April 09, 2020
“What we've seen is a tremendous surge of responses across both members and the digital solutions community to find ways for technology and digital to help address the crisis,” says Oliver Lignell, vice president, Avia.
Welcome back to Pop Health Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.
Today we are joined by Oliver Lignell, Vice President of Virtual Health at AVIA.
Hi, this is Oliver Lignell. I'm the Vice President of Virtual Health at AVIA. AVIA is a company wholly dedicated to advancing the use of digital solutions to improve health care.
We're largely a membership organization with more than 50‑plus health system members and partners, including the American Hospital Association, and we provide collaborative services to this network, along with consulting services.
We work collaboratively with our members and clients to solve the most pressing issues in health care, whether it's the digital front door, reducing administrative costs, managing and supporting Medicaid populations, and other innovative areas of work. We've had tremendous success and growth helping health systems innovate, stay competitive, and improve the overall health of their populations.
I've been working in health care for more than 30 years now, both in leadership roles and consulting on innovative solutions in health care from a variety of perspectives. I have industry experience and I was a technology leader at Kaiser Permanente and Cigna.
I have consulting experience working with Accenture and Cognizant. Earlier in my career I worked for a technology vendor delivering digital solutions as a developer and a designer.
Right now I've been at AVIA, leading our work in virtual health for about two and a half years. It's been a fun ride, and this work going on right now to support COVID‑19 is incredibly exciting.
The impact, of course, and obvious to everyone in the audience, is huge, and still unfolding. Hopefully the measures we've taken will help mitigate its size. From our perspective at AVIA, from a digital solutions perspective, our focus is entirely on the use of digital to improve health care.
What we've seen is a tremendous surge of responses across both members and the digital solutions community to find ways for technology and digital to help address the crisis. What we know is that the urgency of this need has caused barriers to drop all across the country that have, to this point, really held back on mainstream use of virtual health solutions.
Some examples are that regulatory barriers have been eased, commercial copays waived, and most importantly, the demand for information and care without physical interaction has just gone through the roof.
I have some interesting examples most people may be familiar with. The Office for Civil Rights, HHS, the FCC, even the inspector general and CMS, have all been waiving barriers and easing regulatory restrictions.
The last point I would mention is, from a big picture perspective, hospitals and solution companies are truly working day and night to enable digital care pathways to battle COVID‑19 in a variety of ways.
In terms of reducing disease transmission and improving responsiveness, I would call out three key virtual health capabilities. First, and probably most familiar, is virtual visits. Second, virtual triage through chatbots or symptom checkers. Third, remote monitoring. All three reduce transmission of disease and improve health system responsiveness. Here's why.
First let's talk about chatbots. Chatbots and symptom checkers have truly come of age in the last four or five years, using artificial intelligence and machine learning. What they offer is really self‑service, 24/7 response to patients and consumers.
Where they help in this crisis particularly is they have up‑to‑date protocols for COVID‑19, and often with the best solutions, the ability to use that AI to identify thousands of other symptoms. They can provide symptom education, and critically, they identify the most appropriate site of care.
If care is needed, they can connect consumers or patients to virtual visits, or on‑demands visits, or scheduling virtual visits, truly an inexpensive and highly valuable tool that we're seeing being used and adopted quickly across our members.
Second, I would call out virtual visits. Virtual visits is a broad term, and truly they come in several different flavors. You have synchronous virtual visits, which would be phone calls most commonly, or more readily used video visits. There's also asynchronous virtual visits, which are either texting solutions or form‑based visits, which are a self‑service collection of information for an offline provider response.
These really have an impact because transmission is reduced because patients are at home. They're not receiving the visit in a clinic or emergency rooms, where the chance of infection is much higher.
Secondly, the time required for an effective visit is often much shorter than an in‑person visit, which frees up provider time for others and really increases health system efficiency and overall responsiveness to needs across the populations they serve.
Finally, remote monitoring, which really allows providers to monitor those that are sick at home with COVID‑19, or have other serious health vulnerabilities that put them at risk. When remote monitoring is used, providers monitor vitals for spikes with much greater efficiency.
The digital tools can trigger alerts when threshold values are hit, allowing providers to care for a larger number of patients. Those patients are staying at home, so again, they're reducing the transmission of disease. Because providers can support more patients, the support is targeted and improves efficiency overall in terms of the number of patients that can be supported.
When it comes to tips for health care executives, health systems, and providers, digital solutions in this crisis have really provided a way to innovate and implement immediate solutions. The rush to do so is paramount. We've seen across our membership amazing and creative solutions. When it comes to tips, I have three.
Tip one, think outside the box to leverage and unleash your existing solutions and resources to your advantage. Use those developers, those technologies that you may have invested in and haven't fully built out, and partner with solution companies to address immediate issues.
Tip two, understand what your peers are doing and learn from their successes and challenges. Leverage their networks and association. For example, AVIA has set up forums several times a week open to both members and non‑members to share lessons learned and successes that they're experiencing. That's been incredibly helpful for knowledge‑sharing, connections, and getting the best ideas in place.
Tip three, and in some ways most importantly from a long‑term perspective, be strategic where you can. The crisis will end, and the tools and processes created and tested today will be known. Therefore, make decisions that will have lasting value, or make plans to do so, where you know the temporary solutions won't last.
The reality is that patients, consumers, and providers will be using these new virtual tools at a scale that hasn't been seen before, for months likely. Those will become embedded in the care model. Changing those may be difficult, and planning for the long term is something not to lose sight of.
In terms of providing the very best care, what can folks do to assure and extend that? Take care of providers and staff. Use them at the top of their license. Automate as much as possible, and leverage virtual tools to use quarantined light duty and retired staff to help from home.
Providers are disproportionally affected by the virus and need to quarantine. That doesn't mean they can't continue to help for others if they're not too sick themselves. That's a terrific way to utilize technology to make improvements.
The COVID‑19 crisis has created disruptive, long‑lasting change to the care delivery environment. Absolutely without a doubt. The fact is that virtual health digital solutions today are robust, and the technology is there. What's really prevented this from becoming a more mainstream element to care is the regulatory and cultural barriers that exist. Barriers that vary state by state.
Cultural barriers include a lack of knowledge and trust in the tools to deliver quality health care. That's limited virtual health as a mainstream tool, but that glass has been broken. Its use is becoming more and more common and more accepted as quality care across the US. I believe that it is a lasting change, that the virtual care model is here to stay.
I do have a couple of future predictions that I would make as far as it comes to what this means for virtual care overall. First in the near term, I think regulatory easing that's occurred will become permanent. Virtual triage, virtual visit, and remote monitoring will truly become mainstream parts of the care model.
Midterm, I see virtual being able to handle more conditions and higher acuity as tools and knowledge increases. I expect digital care centers that manage supply and demand of care will become ubiquitous. Long term, I think the cost of care will fall, administrative burdens reduce, and population health will increase.
As far as anything else to add, I would say I'm incredibly excited about the opportunity for virtual health and the ability to advance the model of care. These are really challenging times. I truly wish, and all of AVIA wishes, the best for all patients, providers, staff, and their families affected by COVID‑19.
It's been amazing to see how we're coming together as communities in the face of this crisis. I truly believe there's no limit to what we can achieve in responding to it and improving health care for the country.