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The Leaflet Article

Featured Article:

Taking Virtual Care to New Places

By Randy Moore, MD, MBA, President, Mercy Virtual and David Hirschbuehler, AIA, LEED AP BD+C, Principal, Forum Studio

Nearly 200 years ago, Catherine McAuley and the Sisters of Mercy pioneered a revolutionary new approach to caring for others. Rather than expecting people to come to them, they traveled outside the confines of their convent to deliver care to those with the greatest need.

Today, the Mercy health care system that McAuley and “the walking Sisters” inspired is guided by the same philosophy to bring care where it’s needed most. Thanks to new and emerging technologies, our clinical teams can now serve more people where they are — in their homes, schools and workplaces.

And virtual care is a vital, growing part of our path forward.

When we came together to create the world’s first Virtual Care Center, a 125,000-square-foot building that opened in 2015, we knew that this hospital without beds had the potential to expand our impact and achieve better outcomes than a traditional hospital environment.

Located in suburban St. Louis, this four-story facility enabled us to bring together teams and individuals from various locations in a single coordinated facility focused exclusively on delivering care outside its walls.

Our teams of experienced nurses and clinicians are able to keep an eye on patients around the clock and anywhere in the world. Technology and algorithms are helping to guide the care that’s delivered to each patient, complementing the care that their bedside team is providing.

And the Virtual Care Center equips us to serve patients far beyond the boundaries of Mercy’s four-state market area. This year, in fact, the number of Intensive Care Unit (ICU) beds that we oversee from the facility is projected to be greater in hospitals outside Mercy than from within the system.

Mercy Virtual is also contributing to some impressive clinical outcomes:

• Patients admitted to Mercy’s TeleICU program in 2016 had a 30 percent lower risk of mortality and stayed in the hospital 35 percent fewer days than expected, based on the national APACHE benchmark. In 2017, we’re projecting that about 1,300 people who were predicted to die will return to their homes instead.

• Our virtual sepsis program boosted the early identification of sepsis — the leading cause of deaths in U.S. hospitals —by 30 percent last year.

• The Engagement@Home team, which focuses on the 5 percent of patients with the highest medical care needs, has earned 98 percent satisfaction scores while reducing admissions and unnecessary ER visits by more than 50 percent.

• Mercy’s TeleStroke program has enabled stroke care where it didn’t exist before and improved stroke assessment and intervention time across all stroke care locations. In 2016, across the 29 hospitals with access to the program, patients were typically assessed by a physician within 12 minutes and the rate of administering tPA — the clot-busting drug — for appropriate patients continues to improve performance vs. national benchmarks.

Virtual care is also helping to address medical inequalities in rural communities, where nearly one in four Americans live, but only one in 10 U.S. doctors practice.

To help shape the next generation of health care processes, products and technologies, the multi-functional facility also houses a variety of open workshop and innovation spaces.

Seamless continuum of care

In the two years since the Virtual Care Center opened, we’ve learned a great deal, made significant progress and reaffirmed our commitment to virtual care as a key component to improving the quality and efficiency of health care delivery.

Our vision has never been to replace or compete with traditional hospitals. Instead, we believe virtual care should leverage and extend the patient-centered care that hospitals deliver so effectively.

It’s truly amazing when you consider that someone can be admitted to a hospital in critical condition and within five days, be sent home to continue his or her recovery. But why should that care stop when someone leaves a hospital campus? Collectively, we should be working to expand the level of care that patients receive before, during and after they enter a traditional hospital environment.

Our team is currently renovating the Virtual Care Center building to accommodate the growth and evolution of our programs while facilitating a more seamless workflow between teams. We want patients to experience a seamless continuum of care as they transition from the ICU to a patient floor to their home.

On the building’s third floor, we’re creating a new work environment for more than 275 co-workers to optimize care, streamline workflow and enhance collaboration. Additionally, we’re discussing modifications to the second floor to create an Alpha-Beta incubator for continuous innovation and program enhancement.

Based on our current growth rate, we’re projecting that the building will reach capacity in the near future. To accommodate the continued growth of Mercy Virtual staff, programs and resources, we plan to progressively expand our footprint to include spaces adjacent to existing clinic and hospital environments as well as to other freestanding buildings, all of which will be interconnected.

Building a national consortium

With chronic disease comprising an increasingly greater proportion of hospital capacity and utilization rates, the U.S. health care system needs to transition from a system of acute, reactive care to one that effectively manages the long-term health of an aging population.

That requires shifting our collective focus from managing chronic disease in a hospital bed to keeping individuals from ever developing a disease in the first place. This concept resonates with most people because it just makes sense. And virtual care is a key component to making the idea logistically and economically feasible.

To build a new model of care, however, we need to create a national movement by enlisting the resources and support of other like-minded partners who share our vision.

We’ve already secured strategic partnerships with several other health systems and individual hospitals, including Penn State Health, University of North Carolina Health Care and Tampa General Hospital, among others. We are also forging alliances with product manufacturers, technology firms and other progressive companies that are joining with us in advancing this vision.

These partnerships will enable us to scale up in delivering virtual care capabilities across the country, while at the same time expanding access to expert clinical teams, driving additional data and research, and ultimately driving down costs.

Embracing the new frontier

The Mercy Virtual Care Center continues to serve as a highly effective sales tool. Each week, the facility hosts numerous tours for potential partners and other visitors from across the U.S. and as far away as Rwanda and Saudi Arabia.

Though there will always be naysayers and skeptics who question the long-term viability of virtual care, the building provides a powerful testament to the current impact and future potential of this new frontier. As guests navigate the facility, they follow a purposeful tour path that illuminates Mercy’s 190-year history, mission and commitment to shaping the future of health care innovation. And when they hear more about our commitment to make it an invisible, frictionless experience for the consumer, the light bulb usually turns on pretty quickly.

Another compelling asset of virtual care is that it’s an agnostic model that appeals to people on all sides of the political spectrum. At the end of the day, who doesn’t want to simply improve clinical care and lower costs?

As the health care reform debates continue to divide Washington, D.C. lawmakers, one element that has been notably absent from all proposed solutions is a recognition of the need to transition from paying for a unit of health care — a surgery, pill or diagnostic — to paying for us to deliver a superior clinical outcome and quality of life for people.

Consumers aren’t really interested in buying care; they want to partner with a system that can optimize their health and ability to live well. And they want the whole experience to be convenient, efficient and seamless.

If we could effectively address the risk determinants of heart disease and save people from having heart surgery, for example, it would be infinitely more valuable than allowing someone to get sick enough and performing a really effective surgical procedure.

We’re not proposing the creation of a new way to practice medicine or the development of a new building type. It’s really about shifting our current mindset 180 degrees so the patient is at the center of an integrated delivery system that connects the traditional silos of inpatient care, ambulatory care, home care and virtual care.

In fact, we hope that the term “virtual care” eventually disappears as it’s woven into the fabric of the overall care experience.

Just as the walking Sisters of Mercy recognized they could have far greater impact by leaving the confines of their convent, we believe that we can be most effective and efficient by bringing health care directly to patients. Connected by advanced technology and guided by analytics, we can customize the care we deliver to each patient so we consistently serve them well.

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