How Northwell Health identifies in-between visit care opportunities that drive impact

As much as 80 percent of patients’ health is influenced by things that happen outside the medical setting. How can health systems be present in those moments and provide needed care and intervention when appropriate? One promising solution is automated care programs or chat-based interactions that can engage patients by providing guidance and support between visits to better manage and monitor conditions.

Northwell Health is a pioneer in this type of in-between visit care, and has deployed a variety of Amwell automated care programs to achieve specific outcomes, including better managing transitions in care management, closing gaps in care, and offering continued patient support. 

Here we talk with Dr. Zenobia Brown, senior vice president and associate chief medical officer at Northwell Health, about how health systems can identify the best opportunities for in-between visit care within larger health strategies, and how they ensure those opportunities drive impact.

Q: Can you give us an overview of the automated care program strategy at Northwell Health?

Dr. Zenobia Brown: Northwell’s approach to in-between visit technologies has been ‘what can help us as we try to achieve something that aligns with our organizational need?’ An example of that is that for the past six years we have worked very successfully on our readmission rates. If someone leaves the hospital and then comes back, especially within 30 days, in some cases that represents a clinical failure. We don’t want that for patients. We want patients to be well when they leave our buildings and not need to come back, especially for things that are preventable. So we took a look at how are we interfacing with patients before and after they are in our care. Then we took a look at how we could do that at scale across our 21 hospitals.

One phrase I love is ‘you can fix any problem with enough money.’ If you have a nurse physically follow every discharged patient home for 30 days, that will work. That will 
probably keep people out of the hospital. Of course, that is not feasible and that’s where the technology comes in. That is the disciplined approach that Northwell has taken. We ask ourselves, ‘what are we trying to do clinically? Where is the gap? Can technology help us with this gap?’

Q: What do you need for these automated care programs to be successful?

Dr. Zenobia Brown: Ultimately what you need is for providers to behave differently, and for patients to behave differently. You need an infrastructure that can respond to the needs of those two parties. If I can’t engage with the patient when and how it is convenient to them, then I have no hope of changing their behavior or what happens to them. But when you are mindful of the patient’s needs and they feel that you will be there for them any time they need it, then the trust is built and then behavior changes. We want our patients to call us at the first sign that they are having trouble, but we must be asking the question. We need to be engaged and asking the questions and asking them often. And that’s where the technology comes in. Asking questions multiple times in different ways and at different times when it’s convenient to the patient is what sticks. This creates an infrastructure and provides really good information coming right from the patient. This patient-generated data then comes back to the providers who can then adjudicate that information. 

Q: Can you talk about the different types of automated care programs Northwell has currently deployed and how those programs have helped to reshape in-person care?

Dr. Zenobia Brown: It really spans the gamut of everything from pre-operative, postoperative pain, test results, cancer treatment, COVID-19, etc. It was huge, the ability to do some of this automation during the pandemic. So, when you’re looking at big populations and straightforward things that patients don’t want to get tied up on the phone for it can just be a chat. It lends itself to a lot of use cases.

We talked about patient-generated data and how that extra information is helping us build, reframe, and retool our different programs. For example, a really important issue is the maternal mortality crisis. How do we end that cycle of maternal mortality, particularly amongst Black and Brown women. So, we’ve established the Center for Maternal Health and are using automated care programs to stay connected to these women. How are we hearing 
them? How are we asking them the right questions at the right times when it’s convenient to them? I can now tell you the top reason that moms are escalating back to us through these chats is due to high blood pressure. Based on that information, we can build additional programming to address that specific issue. Post-visit chats that are creating escalations also help us change our behavior during the visit to proactively address some of issues. It’s about enhancing how we deploy our clinical programs as a whole.

We had a patient who, in her in-person encounter, did not reveal that she was having behavioral health symptoms consistent with severe depression, with suicidal ideation. She revealed that in the chat. When the stakes got lower and she was home and she could just put it in her phone, she revealed that. Dr. Zenobia Brown, Senior Vice President and Associate Chief Medical Officer, Northwell Health

Q: Can you provide an example of where an automated care program is moving the 
needle in patient care?

Dr. Zenobia Brown: I’ll give you an example from that high-risk moms’ program. We talk about patients needing to be approached with the questions in multiple different ways, in ways that are convenient to them and speak to them. We had a patient who, in her in-person encounter, did not reveal that she was having behavioral health symptoms consistent with severe depression, with suicidal ideation. She revealed that in the chat. When the stakes got lower and she was home and she could just put it in her phone, she revealed that. She already had the appointment, so standard care would’ve meant no further intervention for this mom until her next appointment. But we were able to have another interaction with her that then surfaced this issue, and then we were able to respond to that. That builds trust. 

Q: How did your team react to these programs?

Dr. Zenobia Brown: I think it’s been invigorating for the team. In cases where the patient needs it, the team has actually interacted more with the patient. There is always a concern with automation that it is replacing a person, but we don’t see it that way. It helps with scaling, it helps with efficiency, and we actually see additional interactions but they’re happening when the patients need it. So, let’s say a single nurse can do ten patient interactions one interaction per patient, ten interactions for ten patients. Well, with automated care, now a nurse can do one interaction for all ten patients, and then that one patient that might have an issue, they might need ten interactions themselves. And then there’s everything in between.

It helps with scaling, it helps with efficiency, and we actually see additional interactions but they’re happening when the patients need it. Dr. Zenobia Brown, Senior Vice President and Associate Chief Medical Officer, Northwell Health

Q: If you had one piece of advice in terms of identifying opportunities for automated care programs, what advice would you give?

Dr. Zenobia Brown: This can help with every aspect of patient care, from something very simple to something very complicated. There are many use cases and because you are trying to do something for so many people, this can surface a lot of very helpful information to make people well. Basically, you’re talking about a new way of delivering care and communicating with patients.

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