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Roxanna: On this episode of Inspiring Health, we're exploring one of our newest digital innovations, Duo Healthcare. So today, we'll talk about the details of the program and how it works, the role of innovation and developing this new service and how WellSpan employees can experience Duo for themselves.

Joining me today is Dr. Brian Pollak, Medical Director of WellSpan Innovations. Brian is also a practicing internal medicine physician in York and now with Duo. Brian's been a leading physician for digital health strategies since 2015. His expertise has shaped nearly every WellSpan digital innovation. Brian, thank you so much for being here.

Dr Brian Pollak: Thanks for inviting me. It's great to be able to talk about Duo.

Roxanna: So Brian, coming off the heels of the pandemic, research shows that digital health is here to stay. While it may have been slow to take hold, the necessity of digital and remote care over the past two years has accelerated by leaps and bounds. What do you make of that fast-tracked adoption that some might say has been long-awaited?

Dr Brian Pollak: You know, in many ways, providers have been practicing telemedicine their whole career. If you treated a patient over the phone, for example, when you are on call, you're practicing telemedicine. If you ever worked with a patient using portal messages, then you're also practicing telemedicine. However, really leveraging technology to connect with patients is long overdue. Some providers might disagree, but patients like the access to their care teams. A survey of WellSpan patients in February this year showed that over 70% of patients would prefer to use a video visit for future appointments if available.

Roxanna: Thanks, Brian. For years, we in medicine watched technology disrupt banking, shopping, food delivery, the hotel industry, and more. Each of these disruptors changed the way that consumers connected to goods or services that they want.

Dr Brian Pollak: Right. And in medicine, we have been concerned that an outsider could disrupt our industry too. But we always seem to run into barriers when we think about finding new or better ways to connect with patients. We're concerned, "Will insurance cover this?" "My schedule is already full. How will I have time to do this?" "Do patients really want this?"

And the pandemic obviously changed everything. The pandemic said, "You cannot see all the patients the same way that you have then. So now, what are you going to do?" Many people are probably not aware that WellSpan had been experimenting with alternate ways to deliver care for a couple of years before the pandemic hit us. These were small pilots, but they gave us enough experience to rapidly scale up some new ways to connect with patients like video visits and e-visits.

Roxanna: Yeah. That's so true, Brian. And I think it was really amazing how all of our teams and providers worked together to develop and to give that care during the pandemic, it was really impressive. I'd like to talk about duo healthcare though. In 2020, Duo began under the name WellSpan Online Primary Care, and it was tested with a group of our employees. We had more than 250 employee customers that signed up. And I know your team learned from their experiences. Can you tell us about Duo and how you use those learnings to get us where we are today?

Dr Brian Pollak: So Duo really consolidates what we learned in those pilot practices and it expands on them. Let's look at how we manage routine care and how we manage acute care in Duo, because one founding principle in Duo is that your routine care is our responsibility. You do not need a visit to address health maintenance, routine labs or other testing.

The Duo care team reviews each patient's chart every six months. And during this review, we look at any interim testing or specialist visits, then we send the patient a portal message to ask some questions, give our assessments and guide the next steps, like maybe going to a WellSpan pharmacy for an immunization.

To make this work, we ask patients to log their blood pressure and weight a couple of times each month. If we see the blood pressure or weight going up, we contact the patient to see what might be happening. And that way, we can catch a problem before it turns into a problem. For acute care, patients access us in the way that they want. We have multiple channels, but I like to think about the different access opportunities, like levels of care. At the base, we have portal messages. They are asynchronous and good for low acuity issues. Above that, we have e-visits, which are portal-based symptom-specific questionnaires that collect standard information about a problem.

If we cannot address the patient's problem with asynchronous communication, then we escalate the level of care to a telephone call or maybe a video visit. And beyond that, we can connect the patient to in-person care, like urgent care or a nearby primary care practice who can see the patient acutely.

With these options, we can get quick follow up on issues too. I will follow up one or two weeks after changing a medicine to see if we are getting the desired effect or if we are getting side effects. And for example, we can quickly adjust blood pressure medicine to get good control within weeks rather than months. We are still learning to deliver in-person care in some regions though. Although WellSpan covers a large geography, we have patients as far north as Potter County down to Baltimore City, and from Pittsburgh to Philly.

Roxanna: Yeah. Good point, Brian. And beginning this month, we'll launch our Duo beta phase with the little town area school district in Adams county. That's a six-month pilot that will target the district's more than 300 teachers, administrators and support personnel.

Dr Brian Pollak: This will be an interesting group, because we anticipate that most of them already have a primary care provider. So it gives us a chance to see how patients want to connect with Duo's services that compliment or supplement their current PCP. The team has set clear goals for the next phase including gaining another 250 members from external partners and an additional 100 internal customers to help collect feedback and to identify opportunities for improvement.

Roxanna: That's so important to get it right, Brian, and it speaks to the importance of continuous improvement. A great key factor for innovation, trying, testing and improving, so that you're creating something that patients really want.

As you know, Brian, I'm currently a patient of Duo and it's so convenient and easy to use. A few weeks ago, I had a healthcare issue, which just needed a quick look from someone. I went on my WellSpan. I scheduled a video visit and I completed my entire process within 24 hours. My visit took less than five minutes and I never left the comfort of my own home. So it's that type of convenience that I was looking for in that situation. I realize that Duo or other tele-health options might not be for every patient, but I think it does help us attract a certain segment of the population and retain more loyal patients.

Dr Brian Pollak: I think it's also important to recognize that for those acute needs, you have options from national telemedicine services, as well as from regional healthcare systems that provide acute video visits. And the difference with the Duo approach is having a longitudinal relationship with our patients and having access to WellSpan's resources.

Roxanna: Absolutely. That's such an important point. Well, we know experience, quality and affordability are so important to our patients. It's what's been driving some of our strategy around leading the region and value, but Duo really hits all three of those, doesn't it?

Dr Brian Pollak: I think it does. Our six-month care reviews address care quality. Our multiple channels improve the patient experience by letting them access us how they want, when they want. I expect that the asynchronous care options will become more important as we look toward value-based contracting that really incentivizes caring for larger panels of patients.

One of the unexpected benefits that I'm seeing is a new type of engagement in myself, that when I see patients in my traditional office, I am on a schedule and I need to keep on schedule so that everyone is seen and satisfied. Only very high priority issues will disrupt that schedule. And while I am seeing patients, if there is a clinical question that I don't know, then I need to remember to read about it later and get back to the patient. Or I refer the patient to a specialist, plus I know that I will have phone calls and portal messages waiting for me at the end of the day.

In a traditional model, this is all extra work at the end of the day. But in the Duo model, this is the work for the day. With Duo model for healthcare delivery, I feel like I can prioritize my day better. Patients who scheduled visits are obviously going to be seen at their scheduled time. But the real bulk of care that we deliver is asynchronous. So I can see the work that needs to get done for the day and prioritize the more important issues.

The asynchronous nature also gives me time to go deep on a patient's problem, so I can do a little more reading. And at the end of the day, I go home feeling like I learned something and that I helped some people and that's satisfying.

Roxanna: Yes, absolutely. I couldn't have said it better myself. And reducing burnout or helping providers feel more joy and practice has got to be a great advantage for Duo. So what's next for Duo and how can WellSpan employees experience it for themselves?

Dr Brian Pollak: For the general public and employers, the goal is to have a market-ready Duo product to launch in 2022. So stay tuned for more updates on Duo and duohealthcare.com. Currently though, any WellSpan Plus or WellSpan Standard beneficiary can join Duo through our benefits plan. You can send us your name at duohealthcare.com.

Roxanna: That's wonderful. Well, I can certainly attest to the fact that I have absolutely loved being part of Duo and it's been a great care experience as well as a very high quality care. So Brian, it's been great to deep dive with you and hear your explanations about Duo. I hope all of our team members listening think about checking it out. It's the transformational innovations like this that are driving our strategy. And anytime we can provide more convenient, affordable solutions to patients, it's a win. So thank you for joining me today, Brian. You've shaped so many incredible digital programs here at WellSpan and I can't wait to see what's next.

Dr Brian Pollak: Well, thank you for having me and thank you for your participation in the Duo Program.

Roxanna: Yeah. Absolutely. Thanks. And that's all the time we have for today. we hope you'll join us for the next episode of Inspiring Health.