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The Second Key Commitment of Revenue Resilience – Creating a Pluralistic Clinical Operating Model

Crashing waves

Series Authors: Tom KiesauDr. Sam BhatiaPaul Griffiths

This series explores the uncomfortable reality that this adaptation will likely span a longer period of time than the authors believe has been widely expected. Three leading organizations — SalesforcePerficient, and The Chartis Group — have come together to share bright spots within the healthcare community that can point the way to building the necessary capacity to adapt.

We identified Six Key Commitments last week and discussed the First Commitment.

Today, we turn our attention to:


Expand access to all clinical specialties virtually, deploying a clinical operating model that seamlessly provides both virtual and physical care as needed/demanded.

The New Challenge: Creating A Pluralistic Clinical Operating Model

As the COVID-19 pandemic swept across the United States, most health systems – the majority of which had completely stopped “non-critical” care operations in response to COVID’s spread – were forced to quickly stand-up virtual capabilities to continue to provide care amidst the shutdown. For many health systems, this effort effectively represented a de novo technical solution deployment across a wide array of (now remote) caregivers, representing the spectrum of clinical specialties at all levels of technical aptitude.

The stories of health systems rapidly deploying virtual solutions were impressive and inspiring. In a matter of weeks, and in some cases days, health systems launched virtual care operations and began to see significant numbers of patients virtually, via telephone, video, eVisits, and other modalities.

In the span of only a month, from March 4 to April 8, the United States went from less than 1% of physician visits conducted virtually to over 50% (according to The Chartis Group’s Telehealth Adoption Tracker). While this massive shift was unequivocally impacted by the drop in the number of in-person visits, it still represented an explosion of virtual cases with a growth rate over that period in excess of 3300%, nationally.

“Five years of digital adoption in under five weeks”

As a health system CEO joked:

           We experienced five years of digital adoption in under five weeks.

While the circumstances were not optimal, the immediate necessary result was achieved. Though health systems were forced to rapidly deploy these capabilities, one outcome that emerged quickly and definitively is that many patients, and large swaths of providers, are now vocal advocates of these new virtual care channels. While there were (and still are) those who are eager to get back to in-person “care as usual,” it is clear that many patients and providers will expect virtual options to remain available now and in a post-COVID world.

Unfortunately, for health systems, the challenge of delivering virtual care and physical care simultaneously is significantly more complex than orchestrating the wholesale shift from physical to virtual care. The rapid, brute force approach that worked to successfully shift from physical to virtual care will not suffice to address the new challenges inherent in the provision of simultaneous and integrated virtual and physical care.  Restrictions associated with HIPAA will return, for many providers reimbursements for virtual care will drop, and the populations of both patients and providers, who were previously captive to the exclusively virtual option, will both now have a CHOICE between virtual and physical alternatives. In addition, and substantially, the physical care workflows, operational processes, and consumer experiences in many health systems were already inefficient and complex. Those inefficiencies and complexities are only further amplified and exacerbated when applied to virtual care.

The Essential Dimensions of the Pluralistic Clinical Operating Model

To successfully navigate this challenge of delivering virtual and physical care, health systems will need to employ a holistic approach to the creation of an entirely new clinical operating model, which considers five key dimensions:

1.    The Care Team Dimension – For many health systems, the “provider” delivering care is synonymous with the physician. As demand for virtual and digital access grows, especially if/when reimbursements shift back toward pre-COVID levels, the legacy cost model of “physician-only” care delivery will be exacerbated and increasingly financially unsustainable. A truly interdisciplinary “care team,” leveraging the capabilities of a more diverse cohort of clinical colleagues, will be required to efficiently and effectively deliver the quality care patients demand. Further benefits of a holistic care team operating ‘at the top of their license’ include increased care team retention and reduced burnout, along with opportunities to improve access and better engage with patients throughout the care continuum. Physicians and broader care teams will need to learn how to adapt to be effective in a virtual modality, as simply replicating a physical approach for virtual care delivery risks missing the need to alter approaches to fully deliver services and create an engaging experience. Finally, providers will need to understand and actively manage quality implications of new, integrated, delivery models.

2.    The Business Operations Dimension – Supporting a multi-channel clinical model will require the creation of new capabilities along with seamless integration with traditional business operations. From “virtual waiting rooms” to consumer digital support, the evolved operations model needs to ensure the digital and physical integrated operation is effective, scalable, and connected both to each other and to the operational backbone of the organization. At the same time, it must consider the impacts to workflows, staffing models, facility needs, and payment models, to name just a few.

3.    The Consumer Engagement Dimension – Deeply understanding consumers’ needs and changing their perceptions of how they interact with their care team is essential. Provider outreach must become proactive and personalized to actively engage consumers in their care and support the shift in how they understand and choose care access options. Consumers need to see and experience virtual care options as a seamless, integrated, and equivalent complement and supplement, not a wholesale substitute, to ongoing physical in-person care.  Health systems must be mindful of factors that can create a ‘digital care divide’; the approach to care delivery must anticipate and address access issues across all populations and explicitly close, not widen, access gaps. Providers will need to shape a model that aligns consumer preferences and clinical and other needs across the patient journey with the recommended options for delivering clinical services, so that they are intentionally creating an optimized delivery model inclusive of virtual and physical modalities. An effective customer relationship management (CRM) solution, paired with an organizational aptitude for deriving consumer insights and targeting outreach, will become “table stakes” for health systems.

4.    The Economic Dimension – The economics of virtual care delivery are materially different than in-person care in terms of capital investments, care team costs, operating support, and reimbursement. Health systems must consider the specific marginal cost economic models for delivering care through each virtual modality, and integrate those into consolidated economic models to manage the structural shifts between virtual and physical care settings over time. Bringing a more longitudinal patient view to the economic analysis, in addition to an understanding of discrete individual encounter financials, will also help organizations make more informed decisions about their use of digital capabilities as an integrated component of the patient’s overall care. The business model of virtual care must be understood for its differences, yet be integrated with the physical care business model, into an effective whole.

5.    The Technology Dimension – While many health systems focus exclusively on specific virtual care delivery technology platforms (e.g., video visit platforms), that represents only a single capability in a broader technology platform redesign that will be required to support the new, integrated care delivery model. Health systems will also need to define requirements and seamlessly integrate technology across the EHR, CRM & ERP, as well as supporting “systems of engagement” and “systems of analysis” (e.g., integrated, cross-platform analytic and reporting capabilities, web content management systems).

The health systems that quickly and effectively develop a model that can be deployed in consideration of these five dimensions will be best positioned to serve their consumers’ evolving needs and establish a truly differentiating and enduring strategic advantage against both traditional and emerging disruptive competitors. Those that don’t will find themselves falling further behind accelerating competition and will be forced cost-cut their way to viability, an approach that is unsustainable over the long term. While the transformation won’t be easy, the status quo alternative will be far worse.

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In next week’s post, we’ll discuss the third commitment:

Develop clinical operating protocols that clearly segment COVID and non-COVID patients to distinct sites of care.

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Paul Griffiths

Paul Griffiths is the GM of the Digital Healthcare Solutions unit at Perficient, where he works with hospital and health plan marketing departments on digital initiatives. DHS services integrated healthcare delivery systems around the United States.

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