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Sunday, Apr 21, 2024

Health Care Roundtable

How dramatically has your healthcare organization and operations changed in the wake of the COVID-19 pandemic?  

Kalkat: We were monitoring the news from China in early January as the first airlifts began arriving in the U.S. When the lockdown began in March, we had already begun communications educating our staff and patient community about the coronavirus. When we shutdown elective procedures we knew we would have a significant financial impact but we also knew it was all hands-on deck to address COVID-19 because we were well aware of the growing patient numbers at hospitals across the country. Looking back over the last four months, many of the changes that we established during the pandemic, like new cleaning and safety protocols, will likely be instituted long term and make us a better health care system moving forward.

Andersen: With the enormous impact of COVID-19, we know many things have changed and will continue to change. At the same time, we also know that the key to making it through these challenging times is adapting and taking action to meet consumer needs. Digital-first is the cornerstone of the future of healthcare, and with COVID-19 our digital platforms have given us the ability to act quickly and introduce enhanced digital services that help consumers assess their risk for the virus, connect with a healthcare provider virtually and identify testing sites—all of which are important in flattening the curve. In addition, we launched our C19 Explorer and C19 Navigator tools which are designed to assist public health officials and business leaders in making informed decisions as they plan for re-opening and return-to-workplace. It is innovations like these that will help us to shape the industry for the future.

Rapisardi: The biggest and most immediate operational change was moving to a work-at-home model almost immediately in order to safeguard the health and well-being of our employees while keeping our business operating. In addition to the hundreds of employees we have in Southern California, Cigna has about 70,000 employees globally. With the exception of a few thousand site-dependent employees, the vast majority of our global employees pivoted to working at home very quickly.

Trisal: COVID-19 turned our world upside down – changing everything about our lives, our health care approach and safety. With cancer, there are no elective surgeries, chemotherapies, radiation or immunotherapies. Urgency in delivering care is paramount. A National Cancer Institute-designated comprehensive cancer center with a high number of immunocompromised patients, City of Hope has always maintained the highest infection prevention and control standards. Since COVID-19, we started taking more precautions to protect patients/staff. We initially delayed some appointments but quickly realized that COVID-19 is not going away and that we must treat all patients. We implemented mandatory masking, health screening for patients/staff and a no visitor policy. Doctors, nurses and staff have become surrogate family, using City of Hope tablet devices to connect patients with loved ones. We quickly implemented on-site and drive-thru testing, helping identify patients/staff who were infected early to prevent transmission. All patients must be tested before most procedures, treatments or clinical trials.

How has your organization responded/pivoted during this pandemic?

Bhatia: During the pandemic, Prime’s mission of saving hospitals to save lives has never been more important. Our primary focus has been on the safety of not only our patients, but our staff and physicians who are on the frontlines each and every day. Our organization has rallied together remarkably and worked tirelessly to address the unique needs of each community while making certain all our health-care providers have the necessary resources and equipment to protect themselves from infection. Through a centralized PPE procurement strategy and strategic inventory allocation, our corporate teams provide the communication and support necessary for our hospitals, and providing fact-based information that helps ease the fears our staff and patients naturally feel when dealing with an unknown disease. These are unprecedented times in American healthcare, and we’re proud of the role our hospitals have played in flattening the curve and delivering the care our communities deserve.

Cerf: Our focus is on addressing our members’ needs right now and preparing for whatever may come tomorrow. We are always focused on our mission to ensure all Californians have access to high-quality health care at an affordable price. In addressing the shelter in place environment, Blue Shield of California and Blue Shield of California Promise Health Plan redeployed our staffs to respond to changing member dynamics and needs. This includes:

• Ramping up outreach efforts to members, who are most at risk, and connecting them to resources, or to our community or provider partners, for support;

• Providing assistance and answering questions for new members who just enrolled in Medi-Cal for the first time; and

• Committing more than $200 million to support healthcare providers and hospitals facing financial pressures as a result of the coronavirus (COVID-19) pandemic.

Lee: At Children’s Hospital Los Angeles, our pandemic response has mainly centered on two categories of effort—keeping patients, their families and team members safe from COVID-19; and ensuring that patients continue to receive the pediatric care they need. The first category involves developing measures all hospitals had to consider, such as universal masking guidelines; effective ways to screen patients, visitors and team members before they enter our facilities; and robust on-site testing to realistically identify who has COVID-19. The second category, while covering telehealth and mobile solutions like other institutions, also includes something unique to children’s hospitals—delivering family-centered care. CHLA is built and deigned for families. As the pandemic has required us to minimize density and avoid spread of infection, we’ve worked to structure our visitor policy in a unique way. We screen all patients and visitors, have testing and visitor guidelines for our inpatient units, we have prioritized the safety of our patients, their families, and our team members. To accommodate the need for physical distancing, we have crafted creative solutions to address the reality that patients will often come to appointments with their parents and siblings. Through virtual waiting rooms and expanded outdoor locations for families we are able to balance safety and our commitment to family-centered care. The biggest challenge is that state and local leaders and our data give us new insights every day, so the protocols we’ve implemented may have to evolve on a day-to-day basis.

Trisal: City of Hope responded with speed to reduce the risk of COVID-19 transmission to patients and staff. When COVID-19 hit, we immediately thought about our immunocompromised patients. It is our responsibility to protect them, and it’s also immensely important that they receive uninterrupted care. Patients who were undergoing radiation could not stop without impacting treatment. The same applies to chemotherapy, surgery or immunotherapy. More than 3,500 City of Hope employees also began working from home, which required rapidly expanding existing platforms and remote capabilities to accommodate the sudden telecommuting surge. Employees whose usual job functions were hindered or paused due to COVID-19 joined our “labor pool” to provide essential support. Our employees screen patients/staff prior to entry into City of Hope locations, help patients connect with family during appointments, and serve as patient escorts, among other duties. City of Hope’s commitment to compassionate care continues, despite the pandemic.

Kalkat: Based on the initial reports of the pandemic, COVID-19 was unprecedented, impacting the health care industry like never before. Our first and foremost task was to ensure the safety of our frontline workers. We started procuring PPE very early. Our infection control department followed the latest guidelines and ensured that we do all we can to keep our frontline workers safe. We also started communicating to our physicians very regularly to get their buy-in which is helping us in executing our strategy to combat this virus. We offered our services to our surrounding skilled nursing facilities/nursing homes which houses the most vulnerable population. We immediately cancelled elective procedures, redirected staffing and resources to treat COVID-19 patients. Since the early spike, we have setup tents outside our emergency rooms to increase capacity to better triage these patients.

Andersen: Throughout the response and the ongoing recovery to COVID-19, we have been focused on increasing access and coverage, adapting tools and policies, leveraging our expertise in data and advanced analytics to provide innovative solutions, and delivering outreach and relief to those in need. Our deep roots in the community combined with our commitment to leadership, innovation and agility, have enabled us to quickly and seamlessly work with local, state and federal officials, care providers, customers and community partners in the face of the pandemic. As our state moves forward, we will continue to support the health and well-being of all those we serve, and help to create a better healthcare system for all Californians.

Rapisardi: From the outset, our top priority has been to protect the health, well-being and peace of mind of our employees and customers. To remove financial barriers that might keep people from seeking care, we moved quickly to waive cost-sharing for Covid-19 related testing and treatment. We waived prior authorization requirements for transfers, which made it easier to move non-Covid-19 patients to subacute facilities to free up beds for people who needed hospital treatment the most. We expanded access to telehealth, and even deployed hundreds of our own clinicians to supplement telehealth providers at MDLIVE. We launched the Covid-19 Customer Protection Program to further safeguard customers from “surprise” bills from out-of-network providers, and we launched the Express Scripts Parachute RxSM program to provide access to many prescription medications at affordable and predictable prices for any Americans who lose their health coverage due to Covid-19.

Simpson: Montage Insurance Solutions shifted to all employees working from home with secure laptops. We sent clients their specific carriers’ COVID-19 updates for care, including telemedicine services for those who need to talk to a doctor for COVID or other healthcare issues and EAPs for mental health. Our teams have not missed a beat in negotiating clients’ renewals, virtual open enrollments and promoting wellness in a variety of ways. Claims handling in Benefits, Property & Casualty and Worker’s Compensation continued with updates on any carrier COVID discounts on premiums. We are informing our clients biweekly through webinars, rather than monthly in person seminars, on safely working from home and returning to work, PPP loans, FFCRA, FSA changes, OSHA “new” requirements, safely disinfecting offices – the new clean. Our next 8/11 panel discussion with our carrier partner’s medical directors will be speaking on COVID-19 today, the future, their response and plans going forward.

What are we learning from this pandemic about healthcare delivery or access?

Andersen: The pandemic has many learnings: it has provided additional data showing the impacts of disease are not the same on everyone, that we can be more agile in the face of rapidly evolving situations, and there are better ways for payers and care providers to safely deliver care, improve access and address health equity. The use of telehealth has increased dramatically and shown us a clear path to scaling cost-effective ways for the safe delivery of care to those who need it. To further expand our efforts to make it easier for providers to manage resources and capacity we were able to rapidly develop and deploy a COVID-19 symptom checker on Sydney Care, our app powered by Artificial Intelligence. We can embrace these learnings to emerge even stronger.

Lee: As a safety net hospital for the region’s children, we’re always committed to helping young patients overcome barriers to attaining necessary health care. When the pandemic hit, we were very concerned parents would not bring children in for care, especially immunizations; one of the worst things that could happen is a measles outbreak on top of COVID-19. So we set up a drive-up vaccination clinic so families never have to leave their cars, and created a parallel setup for discharge medication, with a pharmacist handing prescriptions to families as they exit. Additionally, as people have become unemployed or furloughed, many lost their health coverage, creating another barrier to access. To help these families, we have created an in-house process to efficiently guide them through Medi-Cal enrollment for their child, with very successful results so far. One opportunity that has arisen is testing. After our initial efforts to ramp up in-house COVID-19 testing for patients and team members, we found we had the capacity to expand more so we could provide testing for other organizations and pediatricians across four counties affiliated with the CHLA Health Network. Early on, we even provided testing for a few other hospitals who were still establishing their own testing. This provided an indirect way for health care providers to remain at work, continuing to support access, both on our own campus and at other campuses.

Trisal: Health care should be local. We need to deliver cancer/diabetes care closer to our patients’ doorsteps and luckily, with City of Hope’s network that spans all of Southern California, and with 30 clinical locations including our main Duarte campus, we are able to deliver care closer to home with the same quality that a patient receives on our campus and the ability to get the best minds to opine on the best treatments. Because of COVID-19, travel is not only onerous physically but increases the risk of infection exposure. Our $1 billion investment in Irvine to develop and operate a world-class cancer campus and a network of care in Orange County is critical for our patients so that they don’t have to travel far for the latest treatments. In essence, we need to deliver cancer/diabetes care closer to home while still bringing together the brightest minds in cancer/diabetes care.

How well has your healthcare organization responded to the crisis? What are some examples of successes? 

Lee: Two examples come to mind—COVID-19 testing capability, and PPE sourcing and conservation. Thanks to the foresight of our virology experts, Children’s Hospital Los Angeles launched in-house COVID-19 testing for patients about a week into the pandemic, with enough capacity to support partner clinics and some other hospitals as they ramped up their own processes. We have now tested around 10,000 patients, visitors and team members. This is a major reason CHLA has been able to identify and isolate COVID-positive patients quickly, keeping everyone as safe as possible. Like many hospitals, we originally worried that global PPE shortages would impact our ability to maintain a safe healing environment. This is where our COVID-19 Command Center and Supply Chain teams really shined. While Command Center experts analyzed data and guided new policies to safely conserve PPE, Supply Chain members were tracking down and verifying every lead on masks, gowns and other protective gear. We got to a point where we could implement a universal masking protocol for everyone in the hospital, greatly minimizing any potential airborne viral spread.

Trisal: City of Hope is a nimble organization. We pivoted quickly to get the whole organization behind our COVID-19 strategies and execute them in a quick and efficient manner. As our quest to find better cancer and diabetes treatments continues during the pandemic, we are leveraging our research expertise on deadly viruses with COVID-19 similarities to fuel innovative research that will hopefully lead to better COVID-19 treatment and prevention. Our research includes two potential COVID-19 vaccines, possible new therapies and better screening/testing approaches. For example, City of Hope scientists are investigating whether natural killer cells, a group of immune cells that can attack cancer and viral infections, can be used to attack COVID-19 by combining them with chimeric antigen receptor (CAR) T cell therapy. City of Hope is a leader in CAR T research, so we hope to leverage our expertise to help end this pandemic.

While the frontlines of healthcare have been focused on managing the COVID-19 crisis, what has the effect been on voluntary or non-urgent portions of the healthcare industry, and how long will it take for those organizations and practices to recover?

Kalkat: We have seen a significant decline in patient visits to our network of outpatient services. The most worrisome issue is patients delaying preventive care for issues like diabetes and high blood pressure, which are prevalent in our patient communities. This will likely result in delayed diagnosis, unfortunate sickness and possibly increased mortality. As we gave complete attention to COVID-19, we have delayed executing other long-term projects. In response to decreased revenues from the postponement of elective procedures, senior leadership has taken a voluntary reduction in pay and suspended our pension plan match. In addition, we have scheduled weekly furlough days for non-clinical staff to minimize the impact on our health care system’s bottom line. We are pleased to report that impacted employees have taken this difficult decision quite well, all things considered.

Bhatia: During the spring, Prime Healthcare hospitals stopped all elective surgeries and invasive procedures to help prevent the spread of the virus, conserve protective equipment and allow for a potential surge of COVID-19 patients. In the months since the early peak, patients have been reluctant to return to the hospitals for routine screenings, important surgeries and the life-saving care we have historically provided. While vigilance to the virus is still critically important, we have been encouraging our community members not to further postpone procedures essential to their long-term health. Our hospitals have been reaching out to their communities with assurances that, with guidance from state and federal health officials, procedures and processes have been put in place to ensure patient safety during routine hospital visits. COVID-19 isn’t going away anytime soon, and our hospitals are prepared to treat patients as we continue to experience surges in some regions. We remain well prepared to handle non-COVID cases as well.

What are some of the biggest lessons learned to better prepare the health care sector in the future?

Lee: Given the rapidly evolving external guidance and data on COVID-19, we made a commitment early on to constantly communicate decisions coming from Children’s Hospital Los Angeles leadership and the Command Center we set up to respond to the crisis. This took the form of daily Command Center email updates; a dedicated COVID-19 intranet portal and document library; and frequent video leadership huddles and provider briefings. Our President and CEO Paul Viviano also committed to sharing regular internal video messages and hosting virtual town halls with extended Q&A segments. The feedback we’ve received about the transparency of our decision-making has been overwhelmingly positive, especially the powerful and reassuring personal connection team members say Paul has created with them through his messages. That’s another lesson—during times of crisis, it’s critical for leadership to be visible. People ask me, “Why are you here? You’re not taking care of patients.” But if I’m asking thousands of clinicians to go to work, so long as I’m healthy I should be here as well.

Kalkat: COVID-19 has truly been a moving target and it has forced our health care system and those across the country to adapt our thinking and quickly move our feet to keep up with this virus. From staff deployment to supply chain issues related to PPE, COVID-19 has forced us to become better problem solvers, innovators and more resilient, which only bodes well for the future of our industry. This is especially true as public health officials have told us that the virus will become a part of our “new normal” moving forward. The collective experiences that we’ve attained from this pandemic will likely change the health care industry for the better and prepare us for the clinical challenges of the future.

What business opportunities have presented themselves during COVID-19?

Bhatia: As Winston S. Churchill said, “A pessimist sees the difficulty in every opportunity, an optimist sees the opportunity in every difficulty.” The COVID-19 pandemic has created unprecedented challenges for all health care providers worldwide. As Prime Healthcare has tackled these challenges, various opportunities have presented themselves that could shape how healthcare is delivered in the near and long-term future. Addressing and meeting the holistic needs of our patients and their families while also acknowledging the need to preserve the physical and mental well-being of all our health care providers, a key component of the quadruple aim, has been at the forefront of our efforts. Previously unrecognized efficiencies in supply chain, material management and laboratory will now be a mainstay in our operations. Finally, telemedicine is here to stay. We look forward to more robust implementation of various telemedicine services to better serve the comprehensive needs of our patient population.

Do you see some of the rapidly changing business models that have arisen in the last few months as permanent or temporary? Why?

Kennedy: Well, necessity is the mother of invention and, the reality is, we’ve been forced into a spot where social distancing bumped up against the need to continue producing certain deliverables.  As a result of those forces, we’ve really pressure-tested established ideas on whether certain percentages of the job can actually be done remotely.  And, even if they “can,” is it actually optimal, or merely an acceptable band-aid?  Companies are permanently realizing, within the boundaries of whatever their particular organization does, what aspects of the job can be remote, what aspects can be remote in a pinch (but not ideal) and what really needs to be done on-site. In the same way the email came along and replaced “some but not all” phone calls and face-to-face, tools like Zoom will permanently integrate as an additional option for professional interactions, but not a total replacement for meetings that are better done in-person. 

Rapisardi: It’s likely that the use of telehealth, or virtual visits, will continue to grow and become permanent. While virtual visits will never completely replace office visits, patients now see them as a viable alternative for certain situations. With telehealth now available for behavioral health and dental care, in addition to primary care, patients will continue to recognize the value and convenience of virtual visits.

Lee: By far, the biggest change in business model is the widespread adoption of care provided through telehealth services, which received a massive push from COVID-19. In a very short time, Children’s Hospital Los Angeles was able to grow its capacity from less than a dozen virtual visits a week pre-COVID to over 40,000 since the pandemic began. But our vision for online virtual care extends beyond web-based doctor visits. In May, CHLA launched Connected Care, a suite of virtual and mobile offerings giving patients and families greater convenience and access to our team of pediatric experts. In addition to virtual visits, Connected Care includes an enhanced MyChildren’sLA Patient Portal, online second opinions, remote patient monitoring, secure messaging and more. This care model allowed us to address the backlog of patient care needs while complying with statewide Safer at Home orders. Given its success, we have plans to add more Connected Care programs regardless of how long the pandemic lasts.

How does California’s outlook differ from other parts of the country?

Kennedy: Comparing California’s numbers to some harder hit places like New York or Italy, there’s almost a case to be made that we flattened the curve too well.  There’s so much that’s unknown about COVID right now, but if we look at available data, there’s almost a degree of “running its course” that seems to happen before trend lines really start going down.  Looking at California COVID deaths, there’s this weird pattern where the numbers increased, California instituted measures, and then, rather than going down, you have this persistent tail that basically just plateaus.  Then, as measures lift, the numbers are going back up.  So, for California, relative to other parts of the country, I fear things still need to get worse before they can get better — at least according to the data we have today and how it compares to other places that seem to have numbers back under control.

What do you think will be the biggest changes in health care that will come out of the COVID-19 crisis?

Cerf: For Blue Shield of California Promise Health Plan, we have a tremendous opportunity to help the growing Medi-Cal membership in Los Angeles and San Diego Counties where we currently serve members. especially those who have lost employment because of the pandemic. This population is at the very heart of our mission. We’ve launched a new workstream focused on preparing to serve more members as unemployment numbers grow and our members’ health is our top priority. We’ve expanded services available through our community resource centers and shifted our approach as the centers are closed while stay-at-home orders are in effect. Together with our providers and community partners, we have earmarked additional funding to continue addressing food insecurities, domestic violence support and community solution response efforts.

Do you see any silver lining to come from the pandemic scenario?

Lee: I think there are some fundamental benefits we have discovered while responding to this pandemic. Universal masking, for example, is not only reducing risk of COVID-19 transmission for everyone at CHLA, it’s also preventing people from catching other illnesses. One of the recurring questions that we are asking ourselves as we refine our quality and safety protocols is, “Should we do this for the regular flu season?” Additionally, some protocols we’ve developed, like the mobile-phone-based screening tool that visitors and team members access when they arrive at CHLA, have uses beyond the pandemic. I also see several workplace culture shifts that are likely to boost safety and quality long-term. For example, it’s now more socially acceptable to call someone out for not wearing a mask. And while we’ve always emphasized that team members should not come to the hospital sick, today we definitely are less likely to see employees trying to “work through” what they might consider a slight illness.

Bhatia: As a health system of 45 community hospitals across the United States, one silver lining is the bond being strengthened with our communities. People are always asking how they can help, what do our hospitals and caregivers need…everyone has been so gracious and giving. From letters of support to our healthcare heroes, meals for our teams, shoes, food and supply donations, hotel and childcare support, it’s incredible and a true example of neighbors healing neighbors. Another silver lining is the teamwork by our corporate leaders in support of our hospitals. Everyone is demonstrating the need to help one another and they are working together as a team with one common goal. I’m truly grateful and humbled by their expertise, hard work and collaboration. Last but not least, we have seen tremendous innovation in healthcare as a result of COVID-19. And there’s no going back.

Rapisardi: One positive to come out of this is the recognition that social connection is really important. Humans are social animals and deeply need to be connected to one another. During the pandemic, by necessity, we all found ways to stay socially connected even if we’re physically separated from one another. Another silver lining is the growing recognition that mental health is equally as important as physical health. It took a pandemic for people to truly understand that depression, anxiety, loneliness and other mental health issues can affect any one of us, and addressing them is critically important to whole person health. Now, more than ever, people are recognizing the importance of the mind-body connection.

Will the pandemic increase healthcare and insurance costs?

Simpson: Carriers for middle market, 100-500 employees, are keeping renewals competitive. There has been less cost in elective surgeries, knees, shoulders, etc. Many are avoiding healthcare centers due to fear creating worry from providers for those who may have serious heart or other conditions going unchecked, causing hospitals and provider centers to close. Telemedicine is free currently with all carriers during the pandemic. Providers are doing their best to treat patients virtually – face to face, to assess care, which was already on the rise in 2019. SHRM states costs could increase by 7%, showing how self-insured clients are concerned about the potential of increased hospitalizations from COVID. In a recent meeting with Kaiser, they said they are expecting 3.5-5.5% trend increases. We feel it is important to keep wellness going, such as selfcare, EAP’s, etc., to manage stress and to help with cost management. Overall, it is still too early to tell.

As the health care industry continues to transform, will this lead to greater collaboration, affiliations or increased competition between Hospitals and/or Health Systems?

Rapisardi: There absolutely will be more collaboration among health plans, providers, employers and all other stakeholders because it’s absolutely essential. Constantly rising costs that threaten affordability, technological advances, an aging population and many other factors are making health care more complex. The best way to ensure that the right care gets delivered to the right people at the right time – affordably and with laser focus on quality – is through collaboration. That’s been Cigna’s mission and focus for years in Southern California as we developed the Select Network with key clinical partners. Our relationships are based on deep collaboration and integration, where each party brings its unique abilities and assets to the table to best meet the needs of employers and individuals. Our experience shows that collaboration works and delivers better outcomes than the old way of doing business.

Providing care for patients with mental health challenges is one of the biggest issues facing health care systems today. How is your health system addressing those concerns for your specific patient populations?

Cerf: Blue Shield has always understood the importance of mental health to overall care. Since last year, we have been working with schools and community-based organizations that focus on mental health. Last December, the company also launched BlueSky, a multi-year effort to enhance awareness, advocacy, and access to mental health support for middle and high school students in California. A major part of the initiative was bringing therapists into schools to provide direct mental health support to students in need. Now, this service is available through video therapy sessions through our collaboration with Wellness Together. In addition, we enhanced the program to offer online access to mental health and COVID-19 resources for parents/guardians and their children. We will continue this effort and others as we start to transition into the new realities for our members.

Bhatia: Many counties in Southern California, including Los Angeles and Orange, are in dire need of hospital beds for mental healthcare. The national target is a minimum of 50 beds per 100,000 residents. Los Angeles County has fewer than 23, and Orange County faces a more notable shortage (14 beds per 100,000 residents). The increasing shortage of inpatient care beds for behavioral health patients was the primary reason Prime Healthcare recently converted the former Glendora Community Hospital to the Glendora Oaks Behavioral Health Hospital. The new hospital opened in 2019 with a focus on general senior psychiatric care for people with high-risk psychiatric conditions. Prime Healthcare has expanded behavioral health beds in many of our Southern California hospitals. We have supplemented our inpatient behavioral health programs with a telehealth platform and have been implementing outpatient and partial hospitalization programs to provide psychiatric care across the entire continuum of care.

Andersen: We recognize mental health is critical to a person’s overall health and the pandemic has further highlighted the need for support. That’s why we’ve developed new resources in partnership with leading community and health partners. We started a special campaign – #MeMinutes – to promote taking the necessary time for self-care and wellbeing. We are supporting the National Alliance on Mental Illness, creating awareness events and supporting their nationwide virtual walks. We are partnering with Aunt Bertha, a leading social care network that helps connect individuals and families to free and reduced-cost social services in their communities, and Psych Hub, a free digital resource that helps individuals and care providers address behavioral health. We’ve also waived fees for members who use LiveHealth Online to virtually connect to a doctor.

How will virtual care and/or telemedicine affect the delivery of health care in the community in the next 3-5 years?

Kalkat: The increased use of telemedicine will allow the health care industry to service more patients, particularly in specialty areas, such as, psychiatry, diabetes care and cholesterol management, where no physical touch is involved. In my clinical judgment in the next five years, approximately 30% of the visits will be done by telemedicine, which has the potential to revolutionize the industry.

Cerf: Blue Shield’s and Blue Shield Promise’s members have turned to virtual doctor visits by the thousands during the pandemic. My colleagues worked quickly to absorb the rush, recruiting more doctors to take care of our members. Our goal was to effectively manage the expected surge of patients as a result of the COVID-19 pandemic and through Teladoc Health we were able to aggressively expand our provider panels to handle the volume. I believe that virtual care and/or telemedicine will continue to be an added benefit for members to utilize in addition to their in-office visits.

Trisal: Virtual care and telemedicine are benefiting patients during the pandemic. We will definitely continue using more telemedicine in the future. City of Hope’s Hope Virtual transitioned one third of our appointments to telehealth. We have patients who used to travel from as far away as Bishop, California, who don’t have to do that anymore. A patient can take a picture of a suspicious mole and send it to me. I can take a look at it and say, “This one needs a biopsy or this one doesn’t need one. Let’s watch it for six months.” Telemedicine helps patients speak with a doctor from the comfort of their home, improving patient access to quality care. Perhaps they might have ignored a health problem and they would have come to us when a cancer was more advanced. Using telemedicine might allow us to catch more early stage cancers, enabling us to start treatment earlier.

Bhatia: We will see continued expansion of telemedicine capability across all enterprise technology platforms. Remote patient monitoring will play a larger role with the new technology platforms and allow patients to enter health data themselves or via Bluetooth devices. More providers will have access to this type of data. And, we can expect AI-based systems to play a significant role with remote patient monitoring as it will allow the platforms to better alert clinicians to specific patient issues. The consumer will have a wide variety of choices available for telemedicine services through publicly marketed services – this can include specialized services by gender, age, etc. As the guidelines and reimbursement model for telemedicine have evolved and will likely last for the foreseeable future, physicians and patient will both become increasingly comfortable with virtual care visits that can complement the standard in-office visit.

How are today’s technological advances and innovation being leveraged to improve the health and wellbeing of patients?

Rapisardi: Over the past several months, Cigna has partnered with technology companies to bring innovative health and well-being tools and services to market. For example, Cigna’s Express Scripts unit partnered with SilverCloud Health to make a digital mental health platform available at no cost to help customers build resilience and develop skills to manage stress and sleep. Cigna and Express Scripts also worked with Buoy Health on an early intervention screening tool that helps individuals understand their personal risks for Covid-19. Other innovations include an application to identify customers with Covid-19 symptoms checking in for emergency care, and digital resources to assist with at-home recovery. Cigna also partnered with Talkspace to add the digital provider’s behavioral network through private text, voice and video messaging. Additional digital programs available specifically in California include an app-based program for anxiety, depression and burnout, and live video appointments and messaging for obsessive compulsive disorder (OCD).

Improving the “patient experience” is a relatively new concept in medical care,
aiming to add more value to patients. How has the “consumerism” of health care affected your organization and guided your decisions?

Bhatia: Over the last couple of years, patients have transformed from passive recipients of healthcare to active participants in their own health and well-being. They expect an engaging experience and are able to search online for information about any other decision they’re making, so it makes sense they would do the same for their healthcare options. At Prime, we’ve embarked on a patient and family experience journey and we make sure our leaders and team know the importance of providing compassionate care and the positive impact it has for our patients and our reputation. In addition, we comb through online comments and reviews left by our patients for opportunities to recognize staff and to identify improvement areas. Importantly, we aim to differentiate ourselves by creating a consumer-centric patient experience that fosters satisfaction and patient loyalty. Ultimately, the goal is to provide better healthcare and improve patient outcomes, and having patients directly engage in their care has been impactful.

The cost of health care delivery continues to be top of mind among both the consumers of health care as well as many employers and health plans that pay for health care coverage. How are organizations successfully implementing value-based delivery to reduce the cost of care while also improving quality?

Andersen: Healthcare affordability is one of the biggest challenges we face as an industry. We are working to accelerate growth in value-based payment models in which providers are rewarded for efficiency, coordination, health outcomes and care experience, rather than on the volume of care provided. We need to give customers more choices and greater affordability, with a focus on quality. That is why we are building out high-performance networks, featuring only top providers, to deliver on quality and cost. Lastly, this pandemic has shown us technology holds the promise to a healthcare future of greater access to transparency and data allowing the healthcare consumers, employers and other partners to make better-informed decisions.

Trisal: City of Hope recognizes that value-based care should always be connected to better outcomes. We want to deliver the best care at an affordable cost, and we are doing this with employers nationwide. City of Hope has created an offering of unique cancer support services in which our experts work with a patient’s treating oncologist to provide expertise on the latest available treatment. Our innovative approach is designed to work with employees — wherever they’re located — with the intent of improving their care, outcomes and value. Many patients come from other cities that have cancer centers close by, but they understand the ease with which they can access City of Hope’s expertise, providing them with a comfort level that is so important in oncology. In the last two years, our approach has grown to support more than 30 national employers, serving more than 1.9 million people.

Bhatia: Prime Healthcare was delivering value-based care before it even became a buzzword in health care. Our definition of value equates to optimizing clinical outcomes that matter most to patients relative to the cost of care being delivered. Our physician-driven, patient-centric model has proven fundamental to improved quality of care and excellent clinical outcomes. Prime has invested $1.1 billion since 2005 on best-in-class medical technology, including upgraded emergency rooms, radiology equipment, IT upgrades and electronic medical record systems. Prime’s physician-driven model of care has a proven success rate. In the last few years, IBM Watson Heath named some of Prime’s hospitals, including many in Southern California, among the top hospitals in the country for overall performance and patient outcomes. Prime Healthcare hospitals are well positioned as the industry is shifting from volume to value and transitioning from fee-for-service to bundled payments.

Are wellness programs worthwhile investments for employers?

Cerf: At Blue Shield of California, we call it mind body medicine. It’s an evidence-based approach that focuses on sustainable improvements in health and wellbeing of our members. We believe a happy and healthy workforce is key to lowering health care costs for employees and employers. Blue Shield of California is working to reimagine health for individuals, families and communities with its Wellvolution platform, a digital and community health network of 60 digital apps and 30,000 brick-and-mortar community locations – the largest network of such providers in the nation. Since its introduction one year ago, Wellvolution has helped more than 23,500 Californians, including Blue Shield employees, to prioritize their health and well-being with reports of weight loss, reduced stress and reversal of chronic conditions.

Simpson: The wellness industry is a $4 billion industry. The investment and earnings are there. The cost of stress, lack of physical movement, heart disease, cancer, strokes, and mental health have been out of control in the United States. We must commit to promoting selfcare. Montage has sponsored wellness and safety since our inception. It is our relentless mission to keep showing the data results. One client, when onboarded, had a 32% renewal. Meeting their staff nationwide, we were able to increase wellness visits and communicate the difference between generic and brand, saving $1 million in prescription costs. We put in wellness incentives and education that ultimately earned three flat renewals, saving over $1 million in premiums. Our firm puts on over 100 wellness and safety events annually, as well as virtual experiences. It takes hard work to inspire change, yet just by standing for 10 minutes in every 30-minute period, you add years to your life.

Rapisardi: Yes, wellness programs are absolutely worthwhile if employers really do view them as investments and not simply as an expense. An expense is just money out the door, while an investment is spending that is expected to provide a payback over time. In the case of wellness programs, the payback is lower absenteeism, better productivity, and improved health care costs. Cigna’s experience is that when our employer clients take the time to assess and understand the health profile of their workforce, then tailor their wellness programs to meet their employees’ specific needs, implement meaningful incentives to encourage participation, and then promote the program, there is greater employee engagement and better payback. When wellness programs are designed, implemented and communicated well, we see time and again that they provide great value for employers and employees alike.

With over 47 million uninsured Americans, how can the health care industry make insurance affordable and accessible to all?

Simpson: Data before COVID-19 shows the US has 331 million in total population. Kaiser estimates 10-11% are non-elderly uninsured, and that by 2021, 4.7 million more adults could gain eligibility if the 14 remaining non-expansion states would offer Medicaid. There are 16.7 million uninsured eligible for Medicaid, not counting those over 65 that could be shopping on the marketplace. 4.7 million of these uninsured are able to obtain a free bronze plan. California has 178,000 with this availability, so the question is why don’t they? There are 22 million illegally in the US according to the Director of US Citizenship and Immigration Services in 8/2019. Obama’s ACA excludes undocumented immigrants from being able to purchase health insurance. Six states provide coverage to income-eligible children regardless of immigration status, and California recently expanded coverage to young adults, and as of July 7th now allows undocumented adult immigrants coverage, which helps.

How are you and your organization addressing the health and wellbeing of your own employees during this challenging time?

Trisal: City of Hope understands that for the best patient experience you need to have the best staff experience. You need a health care staff that knows that you care about them and that you are rolling up your sleeves and working with them on the frontline. City of Hope is working to address the mental, physical, emotional and economic health of our employees. Our employees should not be worried about their economic, physical or mental health. They understand that our organization is working hard to create the best environment for them to deliver health care. City of Hope is fortunate that we have the right people on the bus. It’s all about the people. The quality of the people who deliver the care brings out the quality of the care.

Lee: We are all living and working in unprecedented times under incredible stresses. I truly believe in order to deliver the highest level of care to patients and their families, we need to take care of ourselves and each other as well. Chief among our team members’ concerns are their personal health and job security, which CHLA continues to address with openness, fairness and empathy. We have had to flex some schedules due to decreasing patient volumes, and we have asked some non-clinical team members to take mandatory vacation. Through it all, we needed to make sure staff stayed connected with us and their patients, so we very consciously rotated people off and on to be as fair as possible; people could also volunteer to take certain days off. Knowing that one repercussion of this pandemic is the traumatic stress it might inflict on work-life balance, we launched an internal program called the Best Together Initiative, which is designed to help team members with programs like a counseling and emotional support hotline; virtual wellness offerings like yoga and meditation; and childcare services. To support childcare options for working parents, we intentionally vacated one of our office facilities and moved our existing daycare center there, so that classes could be safely isolated in separate rooms with more physical distance.

Bhatia: COVID-19 presented Prime Healthcare the opportunity to focus on the broader picture of our staff’s mental health and wellbeing. Mental and physical health go together, and our goal is to create a culture where people can bring their best selves to work and feel like they’re getting the support and resources they need. Prime Healthcare established a Mental Health and Support Hotline and a Nurturing Each Other Support Group, staffed by our own licensed clinicians and available for all employees and physicians. And, we have created our own mobile application that includes helpful wellness resources such as podcasts on mindfulness and self-compassion, along with a multitude of wellness and mental health resources that can help all of us through challenging times in our lives. These efforts, along with strong leadership and consistent communication, demonstrate that we are all in this together.

Kalkat: Our staff is the backbone of our organization and we strive to do everything we can to ensure their safety and providing them with access to all forms of PPE. For staff that treat high-risk COVID-19 patients or may have been exposed, we provide free accommodations at nearby hotels. Senior leadership has hosted several virtual town hall-styled meetings to answer questions from staff with thorough and up to date responses. This unprecedented medical emergency has had a psychological impact on many staff members. To help navigate through the physical or mental health challenges presented by this virus, we have various resources available, including our Employee Assistance Program and telehealth services for staff and their dependents.

Simpson: We are in a fast-paced, high-pressure industry managing all we do for our clients. COVID-19 has changed things. Oddly enough, I see employees more rested, while traces of fear are still there. Working from home has been good for our employees. I see joy in the faces of their children by being with parents more. They are welcomed to Montage, wearing their little masks in the hallways. We needed a break from ourselves. We had to postpone gym memberships, yet kept virtual yoga going. We offered a membership to online classes that have hundreds of options. We practice self-responsibility with CDC requirements. Telemedicine is promoted with the EAP. We have a virtual casual call every Friday including everyone now working on 21 days of gratefulness. Last month we gave each employee $200 to further the mission of any client or organization of choice. Spirits are lifted through promotion.

Cerf: Blue Shield of California created a task force to gain input from our 7,000 employees at 22 locations, to consider systematically what needs to be done to ensure everyone’s safety when we return to our offices. We’re offering an enhanced paid-leave program, work-from-home tools and reimbursement for teleworking costs. In addition, we knew our staff wanted to do their part in helping the communities that are even more in need. We launched the Shield Cares Giving Campaign to run April-June to boost employee giving to any California-based 501(c)(3) nonprofit organization with a 2:1 company match which raised over $850,000 for more than 800 nonprofit organizations across the state. Lastly, we launched Silver Linings, an internal photo-sharing campaign in which employees can connect about how they are living our company values – human, honest and courageous – during this time.

Looking to the future, what do you think the health care landscape will look like in the next year and 5 years from now?

Rapisardi: A lot will depend on whether or not we have a safe, effective vaccine for Covid-19. Without a vaccine, the health care landscape one year from now will look very much like it does now – stressed and strained. With a vaccine, it might begin to approach what until recently was considered “normal.” I tend to avoid making longer-term predictions, because there are so many variables we cannot control; but I do think in five years technology will have greatly transformed the way patients access care and interact with the health care system, in ways that we cannot begin to imagine. And we will have become a lot smarter and better at collaboration, which will make health care more coordinated, affordable and predictable.

As we move forward, what do you want patients and the community to know?

Trisal: City of Hope wants our communities to know that cancer doesn’t stop during the pandemic and any delay in care may worsen a cancer outcome. A recent Science editorial revealed that delayed screenings due to the pandemic could lead to more than 10,000 additional colon and breast cancer deaths over the next decade. Continue with preventive screenings. Continue to talk with your doctor about that suspicious mole. Continue with a colonoscopy or Pap smear. It’s important to pick up cancer early. City of Hope is among the safest places for cancer patients for multiple reasons, which is why we’ve had a low number of COVID-19 patients in our isolation unit. We have longstanding experience with immunocompromised patients, particularly within our bone marrow/stem cell transplant program. This gives us a unique expertise in maintaining the highest standards for infection prevention and control. We are taking extra steps to prevent COVID-19 among our patients/staff.

Lee: When parents choose Children’s Hospital Los Angeles, they can rest assured that they’re choosing the best care for kids in the safest environment. We are committed to meeting you where you are, whether it is meeting you outside for a well-baby visit, or pivoting to address racial injustice as a public health issue, we are working to keep patients safe, and the care that we deliver equitable and inclusive in all aspects.

Kalkat: We’re open. We’re safe. Our main goal is to provide safe and quality care for every patient who comes to Emanate Health. We’re here to address all of our communities’ health care needs, including life-threatening conditions like heart attacks and strokes, as well as chronic diseases such as diabetes or high blood pressure. In addition, we have employed various cleaning and safety protocols, building on guidelines established by the Centers for Disease Control and Prevention and the California Department of Public Health. We’ve also limited visitor access to our hospitals to promote safety. It is imperative for our patients not to delay the care they need now. As the largest health care system in the San Gabriel Valley, our doctors, nurses and staff are here to provide emergency, primary and specialty care for all families, through every stage of life.

Bhatia: We are more than just a healthcare company. We are stewards of a mission, and that mission is to make sure communities have hospitals that provide the highest quality affordable care when people need it the most. Our employees are dedicated and focused and love what they do. We’re proud of the fact that we have never closed or sold a hospital, because communities need to be assured that their health needs will be met, even during the uncertainties of a pandemic. Be assured that we are prepared for whatever challenges lie ahead, and that we are grateful for the faith and trust our patients and their families have placed in us.

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