AVIA has always been a leader in the field of digital healthcare transformation, and Babyscripts has been privileged to partner with them both in a financial and innovative capacity for several years. As the nation’s leading digital health transformation partner, working with over 50 healthcare organizations, AVIA has a finger on the pulse of the digital health market — pre-, during, and post-Covid. 

Babyscripts sat down with Sarah Carroll from AVIA to talk about the current landscape of virtual care. As the director of AVIA’s Medicaid Transformation Project, she has a unique insight into the role that virtual care will play for vulnerable populations, and what the future holds for health systems struggling to recuperate financial revenue lost through the pandemic. 



JP: Thanks for talking to me today, Sarah. Can you lead us off with a little introduction about AVIA and your role there? 


SC: In our role as digital health transformation partner, AVIA provides market intelligence, collaborative tools, and results-oriented consulting to help solve healthcare’s biggest challenges. We use Avia Connect, a knowledge sharing and collaboration platform that provides up-to-the-minute insights and best practices for those who are considering making a play in digital and want to understand the solution landscape and strategic insights. One of our unique capabilities is the collaborative approach that we take across our member network — we include member huddles, opportunities for peer networking both virtually and in-person, and case studies, which really build the confidence of our network and accelerate the pace of change.


We have four strategic initiatives underway. The first is called the Digital Front Door: it’s really a consumerism initiative to make healthcare more convenient and friction-free, primarily through virtual visits and care navigation. We have a Children’s Hospital Initiative that aims to increase access to quality care while solving for lower margins, increased expectations, and competition in the children’s hospital marketplace. We have a third initiative called the Twenty-Five Percent Challenge that aims to reduce the administrative burden and the waste that permeates healthcare while solving for automation challenges, introducing robotic process automation solutions. Our fourth initiative, which I work on, is the Medicaid Transformation Project. Through that we’re aiming to solve complex problems for the most vulnerable in our community: problems like lack of access to behavioral healthcare, the substance use disorder that is so pervasive across the country, as well as unacceptably high rates of maternal and infant death. 


What binds all of these initiatives together is our laser focus on delivering greater value to all healthcare stakeholders through digital. 


I participated in a couple of the summits and workshops that you’ve held. It’s truly amazing — the precision and framework, and the ability to get institutions to change, speaks to your success and impact.


I’d like to discuss with you how the digital health and telehealth market are changing. It seems there are two ways of thinking about digital transformation now: pre- and post-Covid. If we were to rewind to the week before the Covid outbreak and the conversations that you were having with your customers, how were you describing the barriers and the path towards healthcare transformation? Were you identifying specific challenges? 


From the Babyscripts perspective, everyone wants to do virtual pregnancy care but they don’t have the budget, it costs too much, there’s no CPT codes. Before Covid, how did you organize some of those barriers and help your partners overcome them to transform through technology?


I like to think of this question in terms of three Cs: tackling the cost issue, talking about collaboration, and looking for an internal champion.


Around cost, the first two questions we usually get are 1) how much is this going to cost, and 2) will I get paid — in other words, will there be reimbursements for this service. What we try to do is elevate that conversation to consider other financial and organizational benefits of innovation. We offer financial impact modelling, and we consider the different environments that health systems are working in — whether that be fee-for-service or fee-for-value. For the former — specifically in maternity care — we talk about liability and we talk about capacity, because we know those are two significant concerns. In the latter world we talk a little bit about utilization, and we talk even more about outcomes — obviously we want to improve outcomes and avoid unnecessary utilization. What I’m finding fascinating in post-Covid conversations is that government has signalled a greater interest in giving more flexibility to providers to offer telehealth services, and we are expecting that there’s going to be some continued flexibility as we move ahead. In general, that news is really heartening. Also heartening is the fact that more payers are coming to the table in partnership arrangements to support providers. So I think the cost question can be tackled in a number of ways, and we try to do that with a really personalized approach.


In terms of collaboration, I’ve already touched on payers coming to the table and government expressing a bit more flexibility. Health systems are really complex organizations working in complex environments, and we need to acknowledge that change is hard with that level of complexity. What we try to do is work on identifying shared priorities, and a strong governance structure — we place outsize value on performance measures and evaluation planning because we know that folks are more interested in making these types of investments in evidence-based solutions. 


And finally, the third C is all about finding the champions. If the pandemic has taught us anything, it’s taught us about priorities, capacity, and leadership. The creativity and responsiveness that we’ve seen during the pandemic is second to none, and I’d like to think that will continue. I think the pandemic has eliminated any temptation to leave digital transformation to the next leader or the next five year plan. Digital transformation is here and now, and any ability to implement AI, symptom checkers, virtual visits, triage chatbots, remote patient monitoring — those are all here to stay. We believe that digital transformation is now every C-suite leader’s job. 


You spent a lot of time around cost. There’s obviously been a lot of financial devastation because of Covid, but it’s driven additional funding mechanisms as folks are seeing telehealth and virtual health care as a huge opportunity — and they’re willing to take some pretty big bets. The FCC has ushered in a few programs, and there’s more beyond what they’ve done. Could you share some of the work you’ve been doing with your partners to take advantage of these programs?


The CARES act was a $2T funding opportunity across a number of different federal agencies and there were a number of organizations that are now empowered to support healthcare providers. To date, the FCC’s Covid-19 telehealth program has funded 56 organizations in 23 states for a total of $25M. There was a total pot available of $200M  — so they’ve only spent a fraction of available funding. They’ve made the application really easy — it’s an 8-page application, which experienced grant writers know is a relatively easy lift.


Do enough people know about the program?


I think it’s taking off. I wouldn’t be surprised if they’ve only spent that fraction because the FCC has been inundated with applications and they’re still sorting through them. We’ve consulted with about 5 of our clients on their applications and though the application is relatively small, there’s up to a million dollars per application at stake, so it’s not small change. The FCC has provided some guidelines around eligibility and what they want to fund: in general they’re looking to expand telecommunication and information services as well as offer support for connected devices, and they’re mainly looking to support low-income and veteran communities in accessing healthcare.


Where we’re seeing interest is in delivering virtual visits, as well as remote monitoring for patients with Covid recovering at home. But I want to make clear that the funding opportunity isn’t only for Covid patients — the FCC would also like to support non-Covid patients and populations to reduce their risk of acquiring the virus, so long as it’s directed to a low-income community. 


The other bucket of funding, the $100M connected care pilot program, offers more funding over a longer period of time, but the bar to receive it is much higher. They’re looking for organizations that have previous experience in telehealth and are looking to build and expand on that experience. The FCC is specifically calling out opportunities that will lead to better health outcomes at a lower cost. They’re looking to support specific conditions, like individuals that have mental health issues, opioid dependency, chronic disease, and high risk pregnancy. They’re looking to target low-income patients, veterans, and residents in medically underserved areas. 


Are there other areas of virtualization that are getting funding? This program is a great example that there is more funding available to providers to go digital or virtual. Anything else that you’re seeing in your customer base on sponsorship?


We’ve been reflecting on how much the world has changed, just in the last three months. Maybe you went to the JPMorgan healthcare conference — it’s the largest digital health transformation conference in the marketplace, and every year there’s a lot of talk and not a lot of action. And this is in spite of the $58B that has been put into digital innovation since 2010. 


Fast forward 90 days — 120 days — by April, digital healthcare is everywhere: virtual visits, online cognitive behavioral therapy delivered in a virtual setting, guided interactions by text and chat — the world has totally changed. In fact I think it’s safe to say that most health systems have implemented more digital solutions in the past two weeks than in the prior two years. One of our network members told us that they went from 12 virtual visits in 2019 to 100K virtual visits in the last 6 weeks. Folks believe it’s here to say. Patients and providers are pleased with the experience and we’re seeing a lot of interest and accelerated movement in the space.


Will this stick? There are concerns about the future, patient behavior, reimbursement schema, etc., but despite those concerns a lot of these new virtual protocols are being hardwired into the delivery of care. Are we headed into a new normal? Is there a risk that a group of patients get left behind — specifically Medicaid patients? How can we prevent that? 


I’ve made two observations over the last months. The first is that March felt really reactive to me, and April and now May are feeling a lot more proactive. In March, the pace was incredibly impressive. It was amazing to watch how our health systems stood up virtual visits, they stood up remote monitoring, they looked specifically to reduce avoidable visits. Several members told us there’s absolutely no going back from here. The problem — and this is where we get into the proactive piece — is that even though telehealth has taken up some of the space, demand for services is down tremendously. So in the OB-GYN service line alone, Commonwealth Fund just reported that total visits are down by 45% over the last few months. The question is, how do we be more proactive in building patient confidence to seek care when it’s needed and not delay care? How do we build confidence in this rolling recovery period where there will be hotspots of Covid-19 emerging until we have a better handle on testing, tracing, vaccinations, etc.?


To your second point about vulnerabilities — this is obviously near and dear to our hearts — we’ve been tremendously saddened to see the economic toll that the virus has taken. We’ve seen 30 million people in the U.S. become unemployed in the last several weeks. With that, we expect more Medicaid enrollment and more uncompensated care, and that can be financially devastating for our health systems. But that is what the Medicaid Transformation Project was designed to solve for. We believe that digital can be really powerful in overcoming the financial challenges as well as the potential health concerns that our patients face as they navigate this new world. 


To put a finer point on that, since 2018, AVIA was already working with over 30 health systems to reach vulnerable populations. Now this work has become more important than ever, and we will continue to build on it. Babyscripts was one of over 60 maternal and infant health solutions that we examined during our maternal and infant health campaign, and it turned out to be one of just 9 that we selected to be best in class — digital leaders that can really demonstrate improved health outcomes, improved quality of care, improved experience and reduction in total cost of care. We think that AVIA and our partners like Babyscripts are poised for the challenges ahead. 


This new normal is not just a decision of preference at the clinical level. A lot of articles have been highlighting this as a choice, or a behavior that hasn’t been adopted, but financially and from an outcomes perspective, with the increase on the Medicaid roles, on the bottom line on these hospitals — no margin, no mission — I think that virtual will have to be part of that strategy to keep hospitals afloat. 


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