The past year has been a trying one, plagued with unprecedented challenges brought on by a global health crisis unlike any this country has seen in more than 100 years. For hospital and health system leaders, there have been plenty of learnings and reflections during these extraordinary times.
In a recent interview conducted over e-mail, Jason Fish, M.D., internal medicine physician, chief medical officer and senior vice president at the Dallas-based Southwestern Health Resources (SWHR), shared perspectives on his organization’s biggest lessons learned across several dimensions, such as clinical, operational, and digital. Below are excerpts of those responses from Dr. Fish.
It’s certainly been a tumultuous year. What have been the biggest learnings for Southwestern Health Resources as it relates to how the pandemic has upended the healthcare ecosystem and how the organization has been able to persevere?
The healthcare industry initially struggled to manage the COVID-19 public health crisis, given its magnitude, and the initial struggle opened the industry up to criticism, allowing outside forces to create a narrative with incomplete and incorrect information. We also saw how politics influenced public health, perceptions, and decision-making. However, in the end, the government and healthcare organizations learned a great deal about the value of coordinating a solid disaster response plan – from an operational and communications perspective.
With the healthcare industry regaining control of the health narrative, I believe the CDC, State Public Health agencies, and our local health systems must focus on continuously educating the public and providing factual, up-to-date information on the pandemic, the relevant science of the virus and the vaccines, and the vaccination process. In stepping up to that role, SWHR, along with so many other healthcare organizations, has been forced to flex its communication muscles during this pandemic. The initial communications efforts started with reaching out to our network of physicians via newsletters and webinars, equipping them with up-to-date information for their practices and patients. Connecting physicians with the knowledge needed to make the best patient care decisions is core to our mission. It has been crucial to our success during COVID-19 and continues to be useful as we communicate now about the vaccines.
As we understood the virus further, we recognized that certain individuals and communities were at a greater risk for poor outcomes. Patients with chronic diseases were at risk for falling behind on their medical management and other individuals were delaying routine cancer screenings. We focused our communication efforts on identifying those individuals and reaching out directly to them through campaigns as well as through their primary care physicians. In addition, we provided the stratified lists to primary care physicians for priority outreach with televisits. Our focus was on making sure patients did not fall through the cracks during the pandemic. Rapid expansion and adoption of telehealth, plus robust physician education on uses of telehealth and documentation strategies, helped ensure that goal and prepared our large network of physicians to care for more patients, faster and in the safest way possible during the crisis.
In that same context----from both an operations and clinical perspective---what have been the biggest challenges for the organization during this time and what best practices did you implement to work your way through them?
One of the biggest clinical challenges at the beginning of the pandemic was we knew very little about this virus. We fielded many questions about the spread of the virus and how to best protect one’s self. We also received many questions about the vaccines and how individuals will be prioritized. This was difficult initially because little was known, and the science needed to catch up with the practice of medicine. I think many providers struggled because we desired to protect our patients as best as possible, but also had to be transparent in the lack of knowledge at the onset. We found that it was most important to provide frequent, transparent communications.
Operationally, getting our network of physicians set up on telehealth platforms at the onset of the pandemic was a challenge. Most were beginning to explore or were about to launch telehealth. The pandemic caused those plans to be stood up in a matter of days. This required significant strategy and organization, using a tool that was not quite ready for mainstream and a society that was equally not prepared. There also were many questions about how to execute clinical care in telehealth as well as payment.
Despite our efforts to identify at-risk patients, communicate with their PCPs about these patients, and generate patient-facing education, we still found many patients maintained a strong fear of COVID-19 and were delaying scheduled physician visits for chronic disease management and preventive care. We were learning that across the country more people were dying at home from heart attacks and strokes and cancer screenings were significantly lower. We had great consternation that this was going to happen to our patients even with our outreach, thus far. We decided we needed to do more, so we launched a “closing the care gaps initiative” in the late summer and in early fall. We again used data to identify high-risk patients, reminded them of their need to pursue routine care appointments, screenings, tests, and visits, and provided the lists to physicians so they could also follow up to encourage either in-person or virtual appointments. In addition, we worked with third-party partners to send in-home test kits to patients so they could provide crucial information that would support optimal care, such as fecal test kits and diabetes test kits, as well as began offering more options for care in the patients’ homes, such as diabetic eye exams.
As to be expected, many practices faced great hardship. After the national health emergency was declared, it was obvious after only a few weeks that the pandemic would be hard on physicians and their practices financially due to steep declines in volume. We needed to find ways to help our network of physicians weather the pandemic. To support our network of more than 5,500 physicians and other healthcare providers’ practices, we accelerated the quality payments that were designated as Q4 incentive payments and paid them in Q2. In doing so, we were able to get financial support to physicians early in the crisis. We also provided as much information as we could on any options coming from the federal government.
We are in a unique position as a clinically integrated network to help our physician network survive and thrive due to the fact that we have a strong, responsive and agile infrastructure, allowing seamless communication and collaboration across the network – touching community clinicians, academic physicians, researchers, payors and more. I would recommend that any health system or network hoping to achieve success in the coming years invest in a strong infrastructure including robust data analytics, a shared health information exchange and an effective internal and external communications strategy.
Which digital tools have caught your eye most during the crisis and how has the health system evolved its digital health portfolio?
The expanded use of telehealth to care for patients remotely has drastically pushed the industry forward. One of the biggest and most impactful learnings for SWHR during this crisis has been learning how to manage patients via telehealth. In the early days of the pandemic, we recognized that more than 400 of our community physicians had no telehealth capabilities. We mobilized quickly to support their efforts to operationalize telehealth services. We provided instruction on setting up and using the technology, how to bill for telehealth visits, and how to provide clinical care via telehealth. We also gave them instructions to share with their patients so patients could become comfortable with telehealth. Now, all of our community-based physicians have telehealth capabilities. This has led to physicians providing approximately 8,000 virtual visits per day across the network.
As we move forward, I do not see telehealth slowing down. It dramatically increases the touchpoints with patients and will drastically change the way we are able to manage chronic health conditions and population health. After all, patients spend only a fraction of their time in our health systems and a majority of time in their own homes. The use of telehealth has given us a glimpse into their lives, allowing us to build deeper, more personal relationships with patients, and in some cases, see in real life how social determinants manifest themselves in patients’ lives. This inside look at our patients’ daily lives allows us to practice medicine with greater empathy. We can also monitor and leverage data to keep our communities healthy. This could mean realizing that the patient hasn’t received a flu shot this year or recognizing that a patient needs to return for a second dose of the COVID-19 vaccine. Leveraging telehealth, while applying powerful data insights, allows for more opportunities and openings to have these conversations – and ultimately to create better outcomes.
Additionally, from a data and IT perspective, what kinds of lessons have you learned, as a CMO, broadly, in the past year or two?
We are continually piloting, testing and scaling innovations that demonstrate the feasibility of a value-based healthcare system and demonstrating the ability of population health management across the continuum to lower the total cost of care.
The social determinants of health (SDOH) that have always been there have been amplified and exacerbated in the pandemic. As a clinically integrated network, we are continually evolving how we address these unique needs. In recent years, we have learned to leverage the power of data analytics for more robust and proactive population health management. For example, we are able to survey patients to understand the reason for avoiding health care appointments and look jointly for possible solutions.
By capturing data at every touchpoint, we are able to provide value for patients, physicians and payers, even during the pandemic. Data helps identify gaps in care to ensure at-risk patients get routine care, the elderly are being cared for at home, and that all eligible patients are getting their routine vaccinations. During the pandemic, data aggregation and analytics have enabled us to conduct outreach to more than 10,000 patients in high prevalence zip codes and manage screenings of COVID-positive patients for SDOH.
In the year ahead, it’s likely we’ll see lots of healthcare issues that stemmed from the pandemic and delaying care, in addition to all the COVID-specific challenges. What do you view as core strategies that will be necessary to navigate this new landscape?
The global COVID-19 pandemic has been a catalyst for numerous disruptions in healthcare and care delivery. It also has forced the industry to rapidly develop innovations that will continue to shape how healthcare is delivered for years to come. While it is an unnerving time to be a physician, it is also an exciting time to use what we have learned and innovate. For example, I believe that in the coming year we will see an increase in mental health challenges. We have now learned how to successfully manage patients via telehealth and can begin to use those learnings to provide better behavioral health support. In addition to addressing mental health issues, we will also have to address the impact of delayed preventive care. Using SWHR’s robust data, we can identify and educate patients across our network who have put off care and encourage them to immediately work to get back on track before they come in sicker and have more costly care episodes down the line. We have found new ways to coordinate the needed care as well as deliver the care.
I also think we don’t have a choice but to infuse, leverage, and analyze data at every opportunity. A robust data and analytics program coupled with all our physicians being on a shared health information exchange, allows us to capture data across the network and deliver this information to physicians for better decision-making at the point-of-care.
Lastly, I think we need transparent COVID-19 vaccine campaigns to encourage patients to seek the vaccine once it is more widely available. We are hard-pressed to beat this virus without widespread vaccinations, and it is our job as providers and healthcare leaders to communicate to patients the most accurate and latest information so they can make the best possible decision for their personal health, which can ultimately help the rest of the nation.