06/22/20 Denise Brown,
MD
Defining the
Future of Hospitals
·
COVID-19
Redesign Care Around the
Patient
The COVID-19 pandemic disrupted not only the
way we deliver care to patients, but also impacted the business model for
hospitals as volumes dropped. Vituity’s Chief Growth Officer, Denise Brown, MD,
charts the path forward for acute care settings and predicts a positive
transformation enabling a more affordable, accessible, and sustainable future
for healthcare. The key ingredient is identifying physician leaders to champion
the change.
I
never thought I would miss eating in a hospital cafeteria. Before COVID-19, I
would enjoy taking a meal break and chatting with colleagues. But that respite
and others like it aren’t coming back for a while.
Sometimes
this is a profoundly sad thought. In these uncertain times, I’m often nostalgic
for the familiarity and routine of the old days.
However,
uncertainty can also be a massive catalyst for change. I’m hopeful that the
pandemic will achieve what rising costs, government regulations, and declining
margins could not. At long last, we may be on the cusp of a sea change in acute
care that makes our delivery system more cost-efficient, better for physician
resilience, and keenly focused on patient-centric care.
No Going Back
COVID-19
is the most significant healthcare disrupter of our lifetime. For years, we’ve
been talking about healthcare reform as a goal to be worked toward over years
or decades. Now, our hospitals and health systems are being forced to change at
a pace that has been likened to building an airplane in midflight.
To
weather this transformation, we must accept that there is no “post-COVID
world.” The virus is likely to be with us for years to come, if not forever.
(Six years after the Spanish Flu pandemic ended, hospitals were still
admitting elevated numbers of patients with mental health and neurological
sequelae.) This radical reorganization of our reality is necessary — and it
will touch every healthcare institution, starting with hospitals.
The
pandemic has made it imperative to meet patients where they are. We no longer
have the luxury of operating under provider-centric models that force patients
to travel to offices and hospitals for minor injuries and illnesses. Instead,
we now depend on technology to safely treat patients, conserve personal
protection equipment, and slow the spread of the virus.
This
shift is perhaps best exemplified by the rapid ascendency of telehealth, now
almost ubiquitous after decades of sluggish growth. In some parts of the
country, demand for telehealth visits has increased by several thousand percent. What’s more, both
patients and providers are enjoying the flexibility, convenience, and (often)
lower cost of telehealth encounters. As a result, physician and patient
advocacy groups are working to permanently enshrine the emergency telehealth
regulations into long-term expanded access and reimbursement.
What
will the hospitals of the future look like in this decentralized,
technology-driven world? Perhaps the most striking difference will be the shift
from the physical to the virtual hospital. In this new model, only the
most acute patients will receive in-person care. The rest will be managed in
their homes, skilled nursing facilities, and wherever else they can be cared
for virtually.
“To
meet the ongoing challenges of coronavirus, we must engage our clinicians as
champions and co-creators. ”
Denise Brown, MD Chief Growth Officer
Solving Our Most Pressing Challenges
By
connecting patients and providers in new ways, delivery models are also driving
a grassroots movement toward expanded access and quality. This high-tech and
high-touch re-engineering of our nation’s healthcare delivery system may
finally provide solutions to some of the toughest problems in acute care, like:
·
Physician
shortages
Some new technologies have the potential to “force multiply” physicians. For
example, today’s virtual care platforms can leverage artificial intelligence
and natural language processing to automate patient communication and arrive at
a preliminary diagnosis and treatment plan. This allows a single attending
physician to virtually manage the care of several patients at once. These
technologies could help health systems to better navigate provider shortages
due to COVID surges as well as the looming national provider shortage
·
Geographical
health disparities
Virtual hospitals could also solve access issues for patients in rural and
underserved areas. For example, patients receiving some types of medications
for addiction treatment (MAT) previously traveled to outpatient treatment
programs daily. The shift to new virtual treatment models could make MAT
feasible for patients who are homebound, live far from clinics, or are unable
to travel daily due to work or family commitments.
·
Clinical
quality and outcomes
Virtual hospitals of the future could also leverage technology to improve
preventative care. For example, AI platforms can now predict negative events
like heart attacks up to 5 years before they occur. These algorithms could be
built into care delivery systems to trigger clinical intervention ahead of a
serious health event.
·
Capacity
management
In addition to freeing inpatient beds ahead of potential COVID surges, virtual
hospitals could also give patients an additional choice to seek out emergency
care. Telehealth triage platforms like Vituity’s ensure that only those
patients who genuinely need face-to-face care travel to the ED. (The
convenience of this approach would also likely satisfy patients.)
Physicians: Our Greatest Innovation Assets
The
shift from a physical to a virtual hospital represents a seismic shift in care
delivery. After all, despite the clear advantages of virtual acute care, it has
taken a global pandemic for the idea to gain traction. As with any significant
change, healthcare leaders should prepare to endure resistance and gain buy-in
for this new care delivery paradigm.
To
foster this change, we must nurture a culture of physician resilience and
empowerment. Clinicians represent our most direct connections to our patients.
Often, they are the first to recognize both pain points and potential
solutions. As such, they are our most valuable innovation assets. To meet the
ongoing challenges of coronavirus, we must engage our clinicians as champions
and co-creators.
As
a physician-owned and physician-led organization, Vituity has benefited richly
from provider-led innovation. A recent standout example is our virtual front
door to the ED program, which allows patients to begin their ED visit by
clicking a button on the hospital app or website. This immediately connects the
patient to an ED provider who takes a history and determines next steps. In
some cases, the clinician may treat the patient virtually, prescribe
medications electronically, and even schedule appropriate follow-up
appointments. More acute patients will be urged to travel to the ED to complete
the visit in person, often with the same provider.
Another
example is Hospital@Home, a new partnership between Vituity and Adventist
Health. The program enrolls patients who meet safety and diagnostic criteria in
a 150-bed virtual medical-surgical unit served by telehealth, remote
monitoring, and mobile provider teams. This shift in the way we care for
patients requires adjustment but may eventually prove to be the ultimate
clinician satisfier. Many providers who sign up to provide virtual care expect
the experience to be distancing. However, after a few weeks in this space,
clinicians often report feeling more connected to patients and receiving far
more “thank-you’s” than in their office and hospital jobs.
Conclusion
Hospitals
aren’t about to disappear. However, they will shift their focus to the
highest-acuity patients. This is where the emphasis will continue to move to
health systems, which, by their nature, leverage multiple models of patient
care. From live to virtual, a health system that meets patients where they are
can more effectively care for everyone while controlling costs and stewarding
the health of their workforces.
As
shared owners in a physician-led organization, Vituity Partners are committed
to leading this acute care evolution. We are excited to partner with
like-minded organizations to begin creating a more affordable, accessible, and
sustainable future for healthcare.
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