Workplace in Focus Podcast Episode 4 Transcript

Learn about the advancements in telemedicine and how "virtualists” are caring for Banner|Aetna members around the clock with Dr. Brad Younggren, MD, Chief Medical Officer of 98point6.

[ANNOUNCER] You have COVID-19 related workplace questions. Banner|Aetna has the answers. Welcome to Banner|Aetna Workplace in Focus. Now here's your host, Banner|Aetna Market head of sales, Jon Dingledine. 

[Jon Dingledine] Good afternoon everybody. We are back with Banner|Aetna Workplace in Focus. Today we’re with Dr. Brad Younggren from 98Point6. And I’d like to turn it over to Brad just to say a few things about who he is and his role at 98Point6. So Dr. Younggren can you tell us a little bit about yourself please? 

[Dr. Younggren] Sure thanks. I'm an emergency physician by background. Spent my early years in the military, and primarily focused early in the pandemic space around disaster medicine space which is relevant now and now really got involved in technology for humans on the battlefield. That sort of changed the course of my career. Spent time at a variety of device companies for the last 10 to 12 years. Before coming to 98Point6 in January of 2017 to help build out the medical team. There is a responsibility to fall under me or the medical group physicians that are involved in the care delivery of 98Point6, clinical operations team, the research and quality and outcomes program, as well as the care coordination, and population health endeavors at 98Point6. 

[Jon Dingledine] All right great, again welcome. So we've been hearing a lot about telemedicine and virtual care in the last few months. What is virtual care, and howis  Banner|Aetna’s virtual care solution provided by 98Point6 different in its approach to virtual medicine?

[Dr. Younggren] Yeah, 98Point6 is the 24/7 virtual care solution for Banner and their members, throughout Arizona, and really across the country. 98Point6 is offering virtual primary care for adults and pediatric care for ages one and up for Banner|Aetna. And really fundamentally different from traditional analog telemedicine services. That was really very transactional oriented. There’s no longitudinal care. And traditionally done via video visit. We integrate a text-based platform that also has video and phone capabilities of course. But we’re offering on-demand primary care services 24/7 to Banner|Aetna members. So that allows patients to get the care on their terms. When they want to. When it is reasonable and appropriate for them based on what’s going on in their lives. The key to what we use is the 98Point6 app. This the entry point for all patients coming into the clinic. And what this allows us to do is to give patients the opportunity to access care for basically you know any location, any time. Since it has a text forward approach patients can be in what we describe as non-traditional settings. So around a third of our patients’ visits are occurring in non-traditional settings. In between meetings, on a bus, a place where even a video visit may not be reasonable or appropriate based on confidentiality needs. So we offer in contacts and virtual care we’re offering primary care medicine. So we do, we've been doing labs since 2017. In an effort to fully understand how to provide virtual care for many patients that don't have access to primary care. We refer for imaging. We do electronic prescriptions like I said we’ve been doing the labs for quite some time. And with Banner|Aetna we've been supporting care coordination efforts to make sure we can drive patients to the care that they need. 

[Jon Dingledine] Well it certainly seems like times are perfect for a solution like this. Over the past couple months, what kind of increase in activity has 98Point6 seen? How are you managing that spike in activity, we’re assuming it’s a spike. How have you been managing it? 

[Dr. Younggren] Yeah you're correct. We've had, as with many people, things changed with the COVID pandemic crisis. We saw over 300% visit volume increase since the beginning of the pandemic. Fortunately 98Point6 has a number of staff members that de-background and pandemic preparedness response. We started talking back in December about what should our surge capacity look like to make sure we could respond to the patient’s needs. We started building it out, and one of the benefits of having your own physician workforces you really truly understand what your stress capabilities are. For using local tent services that are working for tent services at the same time. They can't all be in the same place at the same time, so it's difficult to understand what your surge capacity could be for your patient population. Since we invest in our own physicians we have been able to address that. Additionally because we have a technology core, a technology company at our core. We have a lot of fundamental knowledge around AI and data science, and so once the CDC started providing guidelines in January around some travel criteria as it related to COVID-19 we were able to incorporate those requirements into our AI that way we could make sure patients who met proper criteria could be identified. We had to refer a couple patients in January to the CDC, specifically around that travel identification. And as soon as the larger surge hit in Seattle, we certainly have been deep in the process of learning how to support our patients from that point forward as it related to COVID-19. The surge plan we developed really allowed us to hire a large number of additional physicians. Traditionally we were only hiring full-time physicians to work for us, but we definitely endeavored to understand a different strategy to approach this large need and we found there are a bunch of physicians who essentially had an opportunity to work for us part time who are high quality. Who had no other work at the time, because they're Brick and Mortar facility had been primarily shut down. This plan we engaged in and hired a large number of additional physicians who we had to train virtually in our platform, it's very unique. We were fortunate enough to have that in place, and also to have a training team that falls under me to help instruct the physicians on how to engage with the technology to deliver the care. And this overall plan really allowed us to maintain our level of service while never sacrificing quality. We never would sacrifice quality, and the physicians we hired during that surge were the same quality and experience that our full time physicians were. They just were not working for us full time. Now to achieve those search numbers that we sort of described we fully understood how many hours a week they could allocate for us. So by having those guaranteed or allocated hours we could add those hours to the overall strategy and make sure that we had enough courage to support our population. 

[Jon Dingledine] So thanks Dr. Younggren. Tell us how did the virtual physicians and caregivers work for 98Point6 effectively manage can for patients. I'm sure folks trying a virtual care visit for the first time are gonna ask the question, can virtual care really be as effective as an in-person evaluation of a patient? So can you give us some insights there? 

[Dr. Younggren] Sure. When we started seeing patients in 2017 we knew we needed to build something that would expand the boundaries of virtual care, beyond even what video analog telemedicine was doing in the market. And so the first fundamental pillar of our approach was, as I mentioned earlier, hiring our physicians as employees of 98Point6. Now that, the hiring our own physicians full time and building a medical group that allowed us to understand surge, to understand quality and care delivery. And allows the physicians to essentially be employed and have time set aside to do a variety of activities that help us improve quality of the service. One of the things we did early on, was we decided that all our physicians would be salary employed physicians. Not paid per patient, or hourly. And we would give them all a percentage out of time devoted to working on non-clinical activities. Because we knew that there was a bunch of work that needed to be done to fully understand what the safe, high quality boundaries were for virtual care. So the physicians need to have the time afforded to work on non-clinical activities. So, as an example, we knew early on that we needed to have time carved out for the physicians to work on the development of not only policies and procedures related to virtual care. Because we knew we needed to fully understand what those were, but also to be involved in providing a high volume of peer-to-peer chart review with each other. So as we grew, we would also grow in our learnings around what the boundaries are around virtual care. Because no one wants to deliver unsafe care, we want to deliver the highest quality of care. Patients trust us for that. Banner|Aetna trusts us for that, and we take that very seriously. No one, you know were not, arguing at 98Point6 100% of the visits can all be done virtually. The goal is to have conversations around these dimensions to fully understand what can be virtualized. And to abate unnecessary in-person visits. That's not only a goal as it relates to the cost of healthcare which is a real goal for sure. But it's also patient experience, so we read so many articles around how patients are really appreciating this new surge of virtual care in the COVID crisis, because they're getting access to their physicians but not ever having to leave home. So we believe that you know by putting a fine point on this, by looking deeply at this on a repeated basis. Developing policies and procedures. Defining boundaries. We can understand better than anyone what the boundaries are for virtual care while maintaining the quality, lowering costs, and improving access. Which are all three pillars of the work we do at 98Point6. 

[Jon Dingledine] That's great insight Doc, thank you very much for that. One of the, one of the main themes in this series are how companies and employees get back to work. And not only get back to work, but get back to work safely. How can virtual care at 98Point6 help them do so safely and effectively? 

[Dr. Younggren] It's a great question. We have employers as an example in multiple spaces. A large cohort of people in the healthcare space us as an employer benefit as one example. We also have people that are working in close quarters –  in factory settings or airplanes. So we’ll work to either provide consultative services just to help an employer that does not have internal expertise. We're working with larger employers. We’re really providing more of a consultative role, working with their chief medical officer or their healthcare team to help execute whatever return to work strategy they've decided is appropriate. And so we can do both of those approaches. We have the intellectual expertise to provide it if an employer have direct access to that kind of expertise or we can just provide a supportive role. Let me give you an example of what we've done. We built a COVID assessment tool that sits on the front end of the virtual clinic. So when patients open the app of their smartphone, they certainly start a visit right then which is how they typically would do it. But if they're not in a position where they would like to do that, and they'd like to do just an assessment of their risk related to COVID they can go run through this COVID assessment tool. When it's done they'll get put into a risker ratification and with some recommendations. They can start out their visit then or later if they so choose. Cause again they still have access to an on-demand 24/7 virtual clinic. And so that was our effort to really provide some information when patients aren't in a position when they want to see a physician in the moment. We are currently working on sort of changes to that system to integrate recommendations around lab testing – as information comes out on a daily basis as it relates to COVID-19. We also have a care coordination team that sits with the medical team and works with our physicians. So as an example as it relates to Banner|Aetna, we’re already doing this around labs to ensure that we have the support to care coordinate patients related to COVID lab ordering on a PCR side as well as the antibody side. So we can work with employers within Banner|Aetna to provide downstream guidance for getting those labs done within the state of Arizona to help them understand where they can actually get testing done. When those tests are completed we bring them back into the virtual clinic, and they can have another conversation with the physician. So we have an employee testing as part of the RTW strategy. We have internal knowledge around the legal, regulatory, and molecular specifics related to testing and can provide expert guidance around building a return to work strategy as it relates to leveraging testing. 

[Jon Dingledine] Certainly some great solutions. Hey doc, one more question, as we close out this session, certainly you and 98Point6 sit in a very unique position to see the changes that have occurred over the last few months for businesses and for patients. Have you had an ‘aha’ moment? Has one thing stood out that's been really surprising to you as you look back over the last few months? 

[Dr. Younggren] I think that the acceptance and acceleration of virtual care as an actual true option for care delivery is now here. And I don't, I can't imagine that the healthcare system within the United States will ever go back to being the same. We’re going to take a lot of the learnings that we have from this pandemic crisis and apply them to getting to the point that we all have hoped for as physicians which is the right care at the right time. Getting patients not only engaged in sickness care, but to engage in wellness care. And we think that virtual care and technology solutions are going to be critical for moving the needle forward there. 

[Jon Dingledine] Yeah, I agree. That's terrific insight. Dr. Younggren we greatly appreciate your time today. We appreciate the insights, and thank you for being with us. 

[Dr. Younggren] Thanks for having me. I really appreciate your time. 

[Jon Dingledine] And thank you everybody we appreciate you for tuning into this episode of Banner|Aetna, workplace in focus. Stay tuned for our next session where we will have a Business to Business Focus and another exciting guest. Thank you very much. 

[Announcer] You've been listening to Banner|Aetna Workplace in Focus. Learn more at bannerAetna.com.