MultiCare Shortens Length of Stay and Reduces Readmissions with Digital Care JourneysMultiCare Shortens Length of Stay and Reduces Readmissions with Digital Care Journeys
Thought Leadership

MultiCare Shortens Length of Stay and Reduces Readmissions with Digital Care Journeys

May 12, 2022
By
Tracy Staniland

Over the past decade, hospitals and health systems have focused their digital and IT efforts on implementing and optimizing their EHR. However, the recent rise of patients as health care consumers who have exceedingly higher expectations for convenient digital experiences with their providers, has motivated health systems to focus their digital transformation efforts on digitizing more of the patient experience. In many ways, the pandemic has woken health systems to the realization that it is no longer patients but digital-savvy health care consumers that they are caring for.

“The pandemic, as terrible as it has been, the silver lining is that it really has accelerated digital transformation efforts from organizations. I think the increased adoption of even telemedicine, which has been around for a long time but finally got real uptick, showed both patients and providers that they can be more adept at using technology,” said Dr. Joshua Liu, CEO, SeamlessMD. “I think it has really opened things up for folks being excited and confident that patients can use these sorts of technologies. It has definitely been accelerated, but I still think there is a lot of room to grow.”

For many health systems their digital transformation journey has focused primarily on brand awareness and patient acquisition strategies such as online advertising and social media. While others have focused on digital online search and schedule with providers and electronic appointment reminders, as well as on-site experience with mobile check-in, and digital wayfinding. However, with the ongoing shift to value-based care, it is simply not enough to just attract and book patients for health care services. 

Today, optimizing the consumer experience involves digital innovation that enables health systems and providers to engage, connect, and monitor patients outside the four walls of the institution before, during and after their hospital stay to deliver a great consumer experience as well as the best possible health outcome. With digital care journeys, health systems and providers can engage patients with personalized care plans through the patient's own smartphone, tablet, or desktop computer so they can send surgery or health condition-specific reminders, deliver interactive pre- and post-care education, and monitor symptoms. 

Digital care journeys involve health systems engaging patients via the patient’s own smartphone, tablet, or desktop computer to send surgery or condition-specific reminders, deliver pre- and post-care education and monitor symptoms. Patients can self-monitor via automated workflows (e.g., receive automated guidance on how to manage constipation post-surgery) and providers can get alerts and dashboards to monitor patient progress remotely (e.g., pain, vital signs, incision photos). Digital care journeys are used across various service lines such as oncology, chronic care, cardiology, orthopedics, bariatrics surgery, thoracic surgery, obstetrics, gynecology, general surgery, mental health, cancer care, and more. Healthcare systems can use a single digital care journey platform system-wide across multiple episodes of care for each patient.

MultiCare’s Digital Health and Patient Engagement Strategy

Leading health systems, like MultiCare, have recognized the value of providing digital care journeys across the board to different service lines and patient populations. Founded in 1882, MultiCare has been committed to providing quality health care and innovation to their communities. In the early '50s they had their first pediatric open-heart surgery at Mary Bridge Children's Hospital, they started the state's first behavioral health center, and they have continued to lead and provide comprehensive behavioral health services in partnership with others and grown that service as the leading service in the state.

“It's best reflected in the way that we form partnerships, with a focus on the relationship and less about being transactional. But that partnership is not just about partners in health care. It's really partnering with the patient as well, and the digital opportunity to engage patients in their own care journey is one of those ways that we meet the promise of our commitment to partner,” shared Paige McCall, Vice President System Service Lines, MultiCare during our recent webinar titled How MultiCare Health System Delivers Digital Care Journeys to Optimize the Patient Experience

With a vision to be the highest-value system of health in the Pacific Northwest, and engage patients with convenient, quality high-value opportunities to support their care and their wellness, MultiCare felt a digital health strategy, and a patient engagement strategy was crucial to offer a consistent patient experience no matter where they were serving in communities across the Pacific Northwest. 

“When we think about MultiCare's vision of being the Pacific Northwest's highest-value system of health it really peels down into three core strategic priorities for our health system. Number one is performance excellence. Are we driving to be in the top quartile, the top decile when it comes to quality of care, when it comes to experience that our patients, our providers, and staff have, when it comes to financial performance and making sure to continue to reinvest in our health system? That is our first strategy. The second is population-based care in terms of our shift from a volume-based to a value-based organization. And third is expanding market presence and access to care and health care services,” explains Ben Chao, President, CareConnect at MultiCare, during our recent webinar. As Ben points out as MultiCare looks at evolving value-based arrangements, when we think about clinical value priorities and figuring out where we get the biggest bang for their buck, where we can apply technology to start to find solutions or in support of that thesis, there are two things that we are identifying as trends:

  1. A different unique set of patient behaviors, particularly against the context of a global pandemic, which was around the patient and treating the patient as a consumer, like we would with any other industry. We often grade ourselves at MultiCare now using Net Promoter Score as opposed to a CG-CAHPS or HCAHPS score when it comes to using digital solutions that really encourage convenience of care and access, whether that is with tools like online scheduling, text-based appointment reminders, and an omnichannel set of solutions.
  1. The other piece is combining those consumer-centric tools and capabilities, push notifications, an easy, seamless way to be able to access my information that's specific to Ben as a person, with clinical content, education and engagement, particularly when we're entering into risk-based arrangements for a high volume of bundled payment-based care, whether that's a knee replacement, a hip replacement, spinal fusion, etc. What we started to realize in our research in the industry is that most companies are good at one of these two things as a solution provider. They will say, "We're going to manage your MyChart SMS gateway for you. We're going to make it really easy and convenient for patients to get reminded to come to their appointment, to fast the night before their surgery,” or they are going to say, "You know, we have the best clinically-validated, peer-reviewed clinical content and care plan specific to this condition or state, and you can buy that from us as a license." What we really were looking for was a partner that was going to do both exceptionally well and not put too much burden on our providers in terms of shaping that together. 

Choosing the Right Digital Patient Engagement Partner

Like with any enterprise software solution, selecting the right technology is critical to supporting corporate objectives, achieving strategic success metrics, streamlining care delivery, and scaling across the enterprise. Equaling as important is identifying measurable targets, and key success metrics. For example, MultiCare was focused on eliminating manual processes during the care journey, as well as reducing phone calls, readmissions, ER visits, length of stay and the burden of printing small take-home patient binders.

For MultiCare choosing the right digital patient education and engagement partner that provided the technology, tools, and educational components as part the end-to-end journey for the patient, meant the platform needed to meet six fundamental decision criteria:

  1. Omnichannel or more versatile enterprise solution for a “one-size-fits-many” that reduces their burden when it comes to number of interfaces and integrations that they would have to build out to help them standardize high-reliability care. 
  2. Turnkey integration into their patient and provider experience to ensure patients who are responding to patient-reported outcome surveys, that those results hit a provider and a care teams in basket enabling them to make some type of well-informed decision on how to manage the patient's care moving forward. 
  3. Well validated clinical content where the vendor had industry studies and evaluations at other health systems where they have seen proof of concept. 
  4. Out-of-the-box content because they did not want their clinical teams to build the content from the ground up. At the end of the day, what they were really looking for was what content does the vendor have in place today, how does that fit within their current workflows and the mindset of the clinical leadership at MultiCare, and how does MultiCare crosswalk that in a sustainable manner.
  5. Versatility of multiple specialties that could be plug-and-play. A digital care plan library was critical to MultiCare. 
  6. Cost of ownership. As MultiCare continues to grow they need the ability to easily extend digital care journeys across other systems, clinics and specialties without feeling the burden of that.

“Using SMART on FHIR integration via the App Orchard, providers can monitor patients without leaving Epic. Being able to either launch SeamlessMD from our instance of MyChart on the patient side or to really pursue that information in more of an omnichannel manner, whether it's with SeamlessMD's separate native application or through more of a web-based microsite specific to the patient, meant that we are going to see value in triggers and nudges to the patients in a wide variety of different origination pathways.”

Chao goes on to share, “One of the things, I think is exciting about our partnership with SeamlessMD is that we feel as though we are in the car with Josh and the team when it comes to continuing to build out the digital care plan library and really push hard on the roadmap. Whether it is in terms of not just a surgical bundle but a post-discharge medical window for sepsis or for CHF or COPD. Part of the roadmap down the road is going to be how do we get into perceptual chronic disease management states and how do we get into behavioral health. That is the next frontier as we tap into what we have already built together.”  

Digital Care Journeys Launched Across Five Specialties and Outcomes Achieved 

In the first year, MultiCare launched five core digital care journeys for total knee replacements, total hip replacements, spinal fusion surgeries, bariatric surgeries, and maternity care. For the whole obstetric package, that service line at MultiCare has long been a group that has had a significant amount of foresight. In 2013 or 2014, that service line had already begun introducing OB video visits as a part of an expectant mother's care journey, attaching a baby heart rate fetal monitor and a blood pressure cuff, and including that as part of a mother's take-home package to replace approx. four or five of the dozen or so OB visits that take place over time. So, for that service line, they really were envisioning a continuation of that type of journey but with more of a regular care companion that can provide instructions and patient-reported outcomes without really needing a face-to-face interaction.

Alignment with the strategic quality of patient experience priorities within MultiCare as well as the ability to collect patient-reported outcomes, track compliance to a protocol, or even post-discharge opiate use, were dimensions of the criteria for selecting the first care plans. Moving forward, MultiCare has assembled a committee to continuously evaluate what year two, three, four and five look like over a progressive rollout. Today, MultiCare is expanding their delivery of digital care journeys with phase two of maternity, urogynecology, colonoscopy as an education platform for patients in preparation and post-colonoscopy, and low back pain. 

Since launching SeamlessMD in June 2021, MultiCare has recognized a significant reduction in 30 and 90-day readmission rates for hip and knee replacement surgeries, as well as reduction in length of stay. As well, MultiCare has been able to standardize the “MultiCare” experience and delivery of consistent care protocols across the health system.

Outcomes Analysis: Hip & Knee Replacement

“When you think about your communities and COVID and all the things that we have really been under pressure about in the last year, year and a half, having this digital engagement has really been helpful, particularly for those patients who might live in rural communities or not necessarily have transportation that gets them quickly to a provider. Having the comfort of being able to ask questions and have their concerns alleviated or receive next steps from their care team really has been the thing that we have felt so proud about, and happy to be able to service our patients in this way,” shared Paige McCall, Vice President System Service Lines, MultiCare.

The Path to Reimagining the Patient Experience

During a recent poll, we asked 126 healthcare professionals “Where is your organization on the path to deploying digital care journeys to optimize the patient experience?”, 40% indicated they are either piloting their first digital care journey or have it deployed across multiple care pathways and 50% indicated they are researching and evaluating. 

As Paige McCall suggests, “if you are trying to do something that is enterprise-wide make sure that you have strong engagement at inception. Prior to rolling things out, make sure that you have been as inclusive as you can be, with all the right stakeholders, and you have really thought through what the pain points might be along the way so that you can try to mitigate those. I think you can never underestimate the amount of communication that is needed to plan and prepare, and to make sure that people understand “the why” behind what you're really trying to do.” For MultiCare, the why is continuing to deliver on quality and engagement and high value for their patients and communities.

One of the most important ways to gets teams to rally for change is to involve them in the dialogue, partner with key stakeholders across the organization from the leadership team to service line operational leaders who are connected to physicians and clinical staff to help educate teams and  physicians to ensure there is dialogue between the providers and patients in the enrollment and engagement phase. Assembling an executive multidisciplinary steering team that includes IT, quality, patient education, physicians, service line leaders, pharmacists, all the key clinical and operational leaders that meets every other month to help plan the communication, the implementation and then the follow-up across the journey is key to achieving desired outcomes and optimizing pathways. 

High-performing organizations are often defined by their ability to embrace a culture that supports continual transformation. By approaching digital transformation with a disciplined approach, and masterminding it effectively, health systems can use EHR-integrated digital care journeys to optimize the patient experience, shorten length of stay, reduce readmissions, and lower costs. 

Watch the on-demand webinar How MultiCare Health System Delivers Digital Care Journeys to Optimize the Patient Experience to hear more about the innovative ways MultiCare is streamlining healthcare journeys, addressing healthcare consumerism, and delivering a consistent patient experience.

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MultiCare Shortens Length of Stay and Reduces Readmissions with Digital Care Journeys

Posted by:
Tracy Staniland
on
May 12, 2022

Over the past decade, hospitals and health systems have focused their digital and IT efforts on implementing and optimizing their EHR. However, the recent rise of patients as health care consumers who have exceedingly higher expectations for convenient digital experiences with their providers, has motivated health systems to focus their digital transformation efforts on digitizing more of the patient experience. In many ways, the pandemic has woken health systems to the realization that it is no longer patients but digital-savvy health care consumers that they are caring for.

“The pandemic, as terrible as it has been, the silver lining is that it really has accelerated digital transformation efforts from organizations. I think the increased adoption of even telemedicine, which has been around for a long time but finally got real uptick, showed both patients and providers that they can be more adept at using technology,” said Dr. Joshua Liu, CEO, SeamlessMD. “I think it has really opened things up for folks being excited and confident that patients can use these sorts of technologies. It has definitely been accelerated, but I still think there is a lot of room to grow.”

For many health systems their digital transformation journey has focused primarily on brand awareness and patient acquisition strategies such as online advertising and social media. While others have focused on digital online search and schedule with providers and electronic appointment reminders, as well as on-site experience with mobile check-in, and digital wayfinding. However, with the ongoing shift to value-based care, it is simply not enough to just attract and book patients for health care services. 

Today, optimizing the consumer experience involves digital innovation that enables health systems and providers to engage, connect, and monitor patients outside the four walls of the institution before, during and after their hospital stay to deliver a great consumer experience as well as the best possible health outcome. With digital care journeys, health systems and providers can engage patients with personalized care plans through the patient's own smartphone, tablet, or desktop computer so they can send surgery or health condition-specific reminders, deliver interactive pre- and post-care education, and monitor symptoms. 

Digital care journeys involve health systems engaging patients via the patient’s own smartphone, tablet, or desktop computer to send surgery or condition-specific reminders, deliver pre- and post-care education and monitor symptoms. Patients can self-monitor via automated workflows (e.g., receive automated guidance on how to manage constipation post-surgery) and providers can get alerts and dashboards to monitor patient progress remotely (e.g., pain, vital signs, incision photos). Digital care journeys are used across various service lines such as oncology, chronic care, cardiology, orthopedics, bariatrics surgery, thoracic surgery, obstetrics, gynecology, general surgery, mental health, cancer care, and more. Healthcare systems can use a single digital care journey platform system-wide across multiple episodes of care for each patient.

MultiCare’s Digital Health and Patient Engagement Strategy

Leading health systems, like MultiCare, have recognized the value of providing digital care journeys across the board to different service lines and patient populations. Founded in 1882, MultiCare has been committed to providing quality health care and innovation to their communities. In the early '50s they had their first pediatric open-heart surgery at Mary Bridge Children's Hospital, they started the state's first behavioral health center, and they have continued to lead and provide comprehensive behavioral health services in partnership with others and grown that service as the leading service in the state.

“It's best reflected in the way that we form partnerships, with a focus on the relationship and less about being transactional. But that partnership is not just about partners in health care. It's really partnering with the patient as well, and the digital opportunity to engage patients in their own care journey is one of those ways that we meet the promise of our commitment to partner,” shared Paige McCall, Vice President System Service Lines, MultiCare during our recent webinar titled How MultiCare Health System Delivers Digital Care Journeys to Optimize the Patient Experience

With a vision to be the highest-value system of health in the Pacific Northwest, and engage patients with convenient, quality high-value opportunities to support their care and their wellness, MultiCare felt a digital health strategy, and a patient engagement strategy was crucial to offer a consistent patient experience no matter where they were serving in communities across the Pacific Northwest. 

“When we think about MultiCare's vision of being the Pacific Northwest's highest-value system of health it really peels down into three core strategic priorities for our health system. Number one is performance excellence. Are we driving to be in the top quartile, the top decile when it comes to quality of care, when it comes to experience that our patients, our providers, and staff have, when it comes to financial performance and making sure to continue to reinvest in our health system? That is our first strategy. The second is population-based care in terms of our shift from a volume-based to a value-based organization. And third is expanding market presence and access to care and health care services,” explains Ben Chao, President, CareConnect at MultiCare, during our recent webinar. As Ben points out as MultiCare looks at evolving value-based arrangements, when we think about clinical value priorities and figuring out where we get the biggest bang for their buck, where we can apply technology to start to find solutions or in support of that thesis, there are two things that we are identifying as trends:

  1. A different unique set of patient behaviors, particularly against the context of a global pandemic, which was around the patient and treating the patient as a consumer, like we would with any other industry. We often grade ourselves at MultiCare now using Net Promoter Score as opposed to a CG-CAHPS or HCAHPS score when it comes to using digital solutions that really encourage convenience of care and access, whether that is with tools like online scheduling, text-based appointment reminders, and an omnichannel set of solutions.
  1. The other piece is combining those consumer-centric tools and capabilities, push notifications, an easy, seamless way to be able to access my information that's specific to Ben as a person, with clinical content, education and engagement, particularly when we're entering into risk-based arrangements for a high volume of bundled payment-based care, whether that's a knee replacement, a hip replacement, spinal fusion, etc. What we started to realize in our research in the industry is that most companies are good at one of these two things as a solution provider. They will say, "We're going to manage your MyChart SMS gateway for you. We're going to make it really easy and convenient for patients to get reminded to come to their appointment, to fast the night before their surgery,” or they are going to say, "You know, we have the best clinically-validated, peer-reviewed clinical content and care plan specific to this condition or state, and you can buy that from us as a license." What we really were looking for was a partner that was going to do both exceptionally well and not put too much burden on our providers in terms of shaping that together. 

Choosing the Right Digital Patient Engagement Partner

Like with any enterprise software solution, selecting the right technology is critical to supporting corporate objectives, achieving strategic success metrics, streamlining care delivery, and scaling across the enterprise. Equaling as important is identifying measurable targets, and key success metrics. For example, MultiCare was focused on eliminating manual processes during the care journey, as well as reducing phone calls, readmissions, ER visits, length of stay and the burden of printing small take-home patient binders.

For MultiCare choosing the right digital patient education and engagement partner that provided the technology, tools, and educational components as part the end-to-end journey for the patient, meant the platform needed to meet six fundamental decision criteria:

  1. Omnichannel or more versatile enterprise solution for a “one-size-fits-many” that reduces their burden when it comes to number of interfaces and integrations that they would have to build out to help them standardize high-reliability care. 
  2. Turnkey integration into their patient and provider experience to ensure patients who are responding to patient-reported outcome surveys, that those results hit a provider and a care teams in basket enabling them to make some type of well-informed decision on how to manage the patient's care moving forward. 
  3. Well validated clinical content where the vendor had industry studies and evaluations at other health systems where they have seen proof of concept. 
  4. Out-of-the-box content because they did not want their clinical teams to build the content from the ground up. At the end of the day, what they were really looking for was what content does the vendor have in place today, how does that fit within their current workflows and the mindset of the clinical leadership at MultiCare, and how does MultiCare crosswalk that in a sustainable manner.
  5. Versatility of multiple specialties that could be plug-and-play. A digital care plan library was critical to MultiCare. 
  6. Cost of ownership. As MultiCare continues to grow they need the ability to easily extend digital care journeys across other systems, clinics and specialties without feeling the burden of that.

“Using SMART on FHIR integration via the App Orchard, providers can monitor patients without leaving Epic. Being able to either launch SeamlessMD from our instance of MyChart on the patient side or to really pursue that information in more of an omnichannel manner, whether it's with SeamlessMD's separate native application or through more of a web-based microsite specific to the patient, meant that we are going to see value in triggers and nudges to the patients in a wide variety of different origination pathways.”

Chao goes on to share, “One of the things, I think is exciting about our partnership with SeamlessMD is that we feel as though we are in the car with Josh and the team when it comes to continuing to build out the digital care plan library and really push hard on the roadmap. Whether it is in terms of not just a surgical bundle but a post-discharge medical window for sepsis or for CHF or COPD. Part of the roadmap down the road is going to be how do we get into perceptual chronic disease management states and how do we get into behavioral health. That is the next frontier as we tap into what we have already built together.”  

Digital Care Journeys Launched Across Five Specialties and Outcomes Achieved 

In the first year, MultiCare launched five core digital care journeys for total knee replacements, total hip replacements, spinal fusion surgeries, bariatric surgeries, and maternity care. For the whole obstetric package, that service line at MultiCare has long been a group that has had a significant amount of foresight. In 2013 or 2014, that service line had already begun introducing OB video visits as a part of an expectant mother's care journey, attaching a baby heart rate fetal monitor and a blood pressure cuff, and including that as part of a mother's take-home package to replace approx. four or five of the dozen or so OB visits that take place over time. So, for that service line, they really were envisioning a continuation of that type of journey but with more of a regular care companion that can provide instructions and patient-reported outcomes without really needing a face-to-face interaction.

Alignment with the strategic quality of patient experience priorities within MultiCare as well as the ability to collect patient-reported outcomes, track compliance to a protocol, or even post-discharge opiate use, were dimensions of the criteria for selecting the first care plans. Moving forward, MultiCare has assembled a committee to continuously evaluate what year two, three, four and five look like over a progressive rollout. Today, MultiCare is expanding their delivery of digital care journeys with phase two of maternity, urogynecology, colonoscopy as an education platform for patients in preparation and post-colonoscopy, and low back pain. 

Since launching SeamlessMD in June 2021, MultiCare has recognized a significant reduction in 30 and 90-day readmission rates for hip and knee replacement surgeries, as well as reduction in length of stay. As well, MultiCare has been able to standardize the “MultiCare” experience and delivery of consistent care protocols across the health system.

Outcomes Analysis: Hip & Knee Replacement

“When you think about your communities and COVID and all the things that we have really been under pressure about in the last year, year and a half, having this digital engagement has really been helpful, particularly for those patients who might live in rural communities or not necessarily have transportation that gets them quickly to a provider. Having the comfort of being able to ask questions and have their concerns alleviated or receive next steps from their care team really has been the thing that we have felt so proud about, and happy to be able to service our patients in this way,” shared Paige McCall, Vice President System Service Lines, MultiCare.

The Path to Reimagining the Patient Experience

During a recent poll, we asked 126 healthcare professionals “Where is your organization on the path to deploying digital care journeys to optimize the patient experience?”, 40% indicated they are either piloting their first digital care journey or have it deployed across multiple care pathways and 50% indicated they are researching and evaluating. 

As Paige McCall suggests, “if you are trying to do something that is enterprise-wide make sure that you have strong engagement at inception. Prior to rolling things out, make sure that you have been as inclusive as you can be, with all the right stakeholders, and you have really thought through what the pain points might be along the way so that you can try to mitigate those. I think you can never underestimate the amount of communication that is needed to plan and prepare, and to make sure that people understand “the why” behind what you're really trying to do.” For MultiCare, the why is continuing to deliver on quality and engagement and high value for their patients and communities.

One of the most important ways to gets teams to rally for change is to involve them in the dialogue, partner with key stakeholders across the organization from the leadership team to service line operational leaders who are connected to physicians and clinical staff to help educate teams and  physicians to ensure there is dialogue between the providers and patients in the enrollment and engagement phase. Assembling an executive multidisciplinary steering team that includes IT, quality, patient education, physicians, service line leaders, pharmacists, all the key clinical and operational leaders that meets every other month to help plan the communication, the implementation and then the follow-up across the journey is key to achieving desired outcomes and optimizing pathways. 

High-performing organizations are often defined by their ability to embrace a culture that supports continual transformation. By approaching digital transformation with a disciplined approach, and masterminding it effectively, health systems can use EHR-integrated digital care journeys to optimize the patient experience, shorten length of stay, reduce readmissions, and lower costs. 

Watch the on-demand webinar How MultiCare Health System Delivers Digital Care Journeys to Optimize the Patient Experience to hear more about the innovative ways MultiCare is streamlining healthcare journeys, addressing healthcare consumerism, and delivering a consistent patient experience.

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