Boston Medical Center CEO Kate Walsh and Christiana Health CEO Dr. Janice Nevin discuss the future of virtual care in supporting vulnerable populations.

Healthcare isn't reaching patients in their community, but tech could help

By Laura Lovett
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Getting the right diagnosis and prescription from a doctor is just one piece to the healthcare puzzle. How much food is at home and whether there is enough money in a patient’s bank account to cover the medication copay can be just as important to determining their medical outcomes. 

Now hospital executives are starting to turn to technology as a way to help serve more patients and address social determinants of health. In a panel at the Annual Thought Leadership on Access Symposium, health system CEOs sat down to discuss digital health's role in these challenges. 

“I think some of our most vulnerable populations will benefit the most from these technologies,” Dr. Janice Nevin, president and CEO of Christiana Care Health System, said during the panel. 

Christiana Care Health System has implemented a virtual primary care practice that allows patients to access care through video chats and text messaging. If needed, an in-person visit can also be scheduled. Nevin said this has led to patients being taken care of in their home setting more often. 

“We talk about waging a war on inconvenience and creating 'radical convenience.' How do you do that? I think what is so important about the time we are in is we have the technology ... to allow us to think about how can we provide a layer of care in the community, in the home, through virtual technology to really drive value and create and experience for people that, I think frankly, didn’t exist,” Nevin said. 

Recently, Christiana Care Health System inked a deal with Medicaid to provide value-based care. Nevin said that looking ahead the health system will focus on not just the patient but their support network as well. 

“When we talk about the future, we need to be a system that truly impacts the health of all the people that live in the communities we serve,” she said. “So, it’s not just about the people who find us and come to us, but it’s about people who live in the same house as that person or live in the same community. They may get their care somewhere else, but we aren’t going to be able to impact the health of that person until we tap into that ecosystem.”

Hospitals are often missing an opportunity to connect patients’ health information with other social factors, often leading to gaps in care, according to Kate Walsh, president and CEO of Boston Medical Center, an academic medical provider that caters to traditionally underserved populations. 

“To Janice’s point on family and community, you know we could have a challenging kid in one of our pediatric practices and have no idea that his mother or father is struggling with substance abuse disorder in one of our adult practices,” she said. “So how do we wrap services around the families and communities in ways that make sense for them?"

Incorporating community factors into healthcare isn’t exactly a new idea. In fact, according to Walsh, Cuba has a low-tech system set up to keep track of their patients’ environment. 

“I know this is a tech conference but if you go to Cuba, they file paper charts by streets and then they put a tab on the outside of it that says if you have asthma it’s purple, and if you have hypertension it's green. You can look at the neighborhoods and see [trends]. It’s kind of a cool idea. So you guys can come up with an app,” Walsh said. 

While most hospitals in the U.S. are not using a system like this, across the country more and more data is being collected. Christiana Care Health System itself has built a new data platform to ingest data from any source including clinical systems and claims data. 

“We have a data platform that gets real-time data that then uses AI [artificial intelligence] and ML [machine learning] to create that patient story,” Nevin said. “It feeds to a data analytics engine and we have risk score set so we can decide what level of risk you want to set. So, in real time, our virtual care team is getting information from our patients.” 

If a patient is at risk of a certain condition, the system can link them up to a service. So patients can be connected to behavioral health specialists, nutritionists, diabetes managers and social workers through the system. 

“We even had loneliness counselors; we had volunteers come and talk to people who are lonely,” Nevin said. 

Data collection can be critical to clinical decision making as well. For example, Walsh said that doctors can see if a prescription is being picked up. 

“Now we can see in our plan data, Patient A['s] diabetes is out of control, [they] never picked up their medicine. Patient B maybe picked up their medicine and might need additional medicine,” Walsh said. 

Getting technologies to patients might not be a difficult as some predicted. Despite economic factors, the bulk of Americans have access to a smartphone

“I started thinking our patients don’t have access to technology. That is not really true. Everyone has got a smartphone, [but] they may not have enough data or a place to charge it,” Walsh said.

There are certain benefits to digital including helping with a language barrier and more conveniently providing care, she went on to say.

“I think for us the next frontier will be jumping over the digital divide,” Walsh said. “We might be paying for data plans or sending people home with an iPad. I think it is a low-cost investment compared to what a hospital admission costs.”