OSF HealthCare Innovating on Strong Virtual Care Foundation

In July, the American Telemedicine Association presented its annual Leadership Awards, and two of the awardees were from OSF HealthCare. Brandi Clark won for her “visionary leadership in expanding digital care access and advancing health equity for Medicaid patients across Illinois,” and Melinda Cooling, D.N.P., M.B.A., was recognized for her “visionary leadership in bringing together clinical innovation, workforce development, and advocacy to transform care.” Healthcare Innovation recently sat down with Clark and Cooling to discuss the evolution and direction of virtual care innovation at 17-hospital OSF HealthCare, which is based in Peoria. 

Cooling recently transitioned to a new role, chief nurse and advanced practice provider executive, at OSF HealthCare. Clark serves as vice president, Digital Care for OSF OnCall, which includes digital platforms and software to connect people with care 24/7 using smartphone apps, text-based check-ins and video visits with live support.

Healthcare Innovation: Congratulations on this recognition from the ATA. Can you talk about what was involved in building the virtual care infrastructure at OSF HealthCare? 

Clark: This work really started 12 or 13 years ago, with building the analytics capabilities within our organization, followed by the build of our innovation infrastructure. A lot of ideas come out of innovation, and then OnCall really became the execution arm of our organization's innovation infrastructure.

HCI: Do you feel like you've built that infrastructure to the point where when new potential use cases arise, you've got the foundation in place to test things out and see whether it makes sense to go forward? 

Clark: Absolutely. I've been in this role for, almost four years. We have the foundational operational infrastructure, as well as the years of experience in what it looks like to operate digital and virtual programming at scale. 

For example, a couple of years ago, we had our oncology leadership come to us and say they wanted to start this new program that's using a digital tool. The senior leader said ‘you should go talk to OnCall. Maybe they can help you.’ We were in a position where we could use an existing resource and try something without having to go hire new people, stand up a whole new department. We were able to just iterate and learn, at a small scale, with the idea that they had built, and now that has grown into a whole department, but it didn't start that way. We were able to spin it up much more quickly than they would have been able to on their own.

HCI: I read that you have developed some remote monitoring programs, including a new model for people 55 and older with two or more chronic conditions. Can you talk about that program?

Clark: That is another example of how we're able to apply the capabilities that we've learned. The Complete Care 55+ primary care model is really a hybrid model of care. There is a brick-and-mortar primary care clinic that's up in the Evergreen Park area on the south side of Chicago. Their patients go to a primary care clinic, but they also have access to all of the digital and virtual capabilities that we have built within our ambulatory digital care structure. 

We have a couple different layers of remote patient monitoring programming for individuals with chronic conditions. For instance, if you just have hypertension, we can enroll you in more of a moderate level-touch of RPM program. For those patients who may have multiple chronic conditions and co-morbidities and who are much more likely to be hospitalized and be higher utilizers of healthcare, we have a higher-touch level of remote patient monitoring available. 

We didn't stand those programs up brand new. For the Complete Care model, we leverage the capabilities that we've built, and we really stitch together from the ground up a model of care for primary care that is digital-first, that gives individuals access to their care digitally and virtually, and then they can come into the clinic when they need to.

HCI: Melinda, could you talk about what your previous job was and your recent transition to a new role of chief nurse and advanced practice provider executive?

Cooling: When I was in the OnCall space, I was the chief clinician executive and oversaw the clinical aspects of our care, working closely with our operational leaders on making sure that we were following best practices and standards of care, looking at our provider models, and what kind of clinicians made the most sense at that point in time for the programs that we were developing.

I moved into this role overseeing nursing and advanced practice from a strategic standpoint for the healthcare ministry. There are three divisions within OSF OnCall, one being digital care, which Brandi oversees; digital experience, which is sort of the front end of the digital experience and the entry into the healthcare system for patients; and then On Demand, which started out as our urgent care clinics, and has quickly grown into the virtual space as well.

I think what's really unique about OnCall is that it started out by defining how important it was to have a leadership structure who could think very differently. Our organization's thought process was saying we have to build this outside of traditional healthcare. Otherwise, it's really hard for people to pivot. When you're in day-to-day operations and running what you think of as traditional medicine inside a hospital or a clinic, it's really hard for clinicians to wrap their minds around these programs without them living outside of that. 

HCI: Melinda, I understand that you took part in a study on digital care and maternal health. Can you talk about that?

Cooling: We did a couple arms of our study, really focusing on the qualitative and quantitative pieces looking at: is the care that we are providing impacting the outcomes for patients? Also, there are some biases that patients don't want to engage that way or they're not going to use that type of technology. So we were trying to demonstrate that, for example, a nurse can communicate and create a trusting relationship with a patient in a pregnancy and postpartum venue. It doesn't have to be a face-to-face interaction.

HCI: I read that you are working on developing the next generation of virtual care nurses, and that you've worked with organizations to develop curriculum. Are virtual care nurses becoming more widely used in hospital settings? 

Cooling: Brandi has done a lot of great work around this, too, with virtual nursing for admission and discharges. I think there's a lot of learnings to be had across the country with some of the different abilities that virtual nurses can take off of the frontline nurses with things like double-checks of meds, and with medication summaries, and more engagement around discharge. And it involves training clinicians in a very different way. I have done some work with both the University of Illinois College of Medicine as well as Southern Illinois University College of Medicine around developing curriculum. 

HCI: Are you also deploying virtual hospitalists? 


Clark: From a virtual hospitalist standpoint, we have a tele-hospitalist program that primarily functions in the evening hours. From 7 p.m. to 7 a.m. we have physicians who are taking care of patients across many of our smaller, more rural facilities where it's difficult to staff a physician overnight, so one physician can help take care of patients across multiple facilities. That program actually predated the initiation of our our digital health entity being formed by about a year. That program has been growing for quite some time. I would say at this point it is covering most of the facilities that it probably could within our health system. 

We also have a digital hospital-at-home program. So those same physicians at night are also taking care of patients in their home. We have the largest operating program in the State of Illinois  under the CMS acute hospital care at home waiver. 

HCI: Did OSF HealthCare develop a lot of the infrastructure for that program internally, or did you work with a vendor focused on that space?

Clark: We did work with a third-party vendor that helped to consult on the the design and build of our program, and they also provide the in-home technology and some of the supportive technology to operate the program. We did build our program a little bit differently than a lot of their partners do in that we chose to in-source nearly everything in the care that's provided. In some larger, more urban settings, where many of their health system partners are, those facilities will tend to outsource a lot of things, like provision of meals and phlebotomy service. We built the infrastructure almost completely within our health system, and are providing all of those services with resources of our health system.

HCI: I saw that virtual behavioral health is listed as one of the things you are working on. We often hear from health systems that finding enough providers in the behavioral health space is tough, and that there's huge demand. So is this one way to meet that demand? And is it a combination of working with a third-party vendor or an app, and then internal resources, but in a virtual space?

Clark: All of the above. We are in the process of building the foundational infrastructure to have that capability within our organization, but today we are still absolutely dependent on our partnerships with third-party providers to help beef up our access, which seems to be never enough for the need in our communities.

HCI: Any last thoughts or things you are still working on fine-tuning?

Cooling: We’ve been diligent about thinking about how to use our resources really well when we think about the different levels of our clinicians. We are really making sure when we talk about top of licensure, that we're talking about where we need a community health worker, where we need a nurse or an APP. Where do we need our physicians? That's important when you talk about scalability and being able to afford these programs. I think we've done a really good job within that space, and always having that innovative mindset around how we can do this differently. 

Being OK with failure is another thing. We can say we built it this way, it’s not working so let's pivot and redesign it, which sounds simplistic, but it is not usually done much within healthcare as a whole. It’s really hard for healthcare to say we failed and we need to pivot. 

Clark: Melinda talked about how we built these things alongside our traditional care delivery operations. We believe that the true optimal value is going to come when we get to the level of integration between the traditional care delivery operations and some of the programming that we've built. That's where we are now — working with other leaders within our organization in more of the traditional in-person, brick-and-mortar spaces to understand how we can leverage the capabilities to get the most value.