Bridging the payer-provider virtual care gap: How UPMC Health Plan used hospital partnerships to improve care, outcomes and experiences for members

Integrated delivery networks (IDNs) share common goals in terms of outcomes, cost reduction and patient experience. But sharing goals hasn't necessarily led to collaboration.

In an Amwell-sponsored Becker's Hospital Review webinar held in June, leaders from University of Pittsburgh Medical Center (UPMC) described how the organization bridged the payer-provider virtual care gap by partnering to share resources and improve the member and patient experience. Presenters from UPMC were:

  • Jeff Gala, Senior Digital Product Manager, UPMC AnywhereCare, UPMC Health Plan
  • Jessica Schunk, Manager of COVID-19 Response for UPMC Health Plan and Employee Health
  • Shannon Seitz, Unit Director, UPMC Passavant

Four key takeaways were:

1. Virtual care exploded during the pandemic. Mr. Gala said that while virtual care had existed at UPMC since 2016, it wasn't until early 2020 that it took off. Initially virtual care was used primarily as a tool for urgent care to help with cost savings, but it quickly expanded in 2020, growing by 500 percent since then. "We had three groups on our platform, and we moved up to 12," Mr. Gala said. "By the end of 2021, we were at a total of 24 groups utilizing the platform as provider groups with 16 of those specifically focused on member care."

2. The pandemic and resulting staff shortages have created unprecedented turmoil, amplifying the need for efficiency and the opportunity for virtual care. Increased demand for care and decreased staffing has made providing high-quality care more challenging. "Vacancy rates, staff quarantines, the big surge we're seeing on a national scale in nurses opting to transition to travel [nursing], there's a very valid growing concern for how we continue to provide safe, high-quality care to the patients we are here to serve," Ms. Seitz said. 

Organizations like UPMC that already had virtual care solutions in place started looking for ways to create efficiency through virtual care while maintaining, if not enhancing, the patient experience.

3. Adversity has created an environment ripe for innovation. For UPMC, the challenges caused by the pandemic meant forming an interprofessional team from across the organization and across disciplines focused on identifying efficiency opportunities utilizing virtual care. This team launched a virtual discharge pilot following orthopedic procedures. 

The pilot involved the hospital's nursing team and nurse case managers from the UPMC Health Plan side of the business. The nurse case managers provided virtual discharge instructions and education to patients while still in the hospital, prior to discharge. It wasn't easy for the bedside nurses to give up total care for their patients, but with a warm handoff and resulting high patient satisfaction scores, they realized they had more time for other important tasks.

4. This payer-provider virtual care partnership worked for everyone. Over the course of the pilot, while involved in providing virtual discharge instructions to more than 300 patients, "we were able to save the inpatient nursing staff more than 20 hours per week," Ms. Schunk said. And patients loved it. "We've been pleasantly surprised by how well received this has been by patients, with average ratings of 4.9 [out of 5.0] given to the providers and 4.8 for the online care," she said.

The pandemic has forever changed healthcare. But some changes have been for the positive. Platforms like Amwell coupled with innovations from UPMC showcase that adversity can ultimately lead to better care and greater efficiency.

To register for upcoming webinars, click here.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 
>