El Camino Health and Prisma Health: their journey in building the hybrid care delivery model

All the challenges that faced health organizations before the pandemic have only been aggravated over the past two years. Total spending on healthcare in the United States nearly reached 20 percent of Gross Domestic Product in 2020. Shortages are projected over the 2020s for physicians and nurses, with staffing now the top concern among health system CEOs.  

Innovative leaders are focusing their organizations on the Quadruple Aim—reducing the cost of care, improving clinical outcomes, enhancing patient experience and enhancing clinician experience—as the best way to meet these challenges. 

A hybrid care model uses virtual care to “leverage the wisdom of the patient, a data set that has been missing: everything that we all carry around with us on how we’re doing on our health journeys and our care journeys,” said Murray Brozinsky, chief strategy officer at Amwell. This data set includes biometric data captured with sensors and patient-reported outcomes offered in answer to simple questions delivered by an automated chat. 

In a session titled, “Unlocking the Quadruple Aim with Automated Virtual Care” at the recent ViVE 2022 event, Brozinsky discussed these themes with two leaders in building a hybrid care model: 

• Deborah Muro, chief information officer of El Camino Health, Mountain View, Calif., and 

• Nick Patel, MD, chief digital officer, Prisma Health, headquartered in Columbia and Greenville, S.C. 

Automated virtual care is proactive 

Virtual care is central to El Camino Hospital’s efforts to differentiate itself from competitors in California’s Silicon Valley region, where expectations for virtual options are especially high. The two-hospital system links digital transformation of care delivery directly to pillars of its strategy, such as building a high-reliability organization with the goal of zero defects and reaching out to patients more proactively, said Muro.   

Readmissions is a focus of these efforts. “We have people coming back to the hospital who shouldn’t be coming back, because we weren’t able to watch over them after they left. Are they taking their meds? Do they have food? Do they have housing? All the social determinants of health play a role,” said Muro. “How are they doing? We found that when we check on our patients, they’re not doing well, post-discharge. They’re usually in a bad place.” The health system is combining Amwell Automated Care Programs with a physician dedicated to checking in virtually with patients post-discharge to root out these problems as soon as possible. 

El Camino is automating proactive outreach to vulnerable patients. For example, El Camino has worked with Amwell on a program to enhance monitoring of patients with chronic obstructive pulmonary disease (COPD),. Clinicians need regular updates on these chronically ill patients regarding any difficulty breathing they are experiencing or if they are feeling fatigued. Amwell Automated Care Programs prompt patients to report on their conditions and alerts care team members to patients who are struggling. 

The health system is integrating bio-stickers that track patient vital signs with an Amwell Automated Care Programs. El Camino is also using Automated Care Programs to stay in touch with maternity patients, before and after delivery and to ensure patients are completing all the necessary preparations for surgery. 

Frictionless, always-on access 

Prisma Health, based in South Carolina, is building a seamless virtual care continuum to wrap around its 18 hospitals and 330 outpatient care sites, said Patel. Automated Care Programs provide the entry point to guide patients to the right level of care, such as enhanced video visits or an in-office appointment, and then follows up with automated check-ins and home monitoring.  

This hybrid care delivery model provides patients with frictionless, always-on access and automated monitoring that enables clinicians to intervene sooner and more effectively. “Care shouldn’t only happen when you walk into my clinic and see me for 15 minutes, if you get 15 minutes at all,” said Patel. “Care should happen when and how you want to do it. It should happen where you live most of the time, which is 99.9 percent not in my hospital or my clinic.” 

For example, Patel explained, a clinician can give a home blood pressure cuff to a patient with hypertension. Automated chats can prompt the patient to use the Internet-connected cuff daily to track blood pressure. If the readings from the cuff are high three days in a row, the chat asks the patient a series of questions: Have you missed a dose of your blood-pressure medication? Are you feeling any side effects of your medication? Are you taking any new medications? Are there any other changes in your health? 

Amwell’s Automated Care Programs analyze the responses and escalate patients in need to Prisma’s dedicated virtual care center or a call center. This virtual care infrastructure takes pressure off physicians and their clinic staff, said Patel. 

Prisma has relied on several Amwell programs and solutions to manage care during  COVID-19. Adopting the Amwell COVID-19 Screener & Triage program cut calls to Prisma’s overwhelmed call center by 40 percent at the outset of the pandemic. Prisma also deployed Amwell Automated Care Programs to provide vaccine information to the communities it serves and to automate return-to-office letters for patients to relieve physicians of that burden. 

Beyond COVID, Prisma uses Amwell Automated Care Programs for total joint replacement patients, post-discharge follow-up care, and pediatric wellness. 

Virtual is hard-wired into hybrid care models 

As mentioned above, El Camino ties Amwell Automated Care Programs and other digital transformation efforts directly to strategy. Muro, a registered nurse, spends time with front-line clinicians and nurses to understand their technology challenges first-hand to inform implementation and ongoing improvements. 

El Camino is using automation to allow patients to self-schedule and answer their patient history questions online before their appointments, along with other elements that shift from reactive to proactive. “If you could be in a wellness world where you’re preventing (disease), you’re using things we have, like genomics, to help guide patients for how they can stay as healthy as they can be and reward them along the way,” said Muro. “We don’t use rewards in healthcare, and we should think about that.” 

Similarly, Patel draws on his experience as a practicing internist. New digital tools must fit existing physician workflows without adding a significant number of clicks to be widely adopted, he said. Crafting a hybrid delivery model requires operating guidelines that make virtual care options a normal part of the decision tree for guiding patients to care. For true digital transformation to occur, automated chats and virtual visits must be part of the regular mix of care options, not a pilot program siloed off from most care, he added. 

“We have to make sure we are thinking of our providers, and making sure we are not making work harder for them, we’re making work much better and easier for them,” said Patel. 

Automation expands capacity, and in particular, it reduces the burden on providers by doing repeated tasks at scale to find the small number of cases that need their intervention. “We’re trying to virtualize and automate a healthcare professional coming out to your home, asking you questions, taking your vital signs—increasingly, those will be ambient vital signs—and then making a decision right then and there,” said Brozinsky. “Hey, you’re fine, keep doing what you’re doing. Or: you’re not fine, here’s some recommendations of what you can do and we’ll check back tomorrow. Or: that’s a problem, we’re going to get you to your provider.” 

To watch the full-length live panel discussion, click here.