For healthcare IT leaders, prioritization and resource allocation can be challenging under normal circumstances (that is, if there is such a thing). But when a global pandemic hits, it graduates to a new level. As teams log 100-hour weeks to ensure patients can receive care, whether it’s virtually or at converted clinics, CIOs must decide which projects — if any — can be postponed, and how to proceed.
Sometimes the answer is none, as was the case for the Northwest region of OptumCare. If the “massive conversion” planned to bring up an organization on Epic was delayed, it would have resulted in a snowball effect, according to CIO Jason Wood.
Recently, Wood spoke with healthsystemCIO about the approach his team has taken with project planning, his team’s initial response when Covid-19 hit, and how they’re dealing with the ramifications. He also shared lessons learned, and discussed the keys to leading through a crisis.
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- Being located in Washington state — an early epicenter of the pandemic — OptumCare Northwest wasn’t just moderately affected by Covid. “It turned our business upside down.”
- The biggest challenge for leadership was the fact that there was no playbook for this situation, and no best practices to be shared, which meant teams had to come together to develop solutions on the fly.
- OptumCare was able to stand up Vivify for symptom checking and patient monitoring and get 60,000 patients on board, which was impressive. But patients weren’t fully educated on what to expect. “There was an opportunity to slow down and lay down a more methodical path.”
- The IT team’s most notable accomplishment was not just deploying video visits, but having it fully operationalized — something that has “real ramifications” in the area of preventative care.
Q&A with Jason Wood, Part 1
[OptumCare – Northwest is part of a large, national network that covers a range of services, including primary and specialty care, urgent care, and surgical care. Based in Washington, it includes the Everett Clinic, The Polyclinic, Physicians Care Network, Physician Care Alliance, Optum Care Network – Washington, and Northwest Physicians Network.]
Gamble: Let’s talk about your team’s response to Covid-19. What were your initial priorities?
Wood: Covid definitely turned our business upside down. Very early on — in late January and early February — I remember sitting in weekend meetings starting to plan to switch many of our walk-in clinics to FURI sites, which covers fever and upper respiratory illness, and funneling Covid patients into those site and figuring out ways to bifurcate the patient population so that we weren’t putting our at-risk patients at greater risk. That was one of the big transitions that we made very early on, and that came with a number of business and technology transformations. We changed our workflows significantly.
One thing we did was establish gates at all of our clinics where we had greeters in full PPE, who used laptops and tablets to start the check-in process. Being able to do that outside of the waiting room was highly advantageous versus bringing these folks all into a waiting room to sit together.
Next was the rapid transformation to telemedicine. We stood up 750 clinicians on telemedicine in three weeks. If you would’ve told me we were going to do that, I wouldn’t have believed you. That was one of the big transitions. But throughout that process, it wasn’t like one day we were humming along doing our operations as we had in the past — or as we had planned for 2020 — and then COVID hit, and there was a single transformation. It was, at times, day by day, or week by week, based on the case counts, based on what the teams from Optum Advisory Services Group were showing us, and the trends we were looking at. We were often reacting on those and local case counts to make pretty significant pivots in the business, sometimes day by day.
Gamble: When you talk about having to pivot, is this something you had experience with? Did you have a plan in place to be able to react to something like this?
Wood: I think no one had a full plan for COVID. It was so unique. I think people brought their expertise and their training together to come up with a solution. We didn’t have a playbook, or any true guide. It was through lengthy discussions and Saturday and Sunday meetings, talking what the data showed, what we saw in other countries, and what it looked like was trending here.
If you remember, a skilled nursing facility in Kirkland, as well as some areas, were the epicenter for the first big surge. So there was no opportunity to say, ‘Let’s see what another area has gone through,’ especially within the United States, because we were doing some of these in the beginning and I was communicating that out to our businesses across the country, knowing that they were going to be next.
We often share some of the things we were implementing, but not necessarily our plan. But we do have folks trained in a number of disciplines who were able to bring that training together to implement, whether it be getting 750 clinicians on telemedicine in three weeks, or transforming our whole structure of clinics in a few days, looking to convert ambulatory surgery centers into micro-hospitals if need be. It wasn’t a class someone took or an event they had gone through; it was a collective experience.
Gamble: In terms of what you did with telemedicine, I imagine you had practices of different sizes, in different locations. What was the key in being able to get these practices up and running?
Wood: Actually, to add to that complexity, some of the 750 were out in the network. So we’d have 42 clinics between the Polyclinic and the Everett Clinic, and we’d have to account for those variances. We were deploying through the IPA, which are independent groups that have different EMRs and have little to no interaction with most of our portions of the business. So it was definitely a challenge.
In the past, we understood that the technology of telemedicine isn’t all that complex; the driver was having a requirement in place. If we were going to take care of these patients, there was no way we were going to bring certain individuals into the clinic. There was risk to the staff and to patients. Some of them were unwilling to come in. It was necessity that drove this — the patients finally needed to do this and were willing to do it, and the clinicians knew it was the only way to deliver care. The payers were aligned, government regulations were eased, and payment parity was implemented. The forces just aligned.
This would have happened eventually, but it probably would have taken a decade, and it would have been very slow. Maybe one payer would have made a change and would incrementally have done it. It was necessity, and the teams collaborating, that moved the needle.
Gamble: What about helpdesk support? Did you have to make changes there?
Wood: That’s been one of the advantages of being partnered with Optum — we probably couldn’t have scaled this quickly to the size we needed to be. When you have 750 clinicians coming on board with telehealth, that’s thousands of visits, and thousands of patients who have never used this technology. We needed to figure out how to support them as well.
For the internal support, we stopped some other projects and put all our efforts into making sure we can support those clinicians. For the external support, Optum stood up a call center that we could direct patients to for help in walking through this. If you imagine a typical IT helpdesk call with a 77-year-old Medicare Advantage patient who hasn’t used a smartphone for something in this, the call isn’t going to go well. And you can’t scale that, but we can turn that into more of a member services-type function. That’s what allowed us to move so quickly.
Gamble: Is there enough demand to continue to offer telehealth services to patients?
Wood: Absolutely. We are seeing the numbers starting to drop off a bit. We went from just shy of 3 percent of all visit being done by video at Everett Clinic, to north of 50 percent. It has started to back down, but we absolutely think this is going to be one of the long-term options for patients.
And then there’s the whole reimbursement thing. We want to get away from that altogether. We want to take the capitation risk on patients so we can deliver the appropriate care and appropriate solutions. With our capitated groups, like Medicare Advantage, we can ignore the parity piece and use it to reach out to get the proper care.
Gamble: You mentioned having greeters in full PPE to prevent people who are infected from going into waiting rooms. This seems like something that could be replicated pretty easily.
Wood: It varies. We were lucky enough to be pretty well-stocked with PPE and so it was an option for us. We’ve definitely pulled back from it as the case counts have gone down. One of the key reasons to have those greeters early on was to ensure that folks were going to the right levels of care. These were folks who essentially just showed up at the door; they hadn’t interacted with us, because we didn’t have that option with a call center to talk through why they came in and if they want to do telemedicine, which is safer for both sides. Part of it was providing that triage or gating component, both there and at lower levels that are non-FURI sites. And so, if someone showed up, we’d ask a few questions — have you traveled out of the country recently? Do you have a fever or other symptoms? That way we’d be able to catch it there and then route them over to the FURI sites.
We have spoken with some groups about this and done some knowledge sharing. We worked closely on harmonizing some of the processes, and shared this knowledge with our partners in New York and Connecticut.
Gamble: Being located in what was the epicenter for Covid and not having a model to follow had to have been difficult. Looking back now, is there anything you wish you could’ve done differently?
Wood: For sure. Things move so quickly — the business was sometimes changing by the day or by the week based. If we knew what the case counts and the patterns looked like, we probably would have made different decisions. There were lessons learned as we went through business process changes or technology implementations. We not only deployed video visits for 750 practices; we also stood up Vivify for symptom checking and patient monitoring. With that solution, we were able to push out 60,000 invites to patients to sign up for Vivify. If you were entering your temperature and you had various symptoms, that would trigger an event to call into our nurse line, and then you could be further triaged. We moved very quickly with that solution, and it was a little bit confusing for our patients in that they hadn’t been fully prepped to understand that this invite was coming in some cases. And with all the scans out there that we’ve seen — including one with Washington State unemployment — as well as general practices where people are a little bit sensitive around clicking on links, I think there was an opportunity to go faster by slowing down and just laying that out in a more methodical path. That was one big lesson.
Gamble: Sure. Hindsight is 20/20, right? On the flipside, what do you feel the organization did really well?
Wood: I’m very proud of the overall response. The leadership team here is fantastic across operations and the Office of the CMO. A few of the projects in particular I’m really proud of — one being the ability to not just deploy the 750 video visit solutions, but to fully operationalize that and get to that point where more than 50 percent of our visits were done through video. If we hadn’t deployed that, those patients wouldn’t have received care. And when you think about the focus we have around preventative medicine, that has real ramifications. We want to protect these patients and keep them from coming in, but not if we’re managing diabetes or you’re not doing preventative care or checks for congestive heart failure. Those have negative consequences that are going to manifest post-Covid.
We saw admits in the hospitals just plummet. A number of initiatives plummeted during the period of time where you would have thought the opposite. You would’ve thought that as the virus swept through the country, admits would have been through the roof, but folks were just not getting care. A portion of that was elective, but for the most part, folks stayed away. And so one of the big worries was that we were going to have folks present post-Covid with serious conditions. If you can get someone in and detect the cancer at stage one, that’s one thing, but if they come in six months later because they were terrified to come in, that’s a different situation.