Why Providence views this patient expense as an investment — ExpressCare CEO Dr. Sunita Mishra explains

Renton, Wash.-based Providence St. Joseph Health began 2020 with the introduction to its virtual care service, dubbed ExpressCare Virtual.

Consumers in Alaska, Washington, Oregon, Montana and California can access the virtual care service through the health system's app, known as Providence Health Connect, or the ExpressCare website. Providence ExpressCare Virtual accepts most insurance plans. However, the out-of-pocket expense for consumers will not exceed $49.

Sunita Mishra, MD, the CEO of Providence ExpressCare played a crucial role in the development in the virtual care service along with Amanda Ashely, manager of operations and physician services for ExpressCare. An internal medicine physician, Dr. Mishra can relate to many physicians about the adoption of telehealth solutions.

"Once I was educated about the protocols and clinical training and that we had the principle that if we can't treat patients in the virtual setting that we will get the patient to the right place, then I felt very comfortable with it," Dr. Mishra told Becker's Hospital Review. "We always talk about taking care closer to patients and this is one modality that is very important to do just that."

Below, Dr. Mishra and Ms. Ashely discuss the development of ExpressCare Virtual as well as why they call some expenses an investment.

Editor's note: Responses have been lightly edited for clarity and length.

Q: How long did it take for Providence to develop ExpressCare Virtual? 

Dr. Sunita Mishra: We have been piloting it on a smaller scale over the past two years, beginning in 2017. Within this past year, we have begun to release the service more broadly. It has taken a while because we knew that we were using a modality that patients liked, but we had to make sure that we had a way to inform them about the care model. As we launch the ExpressCare Clinics we wanted to give patients the option to do things virtually and online. Now that we have been in expansion mode with our ExpressCare Clinics we've launched the virtual services more broadly. It's really been a labor of several years to create a platform that allows patients to choose their care. 

Q: What did you learn during the development processes? 

SM: There was a lot of initial skepticism about treating patients safely through a virtual modality. We have been able to learn what we can and can't do in a virtual capacity over the past several years. We've also come to realize we can do a lot more virtually than we originally thought. One of the big learnings for us was that we also needed to educate our own provider team that we can treat patients safely and effectively through virtual services. The education has really been on both ends: letting patients know that this is something they can avail as well as educating our internal stakeholders that this is an important way to deliver care. 

Amanda Ashley: I think one of the things we have learned is that this is a modality of care that patients really committed to once they have used the service. I think once patients see how easy it is to connect with a provider through a phone or computer and either at work or at home, that their eyes are opened, and they see the opportunity. There really is a demand on the patient side for this. On the same side with our provider time, when we first launched the virtual care services, there were some questions about if providers would feel comfortable using. Over time, we have seen that providers are not only willing to try the virtual care service, but they develop a specialized skill set when treating patients virtually. 

Q: Do you have any examples of a physician who might have been skeptical about using the virtual care service turning into a champion for the technology? 

SM: The folks that we hire are trained to specifically provide virtual care. So, they have been delighted to know about all they can do. I think some of the big wins on our part is when we partner with our primary care teams and are able to treat some of their patients through this modality. I think they really appreciate the approach that we take. 

There's often time concern that when you can't really examine patients you are going to start handing out antibiotics left, right and center, and that it's going to be a lower standard of care. Our physicians have shown that you can still practice to the same quality metrics. A lot of our primary care providers who were skeptics originally are now really appreciative when they see the quality metrics that we have. 

Q: Did you look at other health systems or retail healthcare providers to create ExpressCare Virtual? 

SM: We did. I would say that we looked around at some of the other telehealth offerings. One of the things that was really important to us was having the virtual providers be our own providers. We didn't feel comfortable at the time using another service provider because we wanted those clinicians to embody the same mission, vision and values that our primary care teams had. 

We also thought it was important that the providers were functioning on the same EHR so we could have a broader view of the patient. We talk a lot about connected care through ExpressCare. That really helps us being on the same EHR because we are able to understand the patient's history and navigate them appropriately to other connections within the ecosystem. Overall, after looking at other companies, we thought it was important to build the virtual care service in-house with our own providers. 

Q: You are offering patients no cost to arrange an in-person visit if the virtual provider deems necessary. Do you expect to eat major costs because of this? 

SM: It will be necessary to send patients to an in-person provider. About 25 percent of the patients that use the virtual service end up needing to be treated in-person. But we don't look at the cost to triage a patient out as an expense. Rather, we view it as an investment because we are really creating trust with our patients. It's also an upstream way for us to be able to get in front of the patient and build stronger relationships. 

To give you an example of what that would look like, we had a patient that came in with symptoms of abdominal pain. One of our providers was able to work with the patient so they understood that they actually had what looked like appendicitis. The provider was able to direct them to a hospital where the patient was seen for an appendectomy only two hours after being first seen by the virtual provider. 

Yes, we are eating the cost of that visit, but at the same time we are making sure that the patient gets the right care. For us, that's an investment we are interested in making. 

AA: We are definitely seeing a positive response from our patients after they are being instructed to go elsewhere. It is not a barrier to the patient coming back. They are pleased with the service, happy we helped them find the right level of care and coming back to use the virtual care for a different condition. 

Q: Why do you call your solution a virtual care service rather than telehealth service? 

SM: We did spend some time trying to decide how to name the service. For us, it was that ExpressCare was the overall offering and how patients access it is different, whether it be a clinic or online. We thought virtual was a better way to describe it compared to a telehealth offering because it really still is a face-to-face visit with a clinician just in a virtual setting. 

We have providers that can do virtual and in-person. We also have a hub of providers and patients. 

Q: Are you looking to expand the offering to more of the country or even the world? 

SM: We are now just committed to getting into our own seven-state footprint. Currently, we are operating in five states. We are interested in understanding what consumers are wanting. A lot of them travel and are so mobile that we want to find ways to stay connected to them even when they are not in their home state. As far as international work, Providence does a lot of international mission work and we have had some preliminary conversations about how we could leverage the virtual care service to help deliver care globally. 

More articles on telehealth:
Milwaukee VA conducts nearly 1,500 virtual appointments in program's 1st year
Lehigh Valley Health Network and local ambulance service partner on telemedicine stroke unit 
Mercy Health unveils mobile telemedicine stroke unit

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