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While patients have been deferring routine office visits for preventive care or chronic disease management out of safety concerns, ambulatory practices have been revisiting how these important services can be provided safely and effectively by leveraging technology and adapting their operations. Below are four strategies ambulatory practices have been deploying to ensure they continue to meet the needs of their patients for preventive care and chronic condition management.

COVID-19 dramatically impacted ambulatory care volume in the initial months of the pandemic according to recent analysis from the Commonwealth Fund. While many practices experienced up to a 60% drop in volume during the peak of the shut-down in March and April, visit volumes have stabilized somewhat over the summer months, but continue to be down about 10% across ambulatory settings. Telehealth visits were a saving grace for many practices, though the initial surge in video and telephonic visits appears to have plateaued as providers integrate this new modality into practice workflows.

Four Strategies Deployed for Preventive Care and Chronic Condition Management

Incorporating Population Health Management Solutions and Chronic Condition Registries

Population health management solutions have come a long way in the past decade, incorporating clinical registries that easily identify all the preventive services for which a patient is due and integrating seamlessly with electronic health records where the majority of visit documentation is managed through specialty-specific workflows. With the ability to assign individual patients to multiple cohorts, such tools enable proactive outreach to support patients with chronic condition management needs asynchronously from the face-to-face encounter. For complex individuals with multiple chronic conditions, individualized care plans can be developed to ensure physicians, care managers and other members of the care team are working in concert to maintain connections to their most vulnerable populations, ensuring any emerging care needs are identified and addressed.

Adoption of Telehealth and Remote Patient Monitoring 

The relaxation of payment policies by the Centers for Medicare and Medicaid Services and commercial payers in March of this year enabling payment parity allowed for the rapid adoption of video visits and telephonic care by provider practices. Though the total volume of care provided through these modalities has normalized in recent weeks, their success and utility in managing many common visit types, convenience for patients and ability to extend access suggests telehealth will become a permanent feature of how care is delivered not just through the pandemic, but well into the future. 

Some specialty societies have suggested telehealth can be more effective with the addition of remote patient monitoring systems, where patients track and record their own data and collect digital biomarkers outside the clinic such as vital signs, heart rhythm, glucose, or weight. Home tests for colon cancer are a useful example of how innovation in point of care testing has broadened access to routine screening and minimized the need for colonoscopies as a first line diagnostic approach for individuals not at high-risk for colon cancer.

Leveraging Any Face-to-Face Appointment to Address Preventive and Chronic Care Needs

The Centers for Disease Control and Prevention (CDC) recently issued updated guidance highlighting the importance of using each encounter during the pandemic to assess the immunization status of patients and to perform preventive screenings. If a patient comes to the practice for an acute condition, the CDC recommends offering any needed vaccinations or routine screenings which can be completed in the clinic. They further note that if patients have a video visit scheduled for chronic disease management, providers should determine if they are overdue for vaccines and screenings and to let them know if they are.

Make Adaptions in the Clinic Environment

Most ambulatory practices have modified their operations to ensure a safe environment for staff and patients to continue direct face-to-face encounters where clinically appropriate. In a prior blog article, we highlighted some innovative adaptations put in place by others which are just as applicable here in the context of delivering preventive services and managing patients with chronic care needs. In addition to the rapid deployment of virtual visits, others have instituted drive-through or curb-side visits, used their parking lots as waiting rooms, designated physical space or specific buildings for patient exams, laboratory collection or to perform imaging studies for known healthy or potentially infected patients. As the autumn influenza season begins, practices may consider combining the above strategies to undertake outreach to their at-risk populations and offer dedicated immunization clinics for flu and other recommended vaccinations. 

The pandemic’s toll could grow significantly if patients are unable to receive their regular preventive and maintenance care as previously avoidable diseases develop or exacerbate. Since the beginning of the COVID-19 pandemic in the U.S., healthcare providers have demonstrated incredible flexibility and creativity to maintain healthcare delivery to patient in their care. By continuing to improve on such ideas and adapting them to individual practice locations, the impact of this pandemic on patients will be minimized.  

To learn more ways how you can successfully adapt your practice to the “new normal,” read our eBook “Telehealth in Times of Crisis and Calm”. 

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Graham Brown

Graham Brown

Senior Vice President, NextGen Advisors

Graham Brown is a principal and senior vice president with NextGen® Advisors focused on transforming care with provider organizations. His practice centers on accountable and value-based care strategy, population health management programs, and technology solutions for providers enabling new models of care delivery across the United States.

Mr. Brown is a former senior vice president and national practice leader for population health and clinical integration with GE Healthcare Partners (previously The Camden Group) where he led multidisciplinary client teams in strategy creation, program development, implementation, operations, and performance optimization engagements. He is an experienced leader in organizational development, managed care contracting, and change management initiatives.

Mr. Brown has over 25 years’ experience supporting provider groups, health and hospital systems, integrated delivery networks, and managed care payers to assess, design, contract, and implement systems and structures for population health management. He has worked nationally across the United States and Canada.

Graham completed his undergraduate studies at the University of Victoria, the Emily Carr University of Art and Design, and the Instituto Europeo di Design in Florence, Italy. He is certified in conflict resolution and negotiation by the Justice Institute of B.C. and received his Master of Public Health from the University of Rochester Medical Center.