As the economy slowly reopens, health systems and OB-GYN practices are navigating questions around getting patients back into the office, and the future role of the virtual care solutions they've implemented during the pandemic. President Juan Pablo Segura sat down (virtually) with Mira Ketzler, the senior director of the women’s health service line for Advocate Aurora, to discuss the business implications of Covid-19 and what the future holds for health systems post-pandemic.
I’d like to focus on the business side of things, and how Covid has changed business leaders. You’re the senior director of the service line, managing a very large, multi-state organization. How are you balancing OB and GYN appointments? Have they all gone virtual?
For OB patients we’re following what ACOG recommends and continuing to see our prenatal patients through a combination of virtual care and in-office visits. For GYN, we’ve had to go through a more deliberate prioritization process: we’re looking at our patients to determine who needs to come in, who we can see by video, and which appointments we can delay or push. We’re now at a point where some appointments have been delayed for a couple months, and there are some concerns surfacing about those delays. It’s been a change and a challenge for our patients and our physicians.
GYN patients are obviously different from OB patients — after all, you can’t hit pause on a pregnancy. Is there a concern about reactivating GYN patients? What kind of methods are you implementing to get those patients back on the schedule?
Our priority through this has been on providing care for our patients, and focusing on essential and urgent conditions or procedures. As we start to look at reactivation, we’re approaching it as a dial that needs to be turned on very slowly. We’re looking at the patients that have been waiting now for a couple months to come and see us — some due for cancer screening, some perhaps symptomatic — and working on triaging those patients.
We’re also looking to create a space for our patients that they can trust is a safe place to come to. We’re doing phone screens the night before a visit to check for symptoms, and screening again when they come to the clinic. We’re applying social distancing practices in our waiting rooms and our offices; we’re masking our patients, their companions, our caregivers; we’re encouraging virtual check-ins; and we’re enhancing our cleaning. We want to assure patients that there’s been appropriate attention paid to the environment to make it safe.
What methods are you using to prioritize appointments? You mentioned a scoring system for this?
That has to do with our “elective” surgical procedures (I use elective in quotes). As we look at bringing patients back into the office, we have a need to prioritize not just in GYN but also the surgical world. We’re asking questions to determine the priority of appointments: what is the procedure? Does the patient need to stay overnight? What are their co-morbid conditions? Do they have high risk factors — not just with the procedure itself but with the individual? What is the complexity of their condition? We’re trying to apply a more objective approach in making those decisions — is it GYN surgery? Orthopedic? Cardiac? We’re looking at that in a much more comprehensive way as we start to turn the dial.
We’re opening things up this week in Wisconsin, next week (tentatively) in Illinois. How things get dialed up or dialed back is going to vary by clinic location — Milwaukee may look very different than Oshkosh, for example. It’s not a question of seeing patients — we’ve been seeing patients this whole time — but how we can bring those patients that have been waiting back into the system.
Let’s talk about technology. Telemedicine is now the “it” word in healthcare — there’s been a massive change in perspective and mindset as a result of Covid. Advocate Aurora is one of the most innovative systems in the country in terms of investing in startups and adopting technologies — they really have a comprehensive strategy. How has the utilization of video visits and remote monitoring exploded over the past couple months? Has the mindset toward tech changed in the provider base?
There’s been a couple things that have happened. We’ve been able to do video visits, and that’s been one of the good things to come out of this pandemic. It’s allowed our clinicians and patients to get into the virtual health world — and though it’s been somewhat out of necessity, it’s been very positively perceived both by patients and physicians, not just by our OB-GYNs but also our specialists. For example, our fertility clinics have been able to see patients through video visits who have been waiting a long time to start their course of treatment. It’s been extremely positively received.
Let’s dial into the OB framework. When Babyscripts and Advocate Aurora started working together, we began to virtualize the patient experience to help with convenience and satisfaction and management of practice dynamics. How has Covid changed the structure of prenatal care? There are some practices that are hesitant about restructuring the schedule. You were already rethinking the 14 visit schedule — what else has changed?
In addition to using Babyscripts and implementing that virtual platform for remote monitoring, we’ve incorporated video visits. For many of our practices that were already utilizing remote monitoring — some getting visits down to 7, with an average around 9 — we’ve added virtual visits to enhance the physician’s confidence in remote monitoring. Adding the video component, letting physicians see their patients, adds to the level of confidence.
The other piece that I wanted to touch on is our ability to message out to patients quickly through Babyscripts. When this started, we wanted to be very sensitive to the fact that there would be a lot of changes around visitation restrictions for labor and delivery — messaging out that info in a rapid fashion was important so that our patients could prepare. We messaged out visitor policy for the clinic — we’re not allowing visitors to come with patients unless they have a physical disability or demonstrated need for a companion — we’ve also let our patients know that we’re testing L&D patients to enhance their experience. This communication has helped in minimizing patients’ surprise and managing expectations in what right now is a very challenging time to be pregnant. It’s been very helpful.
Do you think virtual care will be the new standard? Some practices are unsure of what post-Covid will look — practices are worried that their provider-base doesn’t want to implement virtual care and will return to status quo.
We want the option to provide virtual care and video visits to our patients. Whether it’s off-hours, during the weekends, etc. we’ve found that it’s improved clinical flow of care and enhanced the patient experience. There will be a return to the office for some visits that are traditionally in-person, but we want virtual care to stay and we want our payers to accept it — that was the big barrier before.
With the payer incentives for virtual and remote patient care, do you think we can deliver better care?
The value of virtual care is access — even pre-Covid, our patients faced barriers of access — transportation issues, other kids at home, and other obstacles. Virtual care is a way to open up access, particularly for a patient population that had barriers to traditional care in the past — it’s a way to deliver care to our patients that haven’t been able to receive care even in normal times.
This makes me think of the Care Navigator pilot that we developed together using texting — these different modalities work. It’s not just video visits, it’s remote patient monitoring to detect blood pressure, it’s texting to identify issues — we’ll be making the plea together to get reimbursement.
Have some of these changes been hardwired in practices? Are you seeing practices change for the future even during this emergency?
It’s been a combination. At the end of the day, our physicians and patients will say nothing will replace the in-person connection and there will be in-person needs. But some of the hardwiring that we’ve done has enabled a flow that enhances the experience and efficiency at practices, so keeping it loose for our patients and practitioners is something that we’d like to have for the future.
We always look for something good to come out of challenging situations — virtual visits are one good thing that have come out of this pandemic.
About Advocate Aurora and Babyscripts
Advocate Aurora Health is one of the largest non-profit health systems in the country: with over 30 hospitals in Wisconsin and Illinois, they offer more sites of care than any health system in the Midwest and deliver over 32,000 pregnancies annually.
Starting with an Innovation pilot program three years ago and expanding to a robust and thriving partnership, Advocate Aurora has a long-time relationship with Babyscripts.