Rush University Medical Center’s Virtual Care Expansion [Webcast]

One result of the COVID-19 pandemic is the significant spike in virtual care, and it may be here to stay. Virtual care allows patients to access medical care from the safety of their own homes.

In March 2020 alone, telehealth visits skyrocketed 50%. What’s more, thanks to coronavirus, two-thirds of adults say they would be more open to trying virtual care — and nearly 100% of healthcare systems intend to expand their virtual offerings.

As healthcare systems are making plans to grow their virtual care offerings, they’re looking to those who have done so successfully. In this interview, CEO of CareContent, Kadesha Thomas Smith, and Founder of Creative CoStrat Lab, Camille Strickland, talk with Dr. Anthony Perry, MD, Vice President of Ambulatory Transformation at Rush University Medical Center on how they expanded their virtual care to offer patients a seamless — and helpful — experience.

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Watch: “Rush University Medical Center’s Virtual Care Expansion”

Watch below or view on YouTube.

Part 1: Can Virtual Care Grow Patient Volume?	Part 2: Planning A Friction-Free Experience
Part 3: The Virtual Care Menu Of Options	Part 4: Surprises For Video Visit First-Timers
Part 5: Promoting Virtual Offerings	Part 6: Getting Virtual Care Reimbursed
Part 7: Questions To Ask Before Launch	Part 8: Is Quality Of Care Still Good?

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Transcript

Camile Strickland: Hi, I’m Camille Strickland. I am a healthcare and communications strategist. I’m located here in Chicago, Illinois. I’ve been doing this for about 17 years, helping health systems across the country of different sizes and types to differentiate themselves and position themselves for growth. I’m happy to be here today.

Kadesha Thomas Smith: Great, my name is Kadesha Smith. I am the founder and CEO of CareContent. We are a digital strategy and content agency that serves hospitals and other organizations in the healthcare industry. Today, we are here with Dr. Anthony Perry of Rush University Medical Center.

Dr. Anthony Perry: Hello, my name is Anthony Perry. I go by Tony. I am a physician, and geriatric medicine is actually my area of practice. I’ve been working here at Rush University Medical Center, actually, for 29 years now — since 1991. I’ve been working specifically in a role where I’m overseeing an entity we refer to as the ambulatory transformation center. We do things from delivery of buildings to digital programs, so we kind of say from bricks to clicks is kind of the scope we do on a regular basis. Thank you for having me.

Kadesha: Thank you. So, we’re here today to talk about virtual care and how that has grown and sort of exploded at Rush. I shared with you that I was very interested in speaking with you because I am a Rush patient. I was born at Rush, I have had two children at Rush, and I tested positive for COVID-19 at Rush. And a lot of the steps I took to get the test and understand what I needed to do to take care of myself occurred through virtual care that’s with my primary care provider at Rush Oak Park Hospital.

So, I would love for you to just share with our audience how Rush has deployed virtual care in what seems to be a very seamless way. Maybe behind the scenes, it’s a different story, but it seems to be very seamless on the consumer side. So, I’m gonna let Camille dive in with the first few questions just to understand how you guys have successfully been able to do this.

Camille: Yeah, absolutely. So, I think one of the first things I noticed as, you know, a resident of the market of Chicago was just how well you guys have marketed your virtual care program. And so, throughout COVID-19, not being outside much but definitely being online and looking at the ways you guys have pivoted to really talk about how you’re managing care virtually or at least helping to sway fears about COVID and things like that virtually. Because it’s been really fascinating and, like Kadesha had mentioned earlier, just such a best practice.

So, prior to COVID, what were your growth plans around virtual care, specifically for the facilities?

Dr. Perry: Yeah, thank you for the question. One of the things that helped us be successful in sort of the COVID pivot was that we really had an organized strategy that existed before COVID started. We had been working on a suite of tools that we refer to as on-demand. With this concept, these were programs that were supposed to be able to be available to people on-demand — to meet them on their terms at a time of day that worked for them, at a place that worked for them, because they connected digitally with them.

It was primarily a combination of asynchronous visits and synchronous, or video visits. Asynchronous were more in the category of somebody enters information into a portal, the patient goes to a provider, who then afterward reviews the information and sends a response back. And we had a program set up where people could complete visits for low acuity medical problems — little back pain, urinary tract infections, coughs and colds and so forth through that asynchronous platform. Actually, we’re on target to do about 3,000 of those visits in this year, pre-COVID.

In the fall, we had actually launched a video visit program, as well, so that people would have access to on-demand sort of raising their hands and putting themselves in a queue and getting placed in a video visit with a provider, again, for lower acuity types of things that they might want to immediately connect with a provider. This is much more of a transactional care kind of thing, not to replace the primary care provider, like you referred to, Kadesha, in the system. But really to supplement the care that’s available in the system to meet some of those simple — let’s get you connected, let’s get care to your right away on your terms, and let’s let you go about your day, kind of services.

That was a program that we had up and running, and we had done really close partnership with our marketing/communications folks on how we presented that to the public, how we communicated to them, how we integrated an app that our information technology team had built and had deployed over the past year and a half, which was sort of a wonderful, foundational piece in everything that we had there.

Kadesha: When did Rush — COVID-19 was not your impetus to start virtual care and on-demand care. When did this planning start, and when was it officially available in the market?

Dr. Perry: Yeah, you know the planning probably started, say, two and a half years ago. And those asynchronous visits that I referred to have been available for about the past year and a half as a resource that was available to the market, treating about sort of 15 to 18 different kinds of low acuity issues that people go online and get care for. We had been building to a video program, as well, to connect people with video visits, and that had really launched probably about September of last year.

Camille: Fantastic. As a part of that planning process, who were some of the folks that were a part of your team? Who was really in the room thinking through that process?

Dr. Perry: Yeah, you know, it was people in our ambulatory transformation center who were a part of it. It was sitting down together with our information technology folks who really were people who had said video and engagement with people as a primary issue for us had been leading the build of our Rush app and had been leading the build of infrastructure to support video care, as well.

And then, our marketing communications strategy folks were sort of the other leg of the tripod, if you will, really looking at this and thinking about how we presented to the public. So, on the one hand, we think all the time about the services that we present to our patients. But this was also really thinking about how can we connect with the broader consumer population and let them know that Rush is an extremely convenient place to connect to? As we connected to them, also let them know about all the different array of resources that are available through Rush, whether you need to see a primary care provider or you have other kinds of health issues. We have all sorts of ways to connect you and all sorts of locations to get you care.

Kadesha: When you guys were doing this planning, can you describe what you were hoping would be the ideal experience? What would be the ideal flow of a patient initiating a virtual care visit going through to getting treatment or getting it resolved?

Dr. Perry: As we had this conversation, the perspective was always we wanted this experience to be a very friction-free experience from a patient’s perspective as they were going through this. That runs into all sorts of bumps along the way in the healthcare environment because, our environment, oftentimes for very good reasons — maybe not always for very good reasons — but often for very good reasons, we have friction in our environment. We’re very careful with patient information — that’s a regular thing for us and there are very good reasons why we do that. And it’s something that sort of competes with the “Let’s get you quick, easy access,” — that sort of stuff. So, that’s a piece that’s always a piece we’re working on. What’s the way to be very thoughtful about giving people access that works for them, so they get connected to care?

Time matters in this, right? We want to be able to get people care quickly. From the very beginning, we set targets about care. We talked about those asynchronous visits. There are visits where a patient will go in and, if they said they wanted to do a visit for a cough, they would answer a series of about 40 questions that have to do with a cough. Some of them might ask about a fever, and if they have a fever over a certain level, we tell them, it’s probably not for you to be getting virtual care right now, but we can get you connected to an in-person visit.

As they go through those questions there, they answer them and those all go to a provider. We set a standard that said, our goal is that patient has a response back in their inbox within 20 minutes. We sort of created a service standard to the public of an hour, but we said our internal standard is we want you to be surprised and get it back in 20 minutes and have a really neat experience.

That timeliness — much more so than even how pretty the site is and the information is — for us, was a real hallmark of what we were trying to drive on. Not that we didn’t try to make it pretty and look good and present well, as well, but that timeliness, from a consumer’s perspective, we felt was really key to what we were doing.

Kadesha: You know, I’m so glad you admitted that because I didn’t know if I could say that on camera, but when I called to be tested for COVID-19, they said, “Oh it’s going to take a couple of days to get the results,” and I understand that’s the communication to the public. But it was actually the same day.

Dr. Perry: Yeah, that’s terrific.

Kadesha: I think that’s sort of, “Okay, we’re gonna tell her this, just to set expectations, but really we know we can do this same day.” And I really appreciated that because it was Friday so I didn’t know what it was going to be like for the weekend.

Dr. Perry: You didn’t know whether 1 or 2 days meant Saturday and Sunday or Monday and Tuesday, right?

Kadesha: Right, exactly. But they were like, “Pull over, we’ll be back in 30 minutes.” And one comment about creating a friction-free experience — I think the best gauge for my family of knowing that you guys had done that successfully is that I am actually no longer the primary healthcare decision maker in my household. My husband does it because it’s very easy for him to use the app, it’s very easy for him to log onto the video. He’s actually the one that got my primary care physician on the video visit for me to describe my symptoms. So, kudos for that.

Dr. Perry: Yeah, for sure. There’s complexity in there in trying to make an easy way for you to get access to providers. At the same time, we’re very protective of the fact that it’s connected to your healthcare information, right? So, we have to manage through those two dynamics on a regular basis. One of the things is, in this environment, in some ways, it’s an advantage for healthcare systems but in other ways, it’s a disadvantage for healthcare systems.

If we didn’t have any of your healthcare information, in some ways, we could maybe even more easily connect to you because we wouldn’t be so worried about being very protective of that patient information.

Camille: To that end, as you talk about the various ways that you can connect with folks virtually to provide care of any kind, can you talk a little bit about the consideration for you guys that went into video visits versus we saw a lot of chatbots being set up during this time versus social media? What are you seeing as most effective, perhaps? Is it a combination of everything, or do you see that one, right now in this period of time, is really delivering in terms of helping identify folks?

Dr. Perry: Yeah, I think you hit on two points there that are really good points. So, one is — I really do think it’s about having a suite of services. You want to have different types of services that meet the demands of different things because we can do wonderfully fast things with chatbots — we really can. But there are other things we can’t do with them. So, if we let them run in their space and do those types of things that they can turn around really quickly and give you not a 20-minute experience but give you a 20-second experience where you get access to get information — that can be really beneficial.

At the same time, on the flip side, when all this coronavirus stuff was really ramping up in Cook County for us, we actually took the cough and cold reason for visiting our asynchronous tool, and we turned it off because we wanted to actually funnel it all to video. This is because we thought the nuance of it, the complexity of it, the rate at which it was changing from the perspective of guidelines from federal and state and county health authorities and timelines for turning it around and locations of testing — it was a little bit too fast for us to handle through a chatbot or through an asynchronous tool.

We needed to just get the information to our providers and let them talk to people, and be able to manage through that. I really do think it’s different tools for different scenarios. In this case, we really leaned on the video because we thought that in-person, eye-to-eye kind of experience really helped a ton.

Kadesha: Let’s shift to talking about other health systems who may be embarking on this for the first time in an environment where they really don’t have the luxury of doing two and a half years of planning. They are trying to serve their communities as best they can through virtual care, and would really benefit from your insight having done this for a while.

What would you say surprises senior leaders and those people you described on your team — what surprises them the most when they’re planning and trying to deploy a virtual care model?

Dr. Perry: I think there’s probably a handful of things that fit in there. I think in the clinical operations environment, I think one thing people don’t realize right off the bat is that just accomplishing a video visit is sort of an entire workload. You don’t just connect a patient and provider to a visit, but some patients need assistance in getting connected to tools or downloading information on their smartphone or how to log into a system and so forth.

On the provider end, some providers benefit greatly from kind of a workflow that not only provides a patient assistance in getting access to it, but connects somebody with the patient to prep the patient. And make sure that we have the patient, good, set up, and ready to go. We have the provider good, set up, and ready to go. We have a match, now, let’s put you together.

So, it’s kind of a whole workflow that accomplishes a single video visit. You really need to be mindful of that entire workflow if you want to be successful in doing not just one but a whole series of video visits for people, as well.

The other thing is, I think it depends on where you are in the system. When we were running for the past year and a half, what we were crafting was a self-pay, cash business kind of thing. We said, okay, we’ll just allow somebody to say I want to pay $30 for the experience of an asynchronous visit and have an answer in 20 minutes. I may have spent $30, but I’m thrilled by the experience. In that model, part of what pushes it — that has to be a really efficient model. If we want to deliver care for $30, we have to be really mindful of — how do we frame this so that the provider time and the provider end is really efficient, so they can actually do this pretty quickly. So, from a $30 perspective, it works for the system.

The marketplace here, that we really need to be respectful of, really also demands efficiency in how we think about delivering these tools. If we’re really — you guys are on the consumer end and marketing end of things — if we really think about that end of things, we have to be pretty mindful of how that all works out. We can’t just think sometimes the way we do in a traditional healthcare structure, which is a little different.

Camille: That makes a lot of sense. To your point, you’re talking about the fact that this is not just you connect a physician and a patient. There’s an entire process that goes into this. What are some of the milestones that we need to be looking at in order to onboard and prepare physicians to deliver care virtually?

Dr. Perry: I think one of the milestones is actually getting them to do one. There’s a milestone in, as a doctor myself, you tend to think a little bit of your traditional way of providing care. A patient comes into the office, I sit down with them, we talk, we’re face to face, I examine the patient — we do work together in that way. That’s a very important process and a very important way for care to happen.

But, once you get a little bit of experience, you start to sort of open up your mind a little bit and say, wait a minute, there’s actually a lot of stuff I can do, whereas before maybe you were thinking about the things you can’t do when you do a video visit. You start to think about the things you can do when you do that.

You can create a connection with the patient that’s different than talking to them on the telephone — when you can see somebody’s expression, especially when you’re dealing with clinical things. You can see somebody’s expression and tell if they’re in pain, and you can get a sense of their suffering much more strongly than you can over the telephone. And you can interact and you can see how somebody responds to something that you might say to them. You can see if something you might say to them sort of created anxiety for them from their response — the way we can in an outpatient office where we’re sitting down and talking with people.

Once you sort of do one, you start to see what you can do — and I think that opens up the realm of possibility, which is a piece that’s really exciting for us when we look at this. For a lot of people in this world, with COVID, we have a whole lot of providers who have never done a video visit before who now have touched it. In some ways, their minds are being opened up to say, “No, wait — I get it.”

As with anything, there’s a spectrum. Some of those providers who are doing those visits were people who already did video calls and were already in that world and kind of already got it. Some of them were people who had never done a video encounter of any sign — medical or social — at all. They’re getting open up to, “Well, wait a minute, I really do get nice video, and we have a nice infrastructure. I really do have a sense of conversation together with the patient when we’re doing that,” So that, to me, is the biggest hurdle — getting people started really then opens up the realm of possibilities.

Kadesha: Unless, of course, you’re like my primary care provider, who I’ve been with for, I don’t know, a ridiculous amount of years at this point. During our video visit, she was like, “I know the worst thing about this is that you can’t go to the gym — I know, I get it.” She just intuitively knew that was probably the worst thing about this whole ordeal for me. You have that rapport already built up, and you have that relationship already built up.

Dr. Perry: Absolutely. Right, so, when we talk about even our on-demand care — that’s very transactional where we’re treating you for something, and we say hello, we interact with each other. We create a good response to it, and then we each go on our way, right? That is not a replacement for a primary care doctor. It’s really another component of the healthcare system that can be a beneficial thing, but there’s tons of value to that primary care doctor who knows you. Taking that relationship and enabling that relationship with video is a whole additional piece of this that is very multifaceted in some really neat ways.

Kadesha: So, you get your provider to say, “Okay, I’ll give it a try. I’ll do one.” They’re enlightened to how great of an experience it could be. But then you have some health systems and hospitals that are trying to put virtual care in the market, and they’re just getting very low uptake. They’re not getting the adoption that they would like. Do you have any advice for them on how they can help their market embrace it a bit more, or how they can promote it better and what worked for Rush?

Dr. Perry: Yeah, I think it’s a bit of a journey — or it was. One of the things that’s amazing about the world of the COVID response is that we’ve done things in days that would have taken us months, 6 months, 9 months at a time to do to really respond to what was going on because it was such a dynamic environment.

In a normal world, it was kind of a process to really get this out there and really build it up. For the asynchronous visits, we were on a path pre-COIVD to do about 3,000 visits this year. But, it wasn’t — turn it on, and all of a sudden, there are 3,000 visits. It was — turn it on and get the experience with it. How can we learn with what we were doing on there? How can we get feedback from patients very quickly about how we’re doing this? We stood up doing NPS (Net Promoter Score) scoring with those patients after they did visits to get really immediate feedback from people as we were going through this.

So, it’s a process, and I truly think the consumer market is going to adopt tools that work for them. They’re not going to adopt tools that don’t. Working for them means easy access, means multi-channel, means very timely, means different solutions for different points in time, kind of need. It really requires having a focus of thinking of that consumer as opposed to a thinking that really doesn’t have that consumer focus and just thinks, “Patients will come to us the way they normally do.”

Camille: Another thing that I think, much like consumer adoption, is going to vary from market to market, another thing that will vary is the relationship that every system has with the health plans in their areas. I know that that is unique to markets, but are there any general sort of pitfalls or landmines that you think all systems should be thinking about as they think through delivering care virtually and the relationships that they have with their plan? There is a lot of new legislation even through COVID that’s come through around how hospitals and systems are paid for this kind of care, so can you talk a little bit about that?

Dr. Perry: Yeah, that even ties directly into our sort of COVID story on this. We had had our asynchronous visit platform and then our video visit platform, and it was really going around a couple of visits a day — it was not doing a lot of visits in the video world. When coronavirus hit, we had that platform that had a paywall associated with it, and as soon as coronavirus hit, we said well, this is a public health topic, this is a bigger public health topic than our program or our paywall or what have you.

So, what we did was, we took that down. And we put the video out there for people with what we called concern for coronavirus to be able to let them connect with us with no paywall associated with it. It was more — this is public health, we’ve got to get people connected to good information and good services because you could palpably see the anxiety on people when you connected with them by video in this world.

Kadesha, you went through that whole emotional feeling, right? Of being diagnosed with coronavirus when you were going through this. And when we were first doing this — especially in the early days — you could just see the amount of anxiety that existed on people. At one point in time, the governor actually here in Illinois required insurance coverage for video visits. When that happened, we then stood out the ability to use people’s insurance. So, we created a path for people to get to care if they didn’t have insurance but allowed them to use the insurance for the program. And then started creating an insurance-based business, if you will, out of that.

A big unknown for us is what the future of that is going to be, right? We truly just don’t know sitting here right now. So, we’re kind of creating scenarios that are working to be ready for whatever situation happens. If the general insurance coverage diminishes dramatically, if it doesn’t and it stays, if it stays partially — we’re trying to plot out of the scenarios.

One thing we feel confident in is that an awful lot of the public who had never been introduced to a sort of on-demand kind of video care, now has been. And they’re going to look for it in the environment more so than they did before, which is a really neat piece of this because we truly believe that the consumer is going to drive a ton of this. They’ll determine what people should be responding with by their behaviors. So, I think there’s a lot of unknown as to what exactly the future is from the payer perspective.

Our path internally had been, what we were building was a cash-based business. It was $30 for an asynchronous visit, $49 for a video visit and we’re good to go. We were actually working and we were in the middle of preparation for our first insurance plan to come online and provide coverage for it. It was going to be our insurance plan that covers our employees, so we were going to get about 19,000 people who got access to these video visits through their insurance plan. And it was intended to be sort of the first step in stepping into the insurance world with this.

I do think that’s a good spot for people to look when they’re thinking about building programs is always remembering that health centers typically have a large population of people for whom they self-insure. So, they’re really vested in the cost of care for those people, and video care is a great way to provide good service and provide very cost-effective service to people. So, that was going to be our first step into the insurance world. It was supposed to be April 1, and the coronavirus outbreak in Illinois hit before then, so it all got expanded before April 1, anyway.

Kadesha: What questions do you think more healthcare leaders should be asking before they deploy any kind of video visit or virtual care model?

Dr. Perry: I think a first question is what problem they’re trying to solve. It’s a different tool if we said, in the context of your primary care provider, Rush Oak Park Hospital, we are going to roll out video visits as a tool that exists for that practice. That’s a little bit of a different shape and size and structure than when we said, we’re going to roll out video visits for the broader consumer public, and we’re going to work on opening up something that anybody all across Illinois can connect with.

So, I think the key thing is — what are you trying to solve? Is it that you want to be something that is in the marketplace connecting with people and creating connections as initial connections with people? Is it that you want to bolster the structure of your practices that you already have? They’re certainly two related things, but they are different. We have two different applications in that world — both using the same infrastructure and the same underpinnings that our information technology people set up for us, but applying them in different ways with different workflows around them, and so forth.

Camille: I do have one question. Because I think it will come up for marketers eventually as we think about expansion of virtual care over time, is any concern from consumers about — does the quality of my care diminish in any way because now I’m primarily talking to my physician in certain circumstances via video or virtually? Any advice on how to address that? Are you seeing that already as a concern at all?

Dr. Perry: I think we do hear it as a concern from people — we hear it as a concern internally from our own providers, right? I think the answer lies in the fact that it’s not trying to compare itself to and compete with — it’s trying to be different than. There is different functionality that you can do on a video visit than you can do in an in-person office. Think about this — think about the potential scenario where you have some sort of an outbreak in the community where people have something that’s very contagious through their coughing and through their breathing. That’s our COVID scenario. And the ability to create a connection with that person in their home, talk to them, create a conversation, and create a plan with them in their home is actually, from a quality perspective, in some ways, significantly better than having them come down to my office and walk into my office and sit in a waiting room. And then come into the office and see me.

There are scenarios where the telemedicine visit is superior from a quality perspective than what we do in person. Vice-versa, too, there are a lot of scenarios where in-person does things and things can happen in there that we just can’t do on a telemedicine visit.

I think the key is that they’re different tools for different applications. We talked all the time as we first started doing this, to be able to triage people and be able to provide care for them in-home, exactly in this scenario of coronavirus, was a wonderful thing to be able to do — not just from a convenience perspective, but from a safety perspective. You kept those people in their homes, they weren’t sitting in a waiting room. That person could have had coronavirus, or it could have been the opposite — that person could have not had coronavirus, and they could have sat in the waiting room with two other people who did have coronavirus. So, as we went through this, this was a great way to get care at the right place, at the right time, to those people.

But it isn’t always the answer. There are times when it isn’t the best way to give people care, the right place, or the right time. And that’s where, sometimes, we clearly have things where we have some protocol set up where we’ll say to somebody, “You know what, doing this over video or doing this asynchronously isn’t the right application for you. We can get you connected, though.” And that’s where we talked about a whole suite of services or what a healthcare system can do in this. The advantage a healthcare system can do, we can say, “We can connect you with somebody, and we have people right in Oak Park who might be able to connect with you. And we can get you in there this afternoon or tomorrow or something like that.” We have an opportunity to do that with a whole continuum of services that can make sure it’s the right tool at the right time for the right situation.

Kadesha: Well, that’s good to know because as allergy season rages, I am not interested in sitting in anybody’s waiting room. I already told my primary care provider, “This is how we’re going to be doing it unless we have to do it otherwise.” Thank you so much for your time, thank you for sharing your insight, and thank you for being a leader in this market — especially in a hotspot like Chicago.

Dr. Perry: It’s a pleasure. And thank you, both, for your engagement in this topic and for the work that you guys do. I really think you’re in a spot where that intersection between the consumer and healthcare is just a really interesting spot. Where there’s so much that we on the healthcare side can do to make sure we create really good connections to people that really work for them. Technology is just one of the big ways where we can get a lot better — we have gotten a lot better — very fast.

Camille: Absolutely. Thank you!

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