Issue link: https://beckershealthcare.uberflip.com/i/1273352
33 QUALITY IMPROVEMENT & MEASUREMENT In just a few days, COVID upended the episodic and acute care-fo- cused nature of our country's healthcare system. While that has been incredibly challenging, in a sense, the pandemic has actually fueled our strategy. ere's an intense focus on new collaborations and care setting options in response to COVID. e upside is that key components of our roadmap have been fast-tracked. We were able to put the pedal to the floor and deliver new tele- health access points, not just for primary care, but for patients with chronic conditions and behavioral health needs. at resulted in almost 150,000 video and phone visits since the end of March. OhioHealth at Home stood up Advanced Home Services, a pro- gram that allows patients who would traditionally be admitted for observation or inpatient care to be monitored at home. That offers safety and peace of mind for patients and relieves the demand on hospital beds. COVID has also helped us accelerate our analytics work, which is a key component to having a truly holistic view of populations. Population health has been a priority for OhioHealth, but the pandemic put it front and center in a whole new way. In these times of crisis, people got a front row seat to the power of a pop- ulation health mindset fueled by a sound business strategy. It's about the right care, in the right place for the right people. Our back-to-business plans are maintaining that focus as we work to bring volumes back to pre-COVID days. Susan Hawkins, senior vice president for population health for Henry Ford Health System (Detroit) Our overall theme for changes needed in our population health management approaches mirrors changes needed in other areas of the health system: We need to reengage with our customers and each other in both new and different ways in the post- COVID "new normal." Examples include: • New ways to address social determinants of health. In our markets, food insecurity and safe housing needs rose to the top of the list in terms of volume and urgency. • New approaches to case management and chronic condi- tion management across the continuum. Ongoing changes include converting many in-person care-planning visits to telehealth interactions, focusing on transitions of care needs following emergency visits or hospitalizations, and reprioritizing post-acute care in the home over skilled nursing facilities. • Rapid expansion of new services to allow safe care at home and to free up capacity in hospitals and emergency departments during future pandemic surges. Programs such as our Mobile Integrated Health paramedicine and hospital-at-home services that incorporate virtual physician visits and traditional home healthcare will allow us to deliv- er on our population health strategy as a health system. Jason Mitchell, MD, CMO of Presbyterian Healthcare Services (Albuquerque, N.M.) Population health has never been more important than during this pandemic. We have experienced the positive impact of population across our health plan, medical group and hospitals. Through our integrated analytics we: • Identified more than 20,000 health plan members at risk of adverse COVID-19 outcomes and did outbound calls to ensure they had mail order for all prescriptions and helped them get necessary refills. This helped prevent members from going into a healthcare setting unnecessarily, provided information on how to protect themselves from COVID-19 and helped connect them to social services. • Redesigned our medical group's visit templates and pro- cesses based off principles of population health. Using integrated analytics, we identified patients at higher risk and reached out to schedule telemedicine visits to ensure they had all their needs met and ensured medications were refilled. We quickly converted 80 percent of our visits from costly in-person visits to virtual visits and simultaneously saw a reduction in claims cost and improvements in patient satisfaction. • Engaged and supported our physicians and advanced prac- tice clinicians with data and process to develop a variety of new ways to preemptively improve care of diabetes manage- ment, COPD and a variety of other conditions. We are able to detect and do outreach to patients before they have prob- lems and are able to identify when high cost treatments that are not leading to clinical improvements and replace them with affordable solutions that are delivering better results. As the pandemic evolves, we anticipate even more work continu- ing to be driven by population health approaches and solutions. Adam L. Myers, MD, chief of population health at Cleveland Clinic and director of Cleveland Clinic Community Care Our population health strategy pre COVID-19 consisted of many components, each of which has accelerated in pace and heightened in importance. As is the case with many health systems, virtual care has moved to the forefront and is now a crucial component of care delivery. Our ability to scale this quickly has been critical to our success in meeting the needs of the populations we serve. In addition to it becoming a key care modality for all of our caregivers, we also have expanded our "virtualist" team that works collaboratively with our nurse-on-call group, our remote-monitoring program, our house calls group, our SNF-at-home program, our chronic disease management team and our urgent paramedic dispatch program. Linking these innovative efforts into a comprehensive safety net for those most vulnerable has provided a proof case for the approach already in process. COVID-19 has tragically underscored what we previously knew to be true. Years of economic, political, educational, and health access disparities have once again placed African-American and other minority communities at disproportionate risk for COVID-19 and all it entails. We are working collaboratively with other community part- ners to both address the urgent needs and move forward in what will be a yearslong effort to serve as an anchor institution determined to strengthen our communities. As we do so, we are wise to be attentive to how our shi to virtual care can actually worsen access to care for those without reliable broad-band access. Finally, enhancing the value of the care we provide has only become more important, secondary to growing demand and increasingly scarce resources. As a result, we are leaning in on