Transcription:
Jefferson Health Pandemic Recovery: Strategic Insights from Monica Doyle, CSO

Bill Klaproth: SHSMD members play a critical role as to the organizations and communities. They serve this special edition of the SHSMD podcast is part of the COVID-19 conversations series, featuring members, stories, and resources in an effort to provide insight into how some organizations are managing this unprecedented crisis.

Diane Webber: Hello everyone. I'm Diane Webber from SHSMD, and I'm pleased to have with me, Monica Doyle, the Senior Vice President and Chief Strategy officer at Jefferson Health in Philadelphia, Monica, one of the challenges, hospitals and health systems across the country are wrestling with right now is, is how not only to pivot quickly to resume, pre pandemic operations, but also to think about how the pandemic situation has created an impetus to change their strategic plans. So Jefferson Health, your organization has been quite nimble and has demonstrated innovative thinking. And I'm really curious how your planning team has been ramping up for the new normal and beyond. So I thought I'd start with our first question today with asking you to take a step back in time from a planning perspective and share the role you and your team have been playing during the pandemic. So, first of all, welcome.

Monica Doyle: Thank you. And I'm happy to be here with you this afternoon. I think originally we did not think we were going to be so active, but it turns out that our skillset was really helpful and necessary to our incident command center. So very quickly we ended up playing a vital role and I'll just give you some idea of what we were working on. Our team really facilitated the search planning in terms of utilizing predictive models to develop projections of what the case load might be, the hospitalization, the ICU, and the bed needs, and then matching that against our capacity. We did this at a local geographic level, so we could determine which of our hospitals would surge, who might peak and recover in what time-frame, so that we had opportunities potentially to move patients and staff around. We collated and gathered all the search plants to get together, to determine what that overall capacity could be, where there were gaps. And then we worked with our support departments to make sure that our supply equipment facilities and pharmacy plans were aligned and met the needs.

And then we also put up the financials on that as well. We worked with our finance team so that we could assess what the financial implications would be. We also helped to coordinate the response to myriad reporting requirements that were coming from federal state and local agencies and a number of those impacted disbursement from the cares act and the allocation of drugs like Remdesivir. So it was very important that we have accurate and consistent reporting across the enterprise. We became the eyes and ears of the organization and we created daily dashboards and intelligence reports where we summarize what was happening globally on a state level regionally, and even within our four walls. And we also help to prepare reports for our board including a very detailed pandemic response summary. And I would imagine as other organizations, our board was meeting with our management more frequently. So that became a significant body of work for us. So many other things, but that gives you a flavor for what we were doing during the crisis and the pre-surge time-frame.

Diane Webber: It sounds incredibly comprehensive, and I'm sure very valuable to all the audiences that you mentioned here. So, wow. What a way to really step up. So congratulations to you and your team for that very impressive work that was done to really help in those critical times. So at this time, as a lot of the areas, and I'm assuming in your area as well, organizations are focusing on restarting their normalcy and reentry of normal care. So what is the primary focus of the planning team now and what do you anticipate happening in the near future with their role?

Monica Doyle: Sure. So we had a little bit of foresight. We sort of split the team and we had folks who were very much involved in and dedicated to the search planning and response. And then we asked a couple of the team members, one of our ABPs, we really gave her freedom to go out and scour the universe really for anything that she could get about this transformative event. And what would be the immediate and then the lasting impacts on the economy, higher education, as we are part of a comprehensive university the healthcare industry and our health system. So she was working in the background doing that, which position does very well now that we are shifting to a new normal. So one of the things that, a number of the things that we did were understanding the State's requirements for reopening, and we have at least two different States that we work in and they've been very different in their approaches. The impact in the sustainability of those regulatory changes that were enacted to help hospitals manage through the crisis tracking what we call normalization volumes and comparing them to prior baseline. And now we're really involved in developing scenario based forecasts of both COVID and non COVID related volumes for the next 12 to 18 months, which as everyone knows is really a new frontier. There's no historical reference to go to for this. And we continue to scan the environment to understand what the structure of consumer healthcare utilization changes will be and how bad is going to impact us going forward.

Diane Webber: Well, while you mentioned that I'm going to ask you about that. How do you think care will be delivered, you know, within this timeframe of the new frontier? What are some of the big changes you see in from a population health and a patient experience perspective?

Monica Doyle: So I do think that everyone will agree that the genie is out of the bottle on telemedicine. And I think there's likely no going back. Patients relied on it. They liked it. It worked. Providers who may have been reticent in the past, had no choice, but to convert. And I think they ended up becoming more comfortable with it. So I think we'll use that more for triage and ambulatory care, and we'll also likely start to transition to using more remote monitoring in the home to avoid hospitalizations, and those observation type cases. I think from a patient perspective, it's really a double edged sword. Healthcare providers, right, have always been among the most trusted professionals, but that sentiment is even higher now, as they have been elevated to the status of heroes or even superheroes as they risk their lives on the front lines during the pandemic. But there's also a perspective now that a healthcare setting is potentially a dangerous place and it may be for the foreseeable future. We're seeing this with low volume of ED visits and a drop in discharges for MIS and stroke, which you know, is really what everyone is thinking is the next health crisis. So one of the things we really have to do now is to convince our patients that it's safe to seek healthcare, and that it's potentially more detrimental to them in the long term, if they avoid screenings, diagnostic procedures, and treatment. So that that's really how we see the next six months moving forward.

Diane Webber: Yeah. And I imagine your marketing communications experts are probably very helpful in trying to get those ever so important messages out so people can resume care and prevent as you said, other problems non-COVID related from lack of care. I'm going to go back to what you were saying about some of the forecasts that you've been doing and the scenario planning that you've been doing. And those are a couple of tools, but what data sources, resources, or tools have been really helpful to you for planning and forecasting the new and hopefully even better normal?

Monica Doyle: Yeah. So that's a great question. And this has been tough since what much of what we as planners have relied upon in the past is premised on historic utilization and historic consumer behaviors. And really, you know, all that is up in the air. The economic impact the changes that we just talked about in what consumers will anticipate from us in the future, make this all our crystal balls very murky right now. This is a transformational event for every industry, not just healthcare. So we think that the healthcare recovery will move in tandem with national and regional economic recovery. So we're being much more creative in looking at leading indicators like unemployment rates, the rate of the uninsured, consumer confidence with utilizing other services like visiting restaurants or museums, and even looking at mobility data to see, you know, how much are people venturing outside of their homes. So we're evaluating a number of tools that are commercially available from vendors as well as utilizing a demand model that we had developed over the last 18 months and seeing if we can adapt that with some of these inputs. So we'll be able to forecast demand on a more, almost real time basis, more in like the next three months, as opposed to looking as we typically do with one, three, or five year forecast.

Diane Webber: Wow. That sounds great. What a creative use of other data sources. Talk a little bit more about the demand model that you came up with. What thought went into that before this all happened?

Monica Doyle: So we had to have this in our thought process for a number of years and particularly as we came together as a health system. So what we're doing is really modeling from the beginning of the healthcare experience and starting with ambulatory and new patient visits, and established visits, and then determining if we increase those what are those ratios that then translate into you know, outpatient diagnostic testing. Ultimately, inpatient admissions for things like elective surgery, but also being able to toggle back and forth between observation and inpatient admission, because when we're planning for facilities, I mean to use a term it's you know, the heads in beds, it really doesn't matter if observation is an outpatient status. So looking at all of that together and being able to take the best of what we get from a forecasting perspective, layering on what we anticipate our market share will be, and then being able to do those longer term demand forecast based on various scenarios.

Diane Webber: Wow, that sounds fascinating. Sounds like it could be a course in and of itself. So we may tap into you for more information on that in the future. Monica, thank you for that. So let's think about some of the service lines and offerings that Jefferson Health has. And are there those that you already get a sense will get attention first and what kind of care delivery changes are you considering for some of them?

Monica Doyle: Yeah, so our service line leaders are all thinking about this and we're trying to provide as much information to them as we can to support that. One of the areas that we're really focused on right now is our post acute care service line. And in particular, looking at that hospital at home and remote patient monitoring and how we can bring that up. We have a lot of assets in home care anyway, that would help us do this with home infusion, home care and hospice. Some of the challenges though are going to be how quickly are the payers going to respond to this? It's definitely to the patient's advantage to remain at home. It's a more feasible economic model for us than having a patient in an, you know, [inaudible] patient rate, but, but requiring resources that are similar to an inpatient rate. But we really need to get the payment models aligned. We were already heavily invested in telemedicine. So we're able to quickly transition early in the pandemic to virtual care. And we do expect that that will remain a key area of focus for us across all of our service lines. And our primary care providers are really rethinking how they provide access to their patients in a safe and convenient way. So that's just a flavor for some of the things that we're working on with our service line leaders.

Diane Webber: And I'm sure of course, you know, as an organizational member of the American Hospital Association, the AHA has been working quite diligently, 24/7 to really work hard, to get some good reimbursement and financial recovery for hospitals, but as they maintain their context with CMS, they are definitely moving forward notions of supporting expanded reimbursement for this kind of care delivery. So hopeful for changes of that policy in the future. So at this point, I just want to ask if there's one thing you'd tell other planners to do now to help steer the course of tomorrow, what would it be?

Monica Doyle: I think my best advice would be to challenge assumptions and traditional paradigms. Don't assume that we are going to return to the old normal, and that's going to be the new normal. I think this is really an opportunity for planners to move your organization where you likely knew they needed to go anyway. But we, hopefully we can accelerate that and being able to quickly adapt and to employ scenario planning I think will ensure survival. I think that's critical is to be able to have different scenarios laid out, and then be able to pivot as you see which ones will be more likely and will and will play out.

Diane Webber: Yeah. And it sounds like it's a real opportunistic moment too, you know, out of this adversity, which has been really, really difficult to see there, have been new opportunities and it sounds like you and your team are just the kind of individuals to help make that happen. So thank you very much for all the work you're doing. And thank you for taking the time to share your, your lessons learned and your experience with us today. To our SHSMD member audience, please continue to visit shsmd.org. You'll be hearing more of Monica's recording there as well as any resource that she's willing to share, but we've also collected other marketing and planning stories and resources for you. So please take care everyone. And thanks again, Monica.

Monica Doyle: Thank you.

Conclusion: Thanks for listening and know that we are thinking of you during these unprecedented times. For general updates and resources on COVID-19 head to aha.org/COVID-19 and visit shsmd.org for a collection of specific COVID-19 resources for strategists.