A: What have been some of the benefits for patients?
MA: In a virtual world, there are many more opportunities for engagement. For instance, a provider might typically see a patient once a year for episodic care, and then maybe once for a preplanned annual checkup. But the reality is that the patient has also had a variety of other life events related to their health. So if you have a 65-year-old with type 2 diabetes, you might see that person four times a year and maybe have a few ancillary visits. In a more digital world where the person is connected to the system, data may show that they're not doing well from a diabetes perspective.
If we engage with virtual solutions, maybe some of their in-person appointments turn into asynchronous e-visits or a video visit. If the person has questions, they might use a virtual triage self-service tool. And if we identify that their condition is not improving, we might put the person on a remote monitoring platform and start to prescribe a digital therapeutic to help them self-manage their condition. With virtual, the touchpoints could be 150 or 200 a year. It really changes the overall experience.
A: Which digital services have the greatest potential to scale?
MA: Patient self-service has the most potential to scale. We learned that our community would engage with virtual triage, especially with COVID-19. Through asynchronous e-visits, we helped people to determine whether they're qualified for a test. Then we issued a ticket for a test and booked them into a slot. Approximately 37,000 people from September through December went through that process. We saw quite a lot of uptake. But when you look at patient self-service with an eye toward scaling these things, you have to think, are you going to have a centralized approach to do this?
A: Do you have that type of centralized scheme?
MA: We're pushing toward centralization as much as we can to try to take some of the day-to-day challenges off of our front lines. Some of this will remain decentralized, especially where a personal relationship is key. But we want to try to centralize administrative and off-hours work.
With respect to our on-demand video visits, we stood up our own internal model at the beginning of the pandemic to allow people to be assessed for COVID and order a test if they needed it. We went from a few hundred of these a month to thousands a month because it was a centralized, easy-to-access service that was on demand in an average of 8 minutes.
A: How have you redesigned the care model in light of your digital transformation?
MA: We work with each of the service lines of the organizations to determine how their model had to change and what menu of different virtual or digital tools could help. There is a fair amount of adoption because they have input into how things would work. It's a nuanced discussion because there is no one size fits all for it. We approached it using an outside-in approach to understand how to best evolve each practice.
And in terms of rolling out changes, we have sponsorship from physician leadership. We also have training resources that may have originally been devoted to EMR training, which we can deploy for “at-the-elbow” support. And then, we have a broader organizational development department helping with some of the change management aspects. There is no single individual that's responsible for this change, because while it's one thing to know the technology, it's another thing to actually say, "I want to use it." If organizations don't address the broader, "why would I want to use this" question, all the training in the world on how to use it is pointless.
A: How are you measuring success of virtual care?
MA: We're still working through the clinical quality metrics. We don't have all the data in yet, but our belief is that we didn't miss much when it came to quality metrics, even though we shifted a vast amount of care to the home. We also looked at patient satisfaction data. We measured incessantly during this period to see what people felt about virtual care. Were they finding things either helpful or not helpful? We iterated quite a bit during that period. But our virtual patient satisfaction scores were on par or better than what we had for in-person care, and we're already a top performer in patient satisfaction. So those are good for outcomes and metrics over that period of time.
A: What does the future hold for F&MCW?
MA: We see virtual care as providing tremendous opportunity for future growth. In-person care will continue to be essential, but wrapped around these visits will be digital therapies that continue to improve. Patient self-service will enable providers to have an economically sustainable model.
As with any organization, it is important to focus on financial sustainability as we build capacity in virtual care. It’s not just a matter of integrating virtual care into existing care models, but redesigning the care model with virtual care as part of a broader consumer-driven approach.
A: What do you enjoy most about your job?
MA: I am lucky to be able to work with a wonderful team, with an incredible organization, in a really important space in society. The team is small, but it’s made up of some of the smartest and most passionate people I have met. The organization is led by an amazing CEO who supports this work and has the vision to see where it is going.
A: Who has inspired or influenced you in your career? What advice or guidance did that person provide?
MA: This list is long. I have been really lucky to know or find inspiration from many people. An early mentor of mine was Jean Glattke, who as my boss when I was moving from a staff physical therapist to a leader. She modeled behaviors that I aspire to achieve. One quote of hers that sticks with me is, “people don’t care how much you know, until they know how much you care.” At the intersection of technology and healthcare, those words seem very relevant.
A: What do you like to do outside of work? Do you have any special hobbies or interests?
MA: I am an avid cyclist. Those who know me well, know that my dream is to retire in Mallorca, Spain and ride my bike every day.