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It takes a Village: How a pandemic changes patient and provider care and communication

By Carley Thornell | May 4, 2020

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Houston is no stranger to crises. As the epicenter of Hurricane Harvey in 2017, Clive Fields, co-founder and chief medical officer of VillageMD, had to deal with one of the worst natural disasters Texas had ever seen. Earlier this year, the Houston-based primary care group — one location among the organization’s 12 markets — saw two of the city’s first confirmed COVID-19 cases. The pandemic exploded soon after, but this initial contact provided him with unique insights on how his local and national practices can scale caring for and coaching practitioners and patients alike

We recently spoke with Dr. Fields, who shared advice on adapting community-based primary care during one of modern medicine’s most trying times.

The right tools for the right communication strategies

Fields said that while the COVID-19 crisis is not a natural disaster but a humanitarian one, there are learnings that have been applied to each. The key is clear communication not just with patients, but also with VillageMD’s executives and care teams, which include 2,500 primary care partners nationwide.

In addition to updating website information frequently, VillageMD leveraged other learnings from the hurricane. “During Harvey we were able to take advantage of athenaCommunicator to reach out to hundreds of thousands of patients with hundreds of thousands of texts and emails,” he said. “The ability to reach out and communicate proactively to a risk-stratified population has been critical to managing the impact” of both Hurricane Harvey and the pandemic, Fields said.

This is particularly helpful when it comes to outreach about filling prescriptions and medication adherence. VillageMD has an onsite clinical pharmacy in several of its locations, which helps address patients who may have difficulty accessing pharmaceuticals because of transportation issues. During Hurricane Harvey, some Houstonians weren’t allowed to return home as quickly as planned due to extensive damages. “This may require us to send the same prescription to different pharmacies to have our care coordinators or outreach specialists reach out to different phone numbers, or engage different caregivers,” said Fields. “The feedback we get is universally positive just for a patient to know what regardless of what may be going on in society or in a certain city or community, that your offices are open, that you’re available by phone, that you can refill prescriptions.”

Coordinating best practices across different demographics

Using technology to communicate across myriad locations at different stages in their COVID-19 crisis has been essential, said Fields. Several short Zoom meetings and webinars scheduled during off-peak hours help keep employees at all levels across the organization engaged and informed. And analytics from each market help inform educated answers and plans about what COVID trends to prepare for next.

Having globally accessible universal documentation has helped streamline crisis plans across different markets at different stages in their peak battles against COVID, too. VillageMD established a database of documentation for web messages, signs for outside of physical locations, templated outreach letters for both high- and low-risk patients, and how to protect the workforce.

“The kind of communication that we have built into our organization as part of our clinical platform I don’t think has ever proved as valuable as it has during a time of COVID. The ability to exchange information has been critical in us learning from each other as well as sharing best practices,” said Fields. Everything from how to best protect staff, to taking care of patients, to ultimately benefitting from how to pivot a telehealth platform.”

Scaling quickly to employ telehealth

One of VillageMD’s 30-minute webinars was focused on training providers to use their telehealth platform, which grew by 750 new licenses virtually overnight. This opportunity to keep patients and employees out of harm’s way by discouraging unnecessary visits to medical facilities has turned medicine on its head and necessitated some creativity, said Fields. “It’s a really, really interesting time. We’re asking patients who have never felt worse to stay at home and avoid contact with the healthcare system, which if you think about it, is the exact opposite of what we normally do.”

Opening up telehealth opportunities has helped maintain engagement, as this technology is coordinated across care teams — everyone from physicians to care managers and social workers. VillageMD has even expanded services to allow one patient to meet with more than one professional at a time on the same call — an opportunity previously unrealized in-person.

They are also making the experiences as personal as possible, with online audio-visuals that include a front-desk check-in, and nurses prepping patients and “delivering” them to doctors.

Thinking beyond the pandemic

Fields says even in just a few weeks, VillageMD practices has been forever changed —  potentially for the better in some ways. While most physicians may have previously thought of telehealth as a way to deliver simple acute care, “‘One eight hundred may I have a Z-Pak’ has evolved to deliver prevention and screening services,” he said. Across the organization, he’s seen a “rapid” high demand for chronic patient management that has VillageMD strategizing how to integrate lab draws, X-rays, and specialty referrals that are normally conducted in-office. He also sees a lot of opportunities to deliver mental health services via telehealth in the future.

“Telehealth with the ability to access a longitudinal record and to risk-stratify a patient population for appropriate outreach is the triad that I think will bring telehealth somewhat out of the shadows and into the mainstream strategies for how we deliver healthcare in the future,” said Fields. “And the acceleration of telehealth to move toward remote patient monitoring is a millisecond behind.”

To hear more from Dr. Clive Fields, watch this webinar.