It’s no surprise that one of the biggest stories of the year that has forever changed the healthcare landscape is virtual care. But figuring out who’s behind the curtain and when is just one facet – albeit an important one – that requires unique and evolving staffing models. While the keyword for providers in 2020 has been “pivot,” some creative staffing changes that support fiscal sustainability along with patient and provider satisfaction are likely here to stay.

Goodbye waiting rooms, hello centralized offices

Parents’ cars are the waiting rooms of the future, says Dr. Scott Moore, M.D. and his wife Misha Moore, Ph.D., of Green Tree Pediatrics in Michigan. Instead of having patients play with the same toys that need to be constantly cleaned, clinics are instead requesting that patients stay in their vehicles upon arrival. 

A bonus? Eliminating waiting rooms means a streamlined and safer experience for front desk staff, and in turn allows them to focus more on completing timely tasks. “We always say the hardest job in the office is the front desk. You have to ask for money and collect on patient balances. We’ve automated much of that process with athena and integrated Marketplace partner Phreesia. There are certain things in medicine you want to depersonalize — and if you can depersonalize the payments, great,” says Dr. Scott Moore. Taking advantage of automated services frees up front desk staff time, allowing them to focus on other top-of-license work.

Creating a virtual centralized office for their two separate locations has “proven to be wildly efficient,” he said, in addition to being safer. “The less people, the less sets of lungs in the building, the better.”

Keeping a hybrid of remote roles in place

The meteoric rise of virtual care has also added more flexibility into practice operations and enhanced efficiency. At Green Tree, a remote nurse now focuses on patient communications and follow-ups, while an on-site nurse tackles the clinical inbox. Formerly, on-site registered nurses would “jump back and forth” between disparate tasks like patient care and phone calls, said Misha Moore. “But with a cloud-based EMR, there can be eyes on everything, from anywhere,” she said.

Across the continuum, keeping some model of remote care in place means practices can still maintain patient access to care and providers can continue to work safely.  

Dr. Lynn Joffe is no longer dreading the feet of snow that usually fall at her practice, DTC Family Health in Greenwood Village, Colorado. In the past, storms have meant cancellations and transportation issues for staff and patients alike. But telehealth options help Joffe and other DTC providers feel more assured about continuity of care. Plus, with a limited number of on-site exam rooms, they can even add more patients to the schedule virtually than they may have been able to safely in-person. Providers are also happier with the new plan to keep Saturday appointments virtual-only; previously, those were in-person and felt “more like work” than the new model, where care can be delivered from a provider’s couch.

Expanded opportunities to fill open roles

At Chicago-based FQHC Esperanza Health Centers, there’s no end in sight to keeping virtual roles in place – or at least a hybrid plan where some providers can work select days and times from home, says Jessica Boland, Director of Behavioral Health Services. To satisfy the increased pandemic-related demand for services, she’s had to hire several new providers – but thankfully, now has more options to source talent. Previously, being based in metropolitan Chicago meant that some candidates were less interested because it meant commuting into the city five days a week. Boland is encouraged by this year’s results, explaining that her employees’ productivity scores have increased since the start of Esperanza’s virtual care program.

Increase in demand for mental health visits

Across care settings, no-show rates for mental health visits have historically trended on the high side, said Boland. She estimates Esperanza’s no-show rate was 30 to 35 percent for behavioral health visits prior to the transition to virtual care. Today at Esperanza, no-show rates are greatly reduced because patients are embracing telehealth options.

The increase in mental health needs are also growing substantially among youth. “During my career, the biggest change in pediatrics is how much mental health we’re doing. And certainly, that has accelerated a ton during this crisis,” says Dr. Scott Moore. He’s expanded Green Tree’s care management team, whose primary focus is addressing the increased demand for mental health services. “I don’t see this [demand] decreasing or going away after the pandemic is over,” Dr. Moore said.

Using technology for more efficient staffing models

At DTC, Dr. Joffe has been able to use Consumer Scheduling, by which patients can self-schedule appointments without logging in, or click through via messages delivered using athenaCommunicator campaigns. This significantly decreased the number of incoming phone calls staff are required to answer, and DTC hasn’t had to hire for a front-desk role lost by attrition this year.

Capital Area Pediatrics in northern Virginia has also used athenaCommunicator messaging campaigns to connect with patients and their families, thus reducing the number of staff required to manage incoming calls. The team developed an algorithm of staffing demand, drawing from practice and athenahealth network data on acuity and visit type, to more accurately predict staffing needs. Executive Director Allison Ankeny says the practice has always used "data-driven decision making," but that’s been enhanced since the onset of COVID-19.  

Joffe said DTC plans to continue adopting new technologies, because Consumer Scheduling has been such a success to fill scheduling gaps and enhance volume while also contributing to patient satisfaction. The functionality also enables a scheduling hybrid model based on the providers’ preference for in-person and virtual care visits, which is especially important when it comes to infectious disease control and patient preference for convenience. Other practices that provide such experiences just may see more positive patient reviews and scores for a “consumer-grade” experience.

Cross training and increase in number of unique models

Reallocating talent has made DTC more efficient, since staff who previously answered the phones are able to assist with medical care (like giving vaccines) in some instances. Cross-training has made all the difference, said Joffe. “Just teaching our staff how to handle and approach telehealth,” was the initial training hurdle, she said. “Now, we've got most people cross-trained and we've got one of our front office people who's got medical experience giving vaccines. We’re mostly just trying to make our staff work more as a team and be more efficient — trying to decrease their captivity to the phone.”

Similarly, at Green Tree Pediatrics, clinical support staff is cross-trained to answer phones, so in case they have a concern with COVID-19 exposure, they can work remotely.

For others like Hamilton Health Box, a turnkey employer-clinic model, cross-training staff to work both on-site and remotely meant a seamless transition during the onset of COVID-19. Founder and chief medical officer Dr. Glenn Davis says that throughout the pandemic, there has been no need to make technological nor cultural pivots. Having the groundwork laid — including a hybrid of on-site relationship-building appointments along with technology that enables better remote patient-monitoring measures — has yielded a steady stream of income and patients willing to engage in virtual care that could greatly impact chronic care management across the continuum.

Patrick Dornan is athenahealth’s Director in the Client Solution Group; Carley Thornell is a Senior Thought Leadership Writer.