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.

Digital Medicine is a nationally recognized, clinically proven program revolutionizing how we treat chronic conditions combining digital tools and engagement with a dedicated care team.

Ochsner O Bar Supports Patient's Digital Health needsIn 2015, Ochsner Health launched its first Digital Medicine Program for Hypertension. Since publishing success outcome measures in The American Journal of Medicine, Ochsner’s Chief Clinical Transformation Officer Dr. Richard Milani, and his team have built on the framework to support patients with chronic conditions (e.g., Diabetes, COPD) and Maternal care. Over 30,000 patients have participated in an Ochsner Digital Medicine Program.

With the cost of chronic care, including indirect costs (productivity loss) reaching $3.7 trillion a year, Ochsner is focused on better managing chronic care through three key levers: medication management, behavioral change, and frequent data collection from home.

Milani believes that a successful Digital Medicine Program must:

• use the latest guidelines for medication management, important because ideal medications are always changing, and a certain medication may be more effective for one patient (profile) than another.
• be designed with behavioral science to impact lifestyle change, which includes everything from delivering the right type and timing for nudges to aligning patient needs with right level of high touch care support.
• leverage data captured and presented within a reasonable time so that clinicians can respond before the patient’s health becomes a problem.

Dedicated Team, Centralized Monitoring

Ochsner’s Digital Medicine programs are supported by a dedicated team of over 60 professionals, including clinicians, coaches, pharmacists, physical therapists, behavioral scientists, IT developers, technology engineers, user experience, content specialists, data scientists and advanced analytics.

Team members help patients throughout their program journey, with onboarding, educating and ongoing care support.  An important benefit of having one Digital Medicine team is that the program can be personalized to the patient’s specific needs (e.g., required monitoring devices) and supported by the same clinician and coach.

EMR Foundation  

“The technology foundation of our Digital Medicine Programs is the EMR Epic,” explains Milani.  “Our patients are given clinically validated devices approved for the program, with device data flowing into the EMR.”

Ochsner has evaluated and selected a set of devices for this program for each condition, which patients are required to use to connect into the Program. Ochsner distributes the devices and is the point of contact for any technical issues.

Patients access their Digital Medicine Program through the Epic portal My Chart (via website and patient mobile app), where they can view trends on device measures, access educational information, complete assessments, and exchange messages with the Digital Medicine Care team.

“For our clinicians, we have designed dashboards which help triage and prioritize patients based on incoming patient health data including Social Determinants of Health,” says Milani “We have set up alerts for our program care team based on selected physiological and inputted measures.  Other providers of the patient’s care can access information in Epic, including a Monthly Report.

Patient Digital Medicine Program Experience

Ochsner Digital Medicine Patient After a referral from his physician, patient Peter (not his real name) is invited through Epic to participate in Ochsner’s Hypertension Program. Participating in the program means that Peter can reduce time off from work and save time driving time for some appointments.

Peter has the option of having the device(s) and program setup information mailed to him, or if nearby, Peter can stop by Ochsner’s O Bar – a physical location that allows patients to test drive more than 100 Ochsner-approved health apps and purchase devices. There’s a technology specialist behind the counter to answer questions and give app demonstrations. (Think genius bar to support patient health technology).  

Once Peter sets up his blood pressure monitor, his measures are sent to his care team. If any measures are out of range, his care team will reach out to discuss any possible changes needed. Peter’s coach sets up personalized messages regarding lifestyle changes needed and reminders to keep him on track with taking his medication and taking his readings. Peter can communicate with his coach via SMS texting, My Chart messages or via phone.  

“We are seeing that patients prefer to communicate asynchronously with their clinicians and coaches, so we are giving them the tools to do so,” says Milani.

Digital Medicine Program Success

“We evaluate success based on a few key measures,” says Milani. “We look at outcomes and are seeing a consistent 2-3 times improvement in control rates with our program. We also look at Net Promoter Scores (NPS) and we are getting very high patient satisfaction scores of 87-90.”

Ochsner recently conducted a pilot program (beginning in June 2020 and ongoing) to investigate how digital medicine with remote patient management can improve outcomes for Medicaid patients battling chronic diseases like Hypertension and Type 2 Diabetes. The results were statistically and clinically significant. Enrollment in Ochsner Digital Medicine brought nearly half of all out-of-control Hypertension patients under control at only 90 days, which was 23% more likely than usual care. Control rates continued to improve as patients remained in the program during its first 18 months. More impressively, 59% of people with poorly-controlled diabetes achieved control over their condition as part of the digital program – a rate twice as high as usual care.

Most patients achieved control of their hypertension and diabetes within 90 days of beginning the program, even those who had poor control prior to enrollment.

In addition to improving health outcomes, participation in the digital medicine program resulted in high patient satisfaction, with a net promoter score greater than 91 for Medicaid participants. This is consistent with the high patient satisfaction with digital chronic disease management programs at Ochsner among non-Medicaid patients.

“We're offering patients compassionate human care combined with the power of technology, and we’ll continue to expand these programs to help more patient populations”, Milani concludes.

Success in their words

Patients:

“My care team has been really helpful. They’ve explained things to me… offered me suggestions. I really like the fact of daily accountability. I’ve lost about 103 pounds. I feel better. I have energy that I didn’t have a year ago.”

“I know I’m sleeping better–my hair, my skin, my vision–just different things that you start to notice that we take for granted that are all tied into our blood pressure and blood sugar. I’m a living testimony that it (the program) works! I know for a fact Ochsner Digital Medicine has saved my life.”

“I feel like this is more normal. Someone’s got my back and… I will be able to use [the program] for the rest of my life.”

“The Ochsner Digital Medicine Care Team helped me by guiding me in every way possible – giving me tips on my diet and adjusting my medication on the fly. They are a good support team.”

Staff:

“I love the Ochsner Digital Medicine program. As a physician, I love having the Digital Medicine team helping me because it’s like having other coaches on the team.”  Dr. Victoria Smith

Ochsner’s Digital Medicine Program is available to employees across their health system. 

“The Ochsner Digital Medicine program is one of the most important components of healthcare for our (employees). If I can offer better benefits and possibly reduce healthcare costs, why wouldn’t I? We have had employees sign up for the hypertension and Type 2 diabetes programs and have seen many positive results in a short period of time. The program lets your employees know how much they mean to you by investing in them”, Chief of Administration, Chris Kaufmann