Embracing the COVID-19 Disruption: Defining the Future of Hospitals Dear Friends and Colleagues, The late Thurgood Marshall once said, “The measure of a country’s greatness is its ability to retain compassion in time of crisis.” As I reflect on the COVID-19 pandemic and the way that healthcare workers across the country have responded, no other sentiment rings truer. National shortages of personal protective equipment (PPE), test kits, ventilators, and treatment space have pushed our healthcare system to the limits. Physical exhaustion from long hours, the emotional toll of caring for acutely ill patients, and the fear of exposure to self and family members have tested clinicians in ways never before imagined. And yet, throughout this crisis, I continue to be inspired by the compassion on display. This is particularly true across the organization that I feel privileged to lead. By cultivating a culture that empowers providers to champion new approaches to care delivery, clinical innovations can be more rapidly deployed to deliver Letter and expand care in new ways. Now more than ever, it’s vitally important that provider organizations meet from patients where they are to ensure everyone can gain Imamu access to needed care. Tomlinson, MD, MBA In this white paper, I’m pleased to share just a few of the strong advances in care delivery that have come CEO, Vituity out of the COVID-19 crisis. We’ll explore: • The disruption facing hospitals and health systems nationwide. • Why the evolution of patient care requires adoption and development of technology-driven innovations and better-integrated provider teams. • Examples of acute care innovations that help patients access care where and when they need it. • How a culture of innovation and physician empowerment fosters advancement in care delivery. I want to close by thanking all healthcare providers across the country—from the clinical front lines to the incredible management and support behind them. We truly are stronger together, thanks to all of you. Embracing the COVID-19 Disruption The novel coronavirus that swept worldwide in 2020 has disrupted healthcare delivery like no other force in Here are just a few of living memory. As clinicians in New York City and other the issues health systems large metropolitan cities prepared for potential surges of must solve for in today’s COVID-19 patients, health systems around the country landscape: scrambled to expand inpatient and ICU capacity and implement stringent infection control measures. Financial Viability Recouping financial losses, and boosting inpatient volumes and surgical cases. Expanding Telehealth Creating the workforce and infrastructure to manage patients while limiting face- to-face interactions. Clinical Education Training clinicians across the hospital Many hospitals took the unprecedented step of canceling to manage COVID-19 patients with elective surgeries and procedures and absorbing the up-to-the-minute best practices. inevitable financial hit. Some also established dedicated “COVID clinics” in tents or drive-up locations. As supplies of personal protective equipment (PPE) dwindled, technology emerged as a solution to reduce unnecessary face-to-face contact with patients. And with millions of Infection Control medical offices and clinics shuttered across the country, health systems began using telehealth to deliver primary Creating and maintaining protocols to and urgent care. protect patients, staff, and clinicians. While the hope is the COVID-19 pandemic will have an end date in the not too distant future, its impact on the care delivery infrastructure of health systems is significant and long-lasting. Regaining Patient Trust With their missions on the line, health systems need to Convincing patients that it’s safe to bring creative solutions to market in a matter of weeks come to the hospital for emergency (if not days). That’s where solution partners like Vituity and elective care. can help, combining clinical excellence with business acumen to help healthcare organizations raise the standard of patient care and improve operational efficiency. Where is Healthcare Headed? 3 Predictions for the Near Future A necessary and continued evolution is inevitable, as is the redefinition of the traditional hospital model through technology-driven holistic care and better- integrated provider teams. In order to start this transformation, we must accept that there is no “post-COVID world.” The virus is likely to be with us for years to come, if not forever. This radical reorganization of our reality will touch every healthcare institution, starting with hospitals. 1. Shifting Beyond Hospital Walls To continue to care effectively for patients, healthcare leaders must reimagine the idea of a “hospital.” Our challenge is to reconfigure our physical hospitals for the highest-acuity patients while shifting many other services beyond hospital walls. This transformation has already begun in the emergency department (ED). Emergency department volumes have dropped in many parts of the country in response to the coronavirus threat. However, departments must remain poised for surges—either of COVID-19 from episodic to chronic care. And finally, virtual EDs patients or of those who have delayed care during the allow clinicians to treat and disposition many lower- pandemic. To respond effectively, we need to adopt acuity patients outside the ED itself via telehealth. a more encompassing and creative definition of an “emergency room.” 2. A Leap Forward for Healthcare Delivery Technology The ED has traditionally been a first point of contact, Viewed through this lens, the hospital of the future the proverbial front door to the hospital. Thinking shifts from a four-walled physical location to a virtual ahead, this is evolving to a virtual front door that uses one that connects patients and providers in disparate technology (video conferencing, AI chat bots, etc.) to locations. Naturally, this new paradigm demands appropriately triage incoming patients—whether the advances in technology. complaint is chronic, acute, or an exacerbation due to deferred care. With this step, EDs shift from episodic As more health systems make the transition, we will providers to proactive navigators who help patients make likely see accelerated adoption of artificial intelligence informed care decisions. as well as remote care (e.g., hospital at home). Also, advances like longitudinal patient modeling may This virtual front door model solves several perennial help providers to proactively address health conditions problems that have plagued our nation’s EDs for decades. before a crisis like a stroke or heart attack develops. First, it connects patients quickly to the appropriate level of care—primary, urgent, or emergency—rather than The shift from physical to virtual hospitals will require leaving them to guess or fend for themselves. Virtual significant investments in information technology. care also provides pathways that help ED high utilizers Short term, this could be a tall order for cash-strapped (many of whom lack a medical home) to finally shift hospitals. New technologies will connect patients and providers in novel ways and drive a grassroots movement toward meeting However, over the long term, virtual care will likely cost less to deliver while allowing hospitals to reach new patients wherever they are. patients and expand market share. It could also lend itself to more cost-effective staffing models by allowing physicians to supervise advanced providers in urgent care centers and other remote locations. In addition, the ability to care for patients without putting their health and that of their families at risk is 3. New Provider-Patient Relationships an enormous relief to many clinicians. It is perhaps one of the best antidotes to the compassion fatigue and As we redefine hospitals, we also must rethink what trauma we see already in front-line providers that could it means to be a healthcare provider. Going forward, be inflamed by a second wave of COVID-19 outbreaks. expect to see an erosion of the physician and advanced provider-centric model, where patients visit offices Vituity: Here for Hospitals during set hours for care. Instead, new technologies will connect patients and providers in novel ways and Of course, hospitals as we know them won’t disappear. drive a grassroots movement toward meeting patients However, they will likely shift their focus to the highest- wherever they’re at. acuity patients who require face-to-face care. By leveraging multiple models of patient care from live to This shift in the way we care for patients, while no doubt virtual, health systems can more effectively care for jarring for some, may represent a blessing in disguise. all patients while controlling costs and stewarding the Many of our Vituity providers who signed on to provide health of their workforces. virtual care expected to feel more distant from their patients. To their surprise, these clinicians have received As shared owners in a physician-led organization, Vituity an outpouring of gratitude from patients that has Partners are committed to being part of this acute care brought great satisfaction to their work. Providers have evolution. We are excited to partner with like-minded also appreciated the greater scheduling flexibility that organizations to begin creating a more affordable, virtual care allows. accessible, and sustainable future for healthcare. VIRTUAL FRONT DOOR ED Visits that Begin at Home Before COVID-19, EDs were the most commonly visited locations for patients to receive acute care for a wide variety of medical conditions. However, with the arrival of the pandemic, the pendulum has swung in the opposite direction. Patients are avoiding or significantly deferring in-person care, even for potentially life- threatening conditions. Fortunately, due to the recent expansion of guidelines by the Emergency Medical Treatment and Labor Act (EMTALA), patients have increased access to telehealth as an alternative. Virtual visits are proving popular with patients as a more convenient and increasingly effective way of receiving care. To help patients access the right care in the right place, Vituity has launched a virtual ED care program.