Responding to COVID-19: Switching to virtual care delivery

Care management & redesign COVID response

By Carter Wilson, Associate Director for the National Center, and Rebecca Koppel, Program Manager for Field Building & Resources

Individuals with complex health and social needs are particularly vulnerable during a pandemic like COVID-19. Many have compromised immune systems, crowded living conditions, and jobs that either require them to work out of the home or are early losses in the economic downturn. In the current epidemic, programs that serve these individuals have had to rapidly adapt their operations to meet the growing and changing needs of this population. A redesign of services is required to address the emerging needs that the pandemic has indirectly created. Existing operations needed to quickly pivot to dramatically reduce in-person interactions. And new collaborations are necessary to inform, support, and deliver these interventions.

Last year, the National Center launched a working group of 15 individuals tasked with defining the front-line competencies for the field of complex care. The group was diverse in profession, care setting, and geography, but all were actively working in programs supporting individuals with complex health and social needs. The National Center interviewed members of the core competency working group to learn the challenges they were seeing and how they were overcoming them. The result is a series of blog posts highlighting their stories. Click the links below to navigate through the series:

As is the case in much of healthcare, complex care programs often rely on in-person interactions, either in direct care delivery or referral pathways. Given the prevalence of underlying health conditions in the patient population, these interactions are especially risky in complex care. When the pandemic hit, the providers we spoke to knew that alternative telephonic-based workflows needed to be quickly activated.

Kaiser Permanente’s shift to virtual care management

Regina Danielson DNP, is a Clinical Research Nurse who specializes at Kaiser Permanente Mid-Atlantic Permanente Medical Group in Complex Care with the Mid-Atlantic Permanente Research Institute in Rockville, MD. Kaiser Permanente, an integrated managed care organization with 12 million members and over 300,000 staff, is well resourced and operationally sophisticated. As a national organization, they have the infrastructure and expertise to quickly and effectively transition services to a telephonic platform. Within a matter of days, Regina’s team went from 90% in-person visits to 70% virtual, leveraging video capabilities, telephone and email correspondence. Barriers to access this technology, particularly for older patients, were anticipated and addressed. For example, instead of requiring an account to access the platform physicians could text the patient a link to Healthcare Anywhere that would immediately video conference them in along with the option to add the entire Complex Care team or more family supports. 

Kaiser Permanente consolidated offices and redeployed staff to accommodate this new structure. Non-emergency specialist appointments were postponed and those providers tasked with video visits and assisting in new ways. To keep pace with the rapidly changing environment, daily briefings were sent to all staff, notifying them of changes to testing protocols. Weekly town halls provided opportunity for dialogue and connection. 

But what was happening with the social services that Regina’s team navigated patients to? Regina was able to keep track of those changes through her social network. In collaboration with local food banks, her social clubs, friends, and neighbors had begun coordinating food distribution. Many recently laid off or furloughed, these volunteers spread the word about churches and community centers that were offering food and other services through Facebook and Instagram. Regina was able to share these crowd-sourced resources with her team members and patients.

Transitioning a Boston-based peer support program to virtual

Anne Whitman is a peer-support specialist with over 30 years of experience launching, guiding, and participating in peer communities. Up until March of this year, these meetings were in-person. That face-to-face connection felt necessary to build trust and comfort with one another and as a group. Now with Boston Medical Center and Massachusetts General Hospital, Anne is leading her peer network through difficult and stressful times. Some in her peer community, including those with substance misuse and mental health challenges, found the changing and conflicting messages of politicians and the media confusing. Others with medical conditions that required face masks or ventilators, felt they would be denied resources due to pre-existing conditions. Older participants had it the hardest, often struggling to adapt to an online approach while having lost some of their in-person social support.

Getting her community access to the internet, devices, and platforms was the first challenge. Training in basic technology was limited and familiarity low. Still, within a week of the COVID-19 shutdown, peer support specialists were able to launch groups over HIPAA compliant lines. These spaces, along with a peer support call-in line already in place pre-COVID, ensured continued support for the community.

Once the new workflows were established the benefits were obvious. Those who had struggled with social isolation before COVID-19 suddenly had a less demanding way of engaging with others and their participation increased. Those living in smaller towns with limited groups were suddenly able to find their peers, including an LGBTQ community that formed. More social convenings were organized, including art sessions and dinners. A survey is planned to identify any new gaps in needs. While not all peers made the transition to virtual, those who did have found value in this approach. Anne expects that these virtual spaces will continue to be a core part of their offerings even after in-person meetings resume. She warns, though, that for this strategy to be inclusive, additional training in basic technology needs to be available.