demand telehealth.

Across the board, telehealth has played a major role in how health systems are keeping patients outside of the hospital, but still connected to their care team.

All CEOs who responded to Modern Healthcare’s Power Panel survey indicated they’d increased their telehealth investments during the pandemic. CEOs are chosen to participate in the survey.

Dartmouth-Hitchcock Health in Lebanon, N.H., was averaging just three telehealth visits per week before COVID-19 hit; at the height of the pandemic, it was conducting up to 2,000 virtual visits a day. To make sure patients were prepared for a telehealth visit, medical assistants called patients the day before their appointment to walk them through the process and how to use the technology.

Even if telehealth use slows as the pandemic subsides, as some experts predict will happen, it’ll still be a powerful option for patients, said Dr. Joanne Conroy, Dartmouth-Hitchcock Health’s CEO. In the health system’s territory in New Hampshire and Vermont, telehealth could prove a useful tool to avoid missed patient appointments during snow storms, she said.

“People appreciated the importance of virtual everything during the pandemic,” she said. “I don’t think all of that is going to go away.”

Moving forward, Dartmouth-Hitchcock sees telehealth as a market opportunity. The health system is working to create a direct-to-consumer urgent-care telehealth program, which could help to attract new patients, according to Conroy. The program, which is still being developed, will initially roll out to the health system’s employees, who will provide feedback.

As telehealth use soared this past spring, health systems were confronted with a problem: not all patients have access to high-quality internet.

It’s not a new problem, but it took on newfound importance as health systems were forced to shift more and more patient appointments online.

It’s frustrating to be “in the middle of a telehealth visit and it drops or you can’t hear someone,” said David Entwistle, CEO of Palo Alto, Calif.-based Stanford Health Care. For some patient populations, that could go beyond frustration and become an issue of access to care.

“What I do worry about is that there’s some socio-economic demographics that are not going to have access to (this) technology,” Entwistle added.

Health systems are still grappling with how to address that challenge.

During the pandemic, clinicians have been able to replace some appointments with audio-only telephone visits. However, payment for those services from CMS might expire with the public health emergency.

Dr. R. Lawrence Moss, CEO of Jacksonville, Fla.-based Nemours Children’s Health System, suggested that internet access could be the next social determinant of health that health systems target. All CEOs in Modern Healthcare’s Power Panel survey said their organizations need to address patient issues beyond traditional healthcare, including social determinants. 
That typically includes addressing access to food or transportation, but not internet.

Internet access is one of many social factors that Nemours is considering, Moss said.

“Just like I believe the health system needs to play a role with partners in ensuring that every child has access to high-quality food, every child also needs access to high-quality digital connectivity,” Moss said. “A decade ago we wouldn’t have said that, but it’s a different world now.”

Roughly 6.5% of Americans lacked access to wired broadband that met the Federal Communications Commission’s speed benchmark in 2017, according to a report the agency released last year. About 26.4% of rural Americans lack that access, an issue that HHS, the FCC and the Agriculture Department said they’ll tackle as part of a new Rural Telehealth Initiative.

Even if patients do have internet access, they might need help learning to use health systems’ emerging digital tools.

Carilion Clinic in Roanoke, Va., is working to stand up Apple Genius Bar-style technology support stations in its surrounding community, as part of a program to better answer patients’ questions about using the health system’s tech tools and encourage them to adopt the capabilities, said Nancy Agee, Carilion’s CEO. The system hopes to open the first station in a few months.

Given COVID-19, Agee said Carilion is working on possibilities for creating a “virtual” tech bar. The health system is planning to use a new patient education program, which it’s already using to let clinicians assign short educational videos to patients about some conditions and procedures. A set of videos on how to use Carilion’s digital tools, such as its apps, could fit into that resource, Agee said.