Orlando Health Task Forces Focus on Post-COVID Landscape

June 2, 2020
Jerry Senne, vice president of value-based care and population health, describes rescaling the sites of care delivery, re-engineering telehealth

The pandemic is forcing health system leaders to rethink everything from health IT project timelines and building investments to care coordination strategies and virtual visit approaches. Jerry Senne, vice president of value-based care and population health for Florida-based Orlando Health, said the nine-hospital system is re-examining “the delivery models we have in place — from the size of our hospitals to the service spectrum we offer.”

Senne was speaking during a May 19 webinar put on by healthcare data solutions company Innovaccer. He began by describing the impact of COVID-19 and the health system response. Initially Orlando Health redeployed a lot of resources toward the pandemic, including predictive analytics around the course of the disease: the number of lives at risk, inpatient capacity, ICU capacity, ventilator capacity, and projecting demand of PPE and some critical pharmaceutical agents that were in short supply.

He said that Orlando Health’s leadership also began to focus on the recovery even before they got close to the peak of the epidemic. “Our effort is focused on sustainability post-pandemic,” he said. They developed six task force groups that drew from across the system to focus on becoming best in class at treating patients and on re-imagining innovative models of the future. “We are trying to embrace things with speed,” he said.

Senne said Orlando Health has been really hit hard by the financials. “We are in a framework where we are losing several hundred million dollars per month, although we are starting to see some recovery in central Florida,” he said. “Cardiology is down about 20 percent, pediatrics is down about 60 percent, with a great deal of concern about preventative care and immunizations as parents are reluctant to bring their children into an environment they don’t feel safe about. Dentistry has ground to a screeching halt,” he said.

Orlando Health has the largest trauma center in Florida and its trauma volumes are down 60 percent, he said. “People aren’t driving stupid and not shooting each other to the same degree, so I guess there are some blessings in the midst of tragedy. We have seen increases in domestic violence and increases in severe mental and behavioral health issues manifesting. There are a lots of things that are changing and likely to be durable. We have seen our volume of telehealth services go up by a factor of almost 1,000.  So we are beginning to become smarter about how we re-engineer telehealth to something durable.”

Senne oversees a team that manages nine large payer arrangements with more than 200,000 lives in value-based care arrangements with five national health insurers, Medicare Shared Savings and Disney Worldwide Services — the largest direct-to-employer arrangement in the country. He said the whole payment world has been upended by the pandemic as well.

“There are a lot of conversations taking place with payers,” Senne said. “The commercial and Medicare Advantage payers are awash in money right now. What has been devastating to the healthcare system and to providers of care is profit to them. They are in situations where they actually have statutory problems causing them to consider refunds, increasing payment to providers, a whole host of strategies they are looking at, so it is a re-positioning of the industry that is both a blessing and a curse.”

Orlando Health also is rethinking points of contact with patients. “We are relying on new technology and new ways to interact with patients,” he said. Another task force focused on capital expenditures. “Our investment returns are not what they were,” Senne said. “Cash has been depleted by the operating losses. We had a 10-year capital plan that we have to totally recast and revisit. Another team was looking at IT. We were in the middle of a major EHR conversion. We have had to reprioritize the timing of some of that because resources were drawn into the COVID fight.”

Orlando Health also is looking at rescaling the sites of care delivery. “A lot of our one- and two-person primary care offices are just not economically viable anymore,” Senne said. “I get that they have a desire for autonomy and they may be serving difficult communities, but we are seeing a large effort to rescale those into fewer, larger more concentrated economic models that have a chance of success. The same things is true on the site-of-care side. We are focusing on reshaping everything from primary care, urgent care, convenience care, freestanding emergency departments, really rescaling the way those are being designed right now as people are looking for different points of access.”

Senne noted that when you have a high velocity of embracing telehealth, you learn a lot as you go. “One is that some providers are really good at telehealth and some are not,” he said. “We want to have people who are good at office practice focus on office practice and those who are really good at telehealth do that. Second, we are reshaping schedules very quickly. Telehealth is not a 9-to-5 proposition. It involves extended hours, if not 24x7. So we have begun to talk about different types of scheduling.”

Orlando Health is preparing for a gradual recovery. Many people are predicting that this won’t be a V-shaped recovery. “It won’t come back as fast as it went down,” Senne said. “The biggest concern we face in the near term is the loss of employer-based healthcare. There will be a lot of people who get sick but may not have access to healthcare coverage because of losing employment. Like most healthcare systems, we are heavily leveraged against our commercial book of business. Medicare barely covers costs. Medicaid in Florida is horrific. So as a result we are very dependent on employed patients. We are worried about that. We see that the recovery is not going to be linear, but rather a gradual curve.”

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