Building a Hybrid Care Delivery Model

The rapid adoption of virtual care during the pandemic has presented us a unique opportunity to build a new hybrid care delivery model to address the most pressing issues in American healthcare. Improving access, equity, experience, and outcomes cost-effectively requires more than simply adding virtual visits and automated care services such as clinically-intelligent chats and remote patient monitoring to physical care. Those are necessary but not sufficient to transform our healthcare system. 

We’ll see real transformation when we move beyond thinking about the modalities of care as islands. Health systems must seamlessly integrate technology to enhance the work of clinicians and care teams: Automation to offload routine tasks and free up invaluable care team time, remote monitoring to enable patients to get better at home, enhanced data analytics to identify and predict risks so care teams can intervene sooner. 

These technologies need to augment the empathetic, dedicated, highly-trained people delivering care. They need to make their lives easier. And they need to be measured in terms of improved outcomes that care teams can deliver by using them. To paraphrase science fiction writer Arthur C. Clarke, any sufficiently advanced digital health technology should be indistinguishable from magic for patients and providers. 

How will health systems make this transformation? Fortunately, they have been laying the foundation for a decade.

Digital Innovation 2.0

At the outset of the 2010s, the rapid adoption of electronic health records, fueled by federal government incentives for achieving meaningful use targets, set off a health technology boom. Like any technology boom, this one began with a discovery phase. Many health systems explored the technology frontiers through an innovation center and perhaps a venture capital arm.

While exploring, health systems learned how to work with digital health partners. They developed an understanding of what can be accomplished with virtual care. On the flip side, they learned the limitations and complexity of knitting together and managing multiple point solutions. They also learned that piloting solutions in a small corner of the health system doesn’t predict how they will work at scale.  

As we move into the next phase of healthcare delivery catalyzed by the COVID-19 pandemic, health systems are smarter, better prepared, and gripped with a heightened sense of urgency. They are partnering with fewer platforms that deliver more capabilities, serve broader needs, and are applicable to more patients. They are increasingly blending in-person and virtual, synchronous and asynchronous, human-driven and automated, into a hybrid care model. Innovation is at the heart of how they deliver care, no longer confined to innovation group experiments available to handfuls of patients. 

Of course, this next step comes with higher expectations. Digital solutions not only have to score high in terms of patient satisfaction and engagement, but they need to deliver measurable outcomes and meaningful return on investment. Whereas patient engagement was once an end in and of itself, it’s now simply a means to an end. Digital solutions should no longer be measured standalone but by how much they contribute to the following equation: giving more patients access to better care experiences that deliver better health outcomes at lower cost.

From pilot to hybrid care model

UCSF Health in San Francisco illustrates this journey. UCSF has put its Center for Digital Health Innovation at the core of care delivery. We partnered with UCSF on a remote monitoring program for lung transplant patients. They are highly vulnerable to a communicable respiratory disease like COVID-19, but they also can see their conditions deteriorate rapidly: It was imperative to find a way to monitor these patients in their homes. 

UCSF sent each patient a home spirometer to measure lung function, and partnered with Conversa to help monitor the spirometer readings and patient-reported information about their condition. These patients receive excellent care at home while avoiding potential exposure to COVID from in-person visits. As Dr. Michael Blum, UCSF’s Chief Digital Transformation Officer, recently said in an interview with the San Francisco Business Times, “It provides extremely high quality of care that appears to be even more effective than if they <patients> were going to laboratories to get testing.”

Now, UCSF is looking across its many specialties for more ways to incorporate remote monitoring and automated care for their patients.

Taking the next step

True hybrid care delivery requires a holistic view of patients through comprehensive data that flow among care modalities. Health systems should increasingly complement clinical data with social determinants of health, behavioral, and environmental data. 

When providers have this comprehensive view of the patient, they can work together as a care team to surround patients with the care they need. Patients then experience care in any modality simply as care, without thinking about how it’s delivered.

The transformation to hybrid care delivery is inevitable. How long patients and providers must wait for it to get here is up to us. It will certainly go faster if we can get the government behind it. Some specific policy measures that would help include: 

• payment parity for virtual care modalities,
• reimbursing for automated care based on value instead of volume or time,
• expanding access to high-speed internet and connected devices

We must continue to work toward care delivery that 1) seamlessly integrates technology to meet patients and families where they are, 2) uses data to be proactive versus reactive in how we treat patients, 3) is indistinguishable from magic for patients and for our short staffed, overworked frontline healthcare workers, and 4) delivers better outcomes to more people at lower cost.  That is the promise of hybrid care that we work toward every day at Amwell.

Murray Brozinsky is CEO of Conversa Health, a part of Amwell.