It will come as no surprise to anyone who’s worked in healthcare in the last few years – or been a patient — that the practice of medicine has been forever changed. But when the landscape shifts so suddenly, shouldn't the roles that support it?

So say experts from organizations large and small responsible for driving innovative approaches to create a more sustainable continuum while delivering a better patient experience. From digital care navigators making sure the most at-risk (and least tech-savvy) patients have an easy adoption experience to boots-on-the-ground care ambassadors, athenahealth customers are developing novel approaches to meet new needs.

A transition to value-based care requires capital – including human capital. Prior to the pandemic, there were already monumental challenges with a fee for service model, notably that such a system rewards volume over outcomes. The COVID-19 crisis exacerbated those challenges by keeping patients out of doctors’ offices and the ER to put a different kind of strain — financial — on the entire system.

At Gerald Champion Regional Medical Center in New Mexico, Jennifer Gruger transitioned into the full-time physician practices quality programs manager at the end of last year; her expanded position puts added focus on training providers and staff in the transition to more risk-based contracting. “This is an inevitable direction. We need to make sure our providers understand the value of HCC and RAF scores and the entire panel population, and how it's being cared for, and how to really move into a shared-savings environment,” she said of hierarchal condition categories and risk adjustment factor scores (measures in value-based care contracts). “We need to be prepared for a more rigorous focus on care coordination and case management. And we need some additional resources in the quality department.” Gruger was given the greenlight to hire a clinical nurse informaticist, an increasingly popular role that bridges the gap between metrics analysis and nursing practice by combining clinical experience, IT skills, and data expertise. And she also advocated for another new category of hire: the community health worker.

The social determinants of health must be addressed for a holistic view

Gruger says another part of her role is providing education surrounding patients’ social needs. Positive home environments, preventative care, and healthy food, for instance, all contribute to how community health workers “fit in the value-based care puzzle,” she added. Data from the Perelman School of Medicine at the University of Pennsylvania, for instance, has found that having such roles can help reduce hospitalizations by 65 percent — not only does that drive down the cost of care, but influences better patient outcomes. At Esperanza Health Centers in Chicago, patient-facing education comes via a growing team that was formed during the pandemic. The squad of boots-on-the-ground bilingual public health ambassadors canvas some of the most at-risk communities – including Little Village – to form relationships with patients (and potential patients). Conversations tend to be around less episodic care and more about the social determinants of health like food insecurity, clothing distribution centers and medical care like COVID-19 booster shots that promote longitudinal results. Free rideshare programs to clinics helped bring the Little Village vaccination rate to 80%, for instance*. “I feel like we are saving lives,” said lead public health ambassador Julie Vera.

Managing digital care strategies and implementation is essential

Another important function of the Esperanza program is a bit of handholding when it comes to handheld devices. Ambassadors assist patients with technology related to telehealth, or like messaging apps available through athenahealth and the EHR’s third-party Marketplace partners to stay in touch with Esperanza staff. Ambassadors can communicate with each other and connect back with clinicians thanks to athenaOne and the WELL Messenger app.

Adopting new tools and innovations can vary widely between generations, geography, and conditions, for instance, which is why neurologist Dr. Allen Gee has supplemented his staff with a new role: that of the digital care navigator.

As the owner of Frontier NeuroHealth, a practice with three locations in northern Wyoming, many of his patients are senior citizens for whom there can be a steep learning curve when it comes to technology. Add to that the fact that his specialty treats nervous system and brain ailments, the uptake can be troublesome when it comes to adding virtual care or wearable monitoring devices into the mix. 

“It occurred to me, how are we going to use technology to bridge gaps in geographic areas, for instance, if a patient can’t even run their own smartphone,” said Gee. “Then we start adding digital devices.”

He hired Josephine Krause, whose 15 years in IT, project management certification, and passion for treating neural and mental health are the ideal fit for Gee’s Wyoming Health Innovation Living Laboratory. While she helps train patients how to use technology, a big part of that is vetting the right vendors and delving into the user experience side before rolling anything out, Krause said.

Ultimately better technology, tools, and user experiences on both sides of the exam room table may help with clinician burnout, Gee believes. One possibility for increasing patient-provider communication without overloading clinicians is to better leverage wearable devices and software solutions designed to send out automated behavioral reminders. These tools provide more consistent connection between patients without necessarily increasing clinical workloads, he said. “It’s a way to give patients medical knowledge and wisdom.”

New technology brings new challenges to manage and motivate remote staff

Virtual care isn’t the only challenge – and opportunity – facing the healthcare ecosystem. The cadre of professionals who’ve joined the remote workforce permanently makes now a pivotal time for human resources departments to build new ways of working, both together and apart, for the betterment of enterprises and their associates, notes Harvard Business Publishing.

For Sharp HealthCare, an organization that's noted great success using gamification technology to motivate remote workers, the addition of a workforce management business analyst during the pandemic has assisted leaders with task reporting. The goal is more coaching than monitoring, said Gerilynn Sevenikar, vice president of revenue cycle management. “We don’t want employees to be stressed out because they see a red box. They could have gone on break,” she explained. “But if you see five consecutive red boxes, you might want to call that employee and say, ‘Hey, what’s going on? Is the computer not working?’” 

Gamification is another means to encourage engagement, Sevenikar said, especially due to the nature of “friendly competition.” The proof is in the pudding: within six months of implementing Gamify, Sharp noted a reduced staff turnover rate (less than 5 percent); 10 percent reduction in task lag; 21 percent increase in customer service productivity; and 31 percent increase in credit balance productivity.

Role transparency and clarity are essential

It’s not only relevant in wellness that prevention is the best medicine – transparency when it comes to hiring for roles is essential, says Patrick Aguilar, chief medical officer of MedWise Urgent Care. The growing Oklahoma-based 11-location group has had few issues hiring during the Great Resignation due to getting back to basics, he said. Why? Being upfront and active when it comes to job design. 

“We sit down and ask, ‘Do these tasks fit together in a natural way?’ Then, ‘Can one person actually do all of the things we’re asking them to?’ And three, ‘Are we attempting to put the right person for that set of tasks in that job?’,” Aguilar said. “We want to articulate not a job description that looks like it came from a lawyer’s office, but one where we’re clear about what the expectations are.” 

A dedicated team frequently reviews and updates descriptions for open roles as MedWise grows, an exercise Aguilar thinks has ultimately benefited not only candidates, but the talent acquisition team. “The hiring committee has had an easier job of hiring because of the (role) clarity,” he said.

Whether it’s better communication about what roles are, where they are, or innovative jobs interacting with patients, one thing is certain – new ways of thinking about staffing those who will revolutionize care delivery is an essential piece of the healthcare puzzle.

---

*Esperanza Health Centers data from March 2022