Article

Pandemic throws open the digital front door

By Carley Thornell | December 11, 2020

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Dr. Katherine Gregory, a California gynecologist, knew something was wrong with her patient. The woman, whom she’d known for years, never complained. And then one day, came unexpected outreach. “I just saw a little message come through the portal,” Dr. Gregory explained. “I’m kind of having a little bit of a funny feeling. I have a little abdominal pain.’ And I had her come right in. Sure enough, the patient had appendicitis.”

Gregory thinks the outcome would have been much different had she not offered a means of digital communication. “I truly believe that if she had to look forward to a phone tree, being on hold, leaving a message she would have been further along in her illness,” said Gregory, who also says that earlier virtual communications with her patients can lead to fewer after-hours phone calls and costly emergency room visits. 

Such cases are part of the reason she encourages all of her patients to sign up to communicate through the portal at San Francisco Gynecology, which has 98 percent of its panel enrolled. Although her numbers are far from the standard across the continuum, COVID-19 may be changing that. 

With the use of telehealth platforms and others increasing, patients are increasingly likely to use these tools to manage and actively engage in their own health outcomes. That was the consensus Gregory and others across the healthcare continuum recently shared during athenahealth’s first virtual Analyst Day. These changes are important because they reflect not just a pandemic-enforced necessity but a cultural embrace of what Gregory called the “health technosphere” by both patients and providers alike. 

Fellow panelist Aaron Lewis, senior vice president of physician enterprise and strategic growth at LifePoint Health, agrees. “I joke that I can buy a sweatshirt online and hit Apple Pay once — it loads all of my information there and ships to me,” he said. “But I still have to print off every piece of paper before I go to the doctor? It makes no sense. You use your iPhone for everything [else].”

If trends in online payments are any indication, patients are quickly adopting myriad facets of a fully virtual experience. An analysis of more than 100 million claims across several of the highest-volume specialties submitted in our athenaCollector billing service show the share of payments submitted online spiked 30 percent at the onset of the pandemic compared to 2019. They remain steadily higher. In January 2020, online payment rates were running 2 percentage points higher than January 2019, but from March on that year-over-year difference has hovered at 6 percentage points. Online patient payments account for an average of 25 percent of all collections made through athenaCollector across several specialties including primary care, pediatrics, and urgent care.

The pandemic has pushed a shift toward a cashless society in ways that no other event ever has. Whereas before digital payment options were about convenience, consumers have transitioned rapidly of late due to fears about risk of cash contamination. A November Fortune magazine Brainstorm Finance conference, “Rebuilding Business with Digital Finance,” posited that “psychology tells us that it takes 66 days for a new habit to become automatic. Now, [nine] months into the pandemic, new routines ­— from how we bank, to how we purchase, to how we manage money — have fully taken hold.” There’s every reason to believe that patients’ willingness to engage in telehealth and e-commerce may further extend to other online behaviors as the pandemic continues. 

While there may have been great strides made recently in decreasing the number of traditional paper payments, the pandemic will likely also kick removing paper from the healthcare experience into high gear. Gregory’s patients, for instance, have welcomed portal enhancements that allow for the direct sharing of documents and photographs. “It would be wonderful for patients to see their portal as their main repository for all of their information, so it’s their file box,” she said. “As they travel throughout their lives and use different systems, they can just file all of that into their portal as a main hub.”

She just may see her vision fulfilled thanks to the provisions in the 21st Century Cures Act, which went into effect last month. Healthcare organizations must provide patients access to their electronic health data, free of charge, immediately. The most logical way would be via patient portals, asserts PatientEngagementHIT. Colloquially called the Information Blocking Rule, the Cures Act is just the beginning of connecting the dots to enable true interoperability. For Lewis, automation and rapidly adoptable “smart technology” that helps reduce the friction in healthcare are most important in LifePoint partnerships. Access to the right information at the right time is especially impactful for his 88-campus, national organization. “I can look in the future and it’s going to be important for us to connect our hospitals with our ambulatory platform because we are a health system,” he said. “We provide quality healthcare no matter [where] you connect with us in our communities.”

Panelists agreed that COVID-19 just may be the catalyst that propels the patient experience into one that’s consumer-grade. The ease of reserving a specific time for a dining reservation via OpenTable was cited as translating to self-scheduling tools that offer convenience not only for patients but practices that no longer have to answer a deluge of morning calls. 

Gregory frequently looks to the open athenahealth Marketplace for third-party apps that let her staff and providers focus on patient care and functioning at the top of their license. San Francisco Gynecology has been able to maximize volume and increase timely access with a solution that fills cancellations by texting other patients with similar appointments types that are several weeks out. Other patients are able to opt for the earlier, newly open appointment slot.

Ultimately, the tradeoff from the transition to telehealth and a world in which virtual experiences play a larger role may drive a need for others across the continuum to enhance the speed of access to care — making the tools that aid that even more important. 

A report on the Future of Healthcare: Moving Beyond 2020 from Xtelligent Healthcare Media shows almost half of 363 healthcare stakeholders surveyed believe patients will expect to receive “the same quick and timely care” they have gotten virtually during the pandemic going forward. Just what type of care they expect, however — preventative or emergent — generated a response that was evenly split. 

If Analyst Day panelists have their way, innovations that enhance prevention will ultimately be the best medicine. “In general pediatrics, we are completely about prevention," said Dr. Elizabeth Watts, CEO and Medical Director at Capital Area Pediatrics in Virginia. “That is our bread and butter.”