During the recent Home & Hybrid Care Virtual Summit 2024, St Lukes Health shared how they have expanded virtual access to support patient care journeys over the past three plus years. It is refreshing to see how St Lukes views virtual as a big front door to their care network, how they have personalized the entrance and experience across more than a half dozen patient programs and how they have invested in an integrated data platform and tools for better care experiences.

Like other health systems, Idaho- based St Lukes Health is addressing today’s healthcare headwinds including staffing challenges, provider burnout, the consumers increased expectations for their healthcare experience, all within the regulatory and reimbursement landscape.

In September 2021, St Lukes Health launched a telehealth program to patients with one of seven low acuity conditions.  Since then, their virtual program has expanded to provide patients with immediate care access until they can schedule and see their providers, which may take up to a few months.

“Our team value is that we (virtual care) will be the quickest access to a provider”, explains Abby Losinski, MHA, Director of Telehealth at St Lukes. Abby’s group is part of the Consumer access and experience team.

St Luke Virtual & Hybrid Model

Since late 2021, St Lukes has developed needed processes and infrastructure to successfully expand their virtual program with a centralized virtual support team, virtual command center platform to address incoming patient demand and virtual care patient data integration to support care collaboration and a superior patient experience.

While many health systems launch separate virtual programs to support urgent care, mental health,  and chronic conditions, St Lukes centralized team supports many patient populations with virtual care access. They view this virtual interaction as an opportunity to begin a patient relationship.

Several patients targeted by St Lukes for their virtual care program:

• New Patients (December 2021) St Lukes promoted virtual services to welcome patients without a doctor but with an immediate need. During the virtual visit, patients can refill a prescription, get scheduling help and access care support until their appointment. Patients needing a higher level of care are quickly connected with a clinician. 

• Urgent Care (May 2022) Patients at St Lukes’ Urgent Care Centers with high wait times are offered a virtual appointment when they meet certain criteria. Patients use their mobile phones for the visit and are urged to stay nearby if point of care testing is required. This gives patients a chance to be seen when there are no available rooms. 

• Service Line Extension (January 2023) “We are an extension of any department where patients need same day access” (e.g.  primary care, urology, oncology, pediatrics) explains Losinski. “We work with the Medical Directors to build clinical guidelines so that patients are treated the same way whether they are coming in to see a specialist or meeting with our virtual clinician”.  Losinski is proud that St Lukes “can offer multi-specialty care from one centralized team”. 

• Maternity/New Pregnancy (April 2023) After learning about their pregnancy, patients often have questions and concerns. Instead of waiting for their first appointment which may take 8-10 weeks, patients can meet with a clinician virtually and set up notifications in MyChart to immediately receive information about their maternity care and growing baby. During the virtual visit, patients can get scheduling help and care can be escalated if required. 

• Home & Community Access (Sept – December 2023) St Lukes has set up “virtual hubs” enabling patients to connect virtually using digital health tools from a partnership with TytoCare. “We wanted to expand what we can treat virtually because we have new tools. If we can’t see into the ear, we can’t treat it” and the revenue is lost, Losinski explains. St Lukes now offers TytoCare Home devices (e.g. otoscope, stethoscope, throat camera, skin camera) to patients at home and TytoCare Clinic to patients at schools, libraries and workplaces, to capture data for the virtual care team decision support.

St Lukes Virtual Care Access Experience Success 

Their virtual program success is achieved through continuous focus on the patient experience. St Lukes has designed their virtual experience from the outside- in and offers patients the bridge into their health system care network.

Here are several success elements that I have noticed to deliver care continuity:

Designed Patient Experience to fit care scenario. Newly pregnant patients are set on the Maternity path, supported by the virtual team with education, testing and virtual visits until their OB appointment. Service Line Extension patients such as oncology may have access to digital tools for remote monitoring with condition education and support until their specialty appointment.

Partnered for Patient Care Coordination. St Lukes’ Consumer access & experience team has built partnerships with different service lines and settings across their network. Patients accessing virtual care at St Lukes needing more care are escalated to these clinical partners within the St Lukes network. St Lukes ensures patient care quality is maintained by using the same clinical guidelines for virtual and in- person care.

Built Integrated Patient Data & Tech Infrastructure. “St Lukes has decided that virtual care can not be this thing that lives outside of the health system”, Losinski emphasizes. St Lukes has invested to integrate and augment patient data (TytoCare devices) enabling clinicians to access information from all clinical interactions and from patients from beyond the walls to deliver better patient care and experiences.

St Lukes Virtual Care Feedback

Through marketing research, St Lukes has learned: 

Consumers: The “brand” offering virtual care services really matters. Consumers like that the doctors conducting the virtual visits work for St Lukes and live in the community and appreciate that their PCP can view their virtual visit notes.  

Patients: After participating in St Lukes’ virtual services, patients rated the experience an equivalent of 4.9 stars (out of 5). “Thank you for being there when no one else was” shares a patient.

Providers: Clinicians delivering virtual services have a strong provider experience; “appreciate the increased location and schedule flexibility”, “being in the moment for patients” and “getting to work from home”.

St Lukes Virtual Care Direction

Earlier this year, St Lukes launched eVisits, an asynchronous virtual care option. For $29/visit, patients can message a clinician about one of seven symptoms. eVisits are viewed as a virtual care “entry point which affordable and convenient for patients”.

St Lukes will continue expand virtual care access for their patients. “Currently, we are 8am-8pm but we are looking to extend our hours to 24x7” Losinski shared.

It is impressive to see how St Lukes brings patients into their care system through a larger virtual care front door, leverages care partnerships and protocols for consistent patient care quality and empowers care collaboration with integrated data and tools. St Lukes’ virtual care investments and vision enable them to effectively address staffing and consumer expectation challenges while delivering a superior patient and provider care experience.

Navigation Bar for Stanford Health Care Patients“Healthcare today is changing and we need to be a catalyst for change with our patients,” explains Alpa Vyas, Stanford Health Care’s Chief Patient Experience & Operational Performance Officer.  “In order to create a superior experience for our patients, we have expanded our understanding of patient needs through empathy, incorporating design thinking into our clinical and operational processes."

As part of Stanford Medicine, Stanford Health Care has a long history with patient experience and is committed to continuous improvement by collaborating with patients on products, programs and processes. Patient Experience is one of Stanford Health Care’s four main pillars, demonstrating the importance to their organization.

At the PX Symposium in Boston, Alpa will be presenting Design Thinking Rx: A Prescription for Innovative Healthcare Solutions. Join me at the Symposium to learn more about Stanford Health Care and other truly patient- centered organizations. I will be leading a round table discussion to exchange best practices and processes for a superior patient experience. 

5 Questions in 5 mins, Interview by Sherri Dorfman, MBA, CEO Stepping Stone Partners

1. How do you define Design Thinking at Stanford Health Care? How does this fit with Human- Centered Design and Co-creation?

“We view Design Thinking as the ‘How’ we problem solve. We start with the end user/patient and use empathy to gain insight into needs to define the problem. Then we move through the Design Thinking process with ideating, prototyping and testing solutions.

We see Human Centered Design as the ‘What,’ our philosophy of engaging with the patient at the center of our process. Co-creation is the ‘Who’. We collaborate internally with our physicians and staff and externally with our patients.”

2. Tell me how Stanford Health Care gathers and leverages insights during the Design Thinking process.

“We use a ‘Collaboration Model’ where we define the problem statement and then refine it with insights collected from internal (e.g. clinical, operational, technical) and external (e.g. patients, family caregivers) stakeholders. We use surveys, discussions and observations. Depending on the project, our internal discussions may point us to others with specific expertise or experience interacting with patients. For patients, we may observe them (with their permission) in the hospital or their home to understand their needs for care and support.”

3. Can you share an example of how Stanford Health Care has successfully used the Design Thinking process to define a better patient experience?

“We are in the process of enhancing the service that our ground navigation team delivers and are excited about what we have discovered. We want to move beyond typical wayfinding services and hospitality approach. Through discussions with our operational leaders interacting with patients who are looking for information and guidance, and via patient surveys and interviews, we learned about the need for improved communication support and better coordination support. We are defining a new, higher level navigation role which will allow us to expand and enhyance our level of patient support. This may include scheduling appointments post discharge from an inpatient unit or emergency department, arranging transportation, securing lodging for family members and providing care updates on for patients – For example, ‘I spoke with the nursing team and they will be bringing you back in 20 minutes’.”

4. Thank you for that specific use case. Tell me how Stanford Health Care is using Design Thinking to address a broader patient problem.

“During the pandemic, we had to pivot on how we provided care ‘Access’ to our patients, from in -person to virtual visits. Looking forward, we want to start thinking about ‘Access’ differently. We are engaging staff and patients in the process of defining the next generation of care, including asynchronous care. We are learning that patients see care ‘Access’ as much more expansive. Based on insights from staff and patients, we are exploring some ideas including PCP eConsults (curbside) with specialists to determine the need and urgency for the appointment and virtual nurse triage.”

5.  How does Stanford Health Care measure success for PX initiatives?

“Back in 2022, I contributed to a PX Journal article called ‘Measuring what matters: A proposal for reframing how we evaluate and improve experience in healthcare’. Through extensive discussions with industry experts, the journal article concluded that in order to design experiences that are meaningful, we need to understand what really mattered to patients, families and care partners. At Stanford Health Care, we have looked at our surveys where we ask the same questions and engaged with staff and patients for their feedback. With those insights, we have added questions including those to get feedback on new process enhancements.

We are bringing these survey and discussion insights (including open ended comments) to our operational team members in real- time to translate into immediate changes for our patients.”

With planning underway for 2024, Alpa and her team are interested in further utilizing Design Thinking to develop better programming for Stanford Health Care. “We are working on the next generation of care- exploring ways we can use the insights we have gained to create more personalized experiences for our patients.  The Design Thinking process will guide our exploration on how to leverage data and feedback that may be buried within our systems to hone in on specific challenges and solutions – this is where we hope to invest”, Alpa concludes.

It all started with a simple question one day, and grew into a trusted health relationship a few short months later. Sarah was very busy at work that crisp fall morning and had only a few minutes to log in and ask about her daughter’s diabetes medication. Sarah was comforted by the response and a bit intrigued when her Health Assistant Harriet introduced herself and explained that she is a resource to help her and her family with any of her health questions or concerns. They began a conversation about her daughter’s condition and a trusted relationship began.

Later that week Harriet made a follow up call to see if Sarah was able to pick up her daughter’s medication and asked how everything was going. Sarah mentioned that she finally got her daughter’s pills and confided that she was completely overwhelmed. Sarah shared that she was recently diagnosed with breast cancer and that her husband was often unavailable as he traveled constantly for work. She explained that she had a hard time getting to her treatments. After their call, Harriet explored and evaluated resources, and scheduled transportation to help Sarah get to her next appointment. Harriet put the appointment confirmation into Sarah’s patient portal and set up a reminder, including date and time, about the ride to her next treatment.

This may sound like fiction in the current healthcare environment, where services are siloed and patients are burdened with making their own decisions around healthcare – often complex and costly. Sarah is relieved to have this service today. She first learned from her employer about the Accolade platform and health advisor service last summer. It wasn’t until she reached out with a simple question to her health assistant that Sarah experienced the true value of having a healthcare advisor on her side.

A 2016 Harris Poll reveals that 84% of working families placed a value on having a single, trusted resource to help support their healthcare needs. Busy families have limited time and resources so they appreciate having one place to go to help them understand their options and sort through their healthcare decisions. 

Personalized Patient Experience

With the Accolade Health Assistant as the single point of contact for her family, Sarah is able to reach out to Harriet for guidance all along her and her family’s healthcare journeys.  Accolade integrates high tech and high touch to deliver a superior patient experience with lower healthcare costs. 

Accolade Health Assistant Harriet accesses the Accolade platform to interact with and personalize her support for Sarah:

Preferred Communication: Harriet engages with Sarah and her family based on their communication preferences. Sarah likes phone calls and email through the Accolade online portal. Sarah’s husband Sam prefers secure text messages since he can send quick messages and follow up later during his business trips.  

Personalized & Proactive Experience: Harriet’s interactions with Sarah are driven by rich patient profile information, which contains contextual information, social determinants of health and service utilization. Sarah and her family’s profiles are updated with data collected over time and more than 150 data feeds integrated into the Accolade platform. The HIPAA-certified approach creates profiles that are continuously analyzed through sophisticated algorithms and health assistant reviews, which allow for personalized conversations around individual health needs, care gaps and obstacles.

A recent Accolade platform trigger prompts Harriet to reach out to Sarah’s husband Sam when she notices that he is still refilling this pain medication many weeks after his knee surgery.  Harriet sent a text to Sam to inquire about his knee surgery. After a text exchange, Harriett suggested that he see his doctor to discuss his persistent pain.

Patient Education & Connected Health: Sarah and her family can access educational information and recommended health apps. Before Sarah’s husband knee operation, Health Assistant Harriet texted Sam with a link to a video and suggested questions to prepare for his surgery and provider discussion. 

When Harriett spoke with Sarah about her daughter’s diabetes appointment and care plan, Harriet informed Sarah about the Livongo mobile diabetes application available through her employer’s health plan. Together, they review the Livongo app, which can help Sarah and her daughter better track and manage her diabetes. With Accolade and Livongo, Sarah is able to share information from the mobile app with her daughter’s doctor, giving him insight into her problems with controlling her A1C levels.

Continuous Connection to Clinical Resources and Support:  Harriett asked Sarah if she would like to speak with an oncology nurse to help prepare her for her upcoming oncologist appointment. Margaret, an Accolade Clinical Health Assistant and RN, joined them on the line and offered empathetic support by asking more about Sarah’s diagnosis, where she was in her care plan with her doctor, whether she had a support network and what was planned for her next appointment. Margaret provided Sarah with questions to ask her oncologist and recommended a follow-up discussion.

Intelligent Engagement: Harriet and her Health Assistant team are continuously alerted by the Accolade platform. On an ongoing basis Accolade gathers, aggregates and models de-identified data to trigger alerts and guide Health Assistants in further personalizing their interactions with their clients.  Health Assistants are prompted to ask questions about health behaviors and emerging symptoms, applying specialized training and skillset. 

Patient Experience Success Measures:

Paul Csigi, Director of Benefits at Philadelphia- based Temple University Health System (TUHS), rolled out the Accolade solution in 2015 and has over 7,000 employees on the platform today.  “So much of healthcare is getting people to the right place at the right time. Accolade has created an experience where our employees build a relationship with an assistant that gives them what they need, when they need it. Accolade takes a single problem that the patient has called in about and creates a relationship to support the family on an ongoing basis. With all of the information about our employees, Accolade addresses the whole person, connects the patient with clinical resources, and continues to reach out. This helps treat our employees sooner, which is less expensive for our organization.”

In addition to financial measures, TUHS monitors qualitative feedback from employees. With the Accolade platform outreach (phone or online), TUHS is able to capture the patient’s experience engaging with their Accolade Health Assistant:

“I'd like to thank Temple for the Accolade program. We have been going through some really tough times…..my health assistants have been a big support and a big help to my family in helping to guide us to the right doctors to help with family issues and illnesses. I really appreciate this program. Without it, I'd really be lost.”

With two years of the Accolade solution under their belt, Paul Csigi and his team are considering new ways to support TUHS employees. “I have an employee population with diabetes and heart disease. I am interested in learning more about Accolade’s partnerships to bring patient data into the platform to support these populations.”  Csigi sees the benefit of bringing in data from patient devices and smart applications. Integrating this data with the patient’s medical record gives new insights to Accolade Health Assistants, empowering them to deliver even better support and drive improved outcomes.

At the 2016 Consumer Electronics Show (CES) in January, UnitedHealthcare launched Solutions for Caregivers, an online program that provides resources for caregivers and their family; personalized information, a discounted marketplace of products and services and care circle community for ongoing support.

UnitedHealthcare is addressing the evolving needs of a large population of caregivers. According to the Caregiving in the U.S. 2015 report by the National Alliance for Caregiving (NAC) and AARP Public Policy Institute, an estimated 43.5 million adults have provided unpaid care during the prior 12 months,  34.2 million (79%) offering care for an adult age 50+.

“Many caregivers are searching for relevant resources but often don’t know where to start. Solutions for Caregivers addresses the needs of family caregivers through case management services and online resources that help caregivers more effectively care for their loved ones,” shares Dr. Richard Migliori, EVP and Chief Medical Officer, UnitedHealth Group.

Caregiving Burden

According to the Caregiving in the U.S. 2015 report, caregivers spend an average of 24 hours each week helping their loved ones. Many caregivers experience their own physical, emotional and financial strain as a result of their caregiving role. Half of the caregivers indicated “they had no choice in taking on their caregiving responsibilities,” and 40% report being in high-burden situations. When asked about their health, 17% said ”it is fair or poor”, compared with 10% of the general adult population.

Many caregivers (60%) admit they had to make a workplace accommodation, such as taking time off or reducing work hours. On average, caregivers assist with “4.2 out of 7 Instrumental Activities of Daily Living (IADLs),” including transportation, grocery/other shopping, or housework. Most caregivers (84%) report an interest in receiving more information such as “keeping their loved one safe at home” and “managing their own stress.”  

UnitedHealthcare has conducted extensive research with family caregivers to understand their challenges around caring for a loved one. Vidya Raman-Tangella, M.D., head of UnitedHealthcare’s Innovation Center of Excellence, explains, “We heard that each journey is a ‘unique’ and ‘personal’ experience. Family caregivers are often not prepared and do not know where to begin, which causes anxiety. Some caregivers need support recognizing ‘what is good’ when making decisions for their loved one. Finally, UnitedHealthcare heard that the family caregivers did not want to feel alone and wanted to work together with others in their care circle.”

CAREGIVERS MARKETPLACEVidya and her innovation team set out to define a solution based on these caregiver needs. The team started with a portal front end to house a set of tools to help caregivers:

Personalized Information – educational articles and videos that are tailored to the specific medical issues and needs of the care recipient and caregiver. UnitedHealthcare’s articles support the topics requested by caregivers (i.e. safety, stress). Users can save an article for future reference or share with others (i.e. siblings, health coach and clinician).

Marketplace – set of vetted discounted products and services to support the caregiver and care recipient’s conditions and challenges. Product categories include “assistive products”, “home monitoring”, “home safety” and “medication management.” Service categories span “financial”, “in-home care”, “nutrition” and “transportation”. Regarding “nutrition,” caregivers can order meals that are tailored to the care recipient’s health condition (i.e. low salt, low sugar). UnitedHealthcare’s marketplace is designed to support caregivers for activities they undertake on a regular basis, including transportation, shopping and house work. 

One service option is for a “Care Manager” who can help the family plan or respond to care recipient/caregiver needs, via online, phone or consult (secure messaging). Some caregivers may have a health plan benefit that covers the care manager service, while others have the option of paying the hourly fee.

Currently, UnitedHealthcare has mostly national companies and a growing number of regional and local offerings in the marketplace. Based on the care recipient’s zip code, there may be a national service provider such as CareLinx, which offers services in the specified geography.

Community Support – centralized place where caregivers and friends of a loved one can connect, share insights and concerns (i.e. how does mom look today), add and view medical appointments & meetings on a daily/weekly/monthly calendar, post and assign tasks (i.e. a ride to the doctor’s appointment) and access a library of documents such as medication lists, doctors list, health records and a living will. The solution serves as a repository of this information, however there is no integration with the EMR or any clinical information 

Caregivers can also invite others, such as clinicians and in-home caregivers, and enable them to securely access information and communicate on a common platform.

Although other companies promote online caregiver offerings today, UnitedHealthcare has designed a 'personalized caregiver solution'. During the sign-up process, the caregiver creates a profile by responding to set of questions about the care recipient; relationship, age, zip code, conditions and challenges. The caregiver also indicates their own health conditions and challenges. 

For example, when family caregiver Carla responds that her 86-year-old mother has hypertension and diabetes and is dealing with mobility issues, and she (the caregiver) is experiencing depression, Carla will see articles, videos, products and services that are relevant to both of their needs.

Caregiver Solution Pilot

UnitedHealthcare is providing the Solutions for Caregivers program to large employers at no additional cost for employees to access the online services. As of January 2016, Solutions for Caregivers is being promoted to over 1 million employees. Currently, Solutions for Caregivers is also accessible to the public. For people using the employer-sponsored version, the company can cover the costs associated with care management services, enabling caregivers to access more holistic support. In comparison, people accessing the consumer site, or instances where the employer has not purchased the additional care management services, can pay out of pocket for these resources. In both versions, caregivers can access customized content, shop from the marketplace, and use the myCommunity resources.

UnitedHealthcare has received positive comments about their Caregiver solution, that it “saves time” and they would “recommend it to other caregivers”.  To date, UnitedHealthcare has also noticed that many users are in the early stages of caregiving.

Future Solutions for Caregivers

“While it will take the rest of 2016 to build the volume of users, we will continue to grow our marketplace through strategic partnerships with product and service companies. We are especially interested in technology solutions for caregivers”, shares Dr. Vidya Raman-Tangella.

UnitedHealthcare is planning to leverage all customer service touch points to identify caregivers who are currently moving along the care journey or will be on the journey soon as potential users of the solution.

“Throughout the year, we will learn how this program is delivering value to caregivers and care recipients. With Boomers turning 70, we will be particularly interested to see how our offering will be used to support the boomers as they retire as well care for their loved ones”, explains Dr. Raman-Tangella.

“This program and others from UnitedHealthcare are making it easier and more convenient to people to take charge of their health and the health of their loved ones. By using technology and personalized resources, we are helping people to live healthier lives”, Dr. Migliori concludes.