How Stanford Health went all-in on a virtual-first COPD program
Stanford Health Care is collaborating with a virtual-first provider for pulmonary rehabilitation to expand access to chronic care for COPD patients and improve outcomes.
Healthcare access is critical for chronic disease management. Chronic disease patients require consistent and long-term care; however, patients may face barriers to accessing that care due to social determinants of health. Health systems are increasingly turning to virtual care tools to combat these challenges and expand chronic care access.
Stanford Health Care's recent collaboration with Kivo Health highlights this trend. The organizations are working together on an initiative to offer virtual pulmonary rehabilitation to chronic obstructive pulmonary disease (COPD) patients.
According to Leah Rosengaus, senior director of digital health at Stanford Health Care, the collaboration aligns with the health system's broader initiative to create a network of virtual-first referral providers.
"The scope of the collaboration is actually in some ways kind of unique, but I think represents an emerging trend in the market, which is virtual-first providers being integrated in such a way that the patient's medical home or home health system can refer to a virtual provider as easily or even more easily than they do within their own brick-and-mortar traditional referral work," she said.
To foster a successful collaboration, Stanford leaders thoroughly vetted the virtual-first provider to ensure its services would meet the needs of its patients and employed various strategies to overcome implementation and patient engagement challenges.
UNDERSTANDING THE TECH VETTING PROCESS
Pulmonary rehab can be highly beneficial for many patients with chronic lung disease, including those with COPD and pulmonary fibrosis, according to the American Lung Association. These rehab programs offer education to increase awareness about the disease and exercises to strengthen the lungs and mitigate symptoms like shortness of breath.
However, Rosengaus noted significant barriers to accessing pulmonary rehab, primarily due to capacity constraints within the health system and transportation challenges.
This led Stanford Health Care to explore virtual options for pulmonary rehab. The health system has an established vetting process for adding virtual-first providers to its network. The first step is to assess the quality of care being offered.
"The most important aspect of the service that's being offered is the clinical care," said Rosengaus. "So that's the first thing that we look for and vet when we're identifying virtual-first providers for our network: Who is in that provider group? What are their credentials? How are they trained and onboarded? What are the clinical protocols that are used? Do we see evidence-based medicine being applied? What do the clinical outcomes look like for their patient population?"
Then, the health system evaluates the patient experience offered by the virtual program. This includes ensuring that the virtual-first provider provides technical assistance so that patients feel supported when learning to use new technology.
The scope of the collaboration is actually in some ways kind of unique, but I think represents an emerging trend in market, which is virtual-first providers being integrated in such a way that the patient's medical home or home health system can refer to a virtual provider as easily or even more easily than they do within their own brick-and-mortar traditional referral work.
Leah RosengausSenior director of digital health, Stanford Health Care
The health system also examines whether the provider is ready and able to integrate with the system overall. Rosengaus underscored that this is relatively new in the digital health industry, where it is more common for health systems to subcontract technology development and ongoing management to vendors or for virtual-first providers and digital health companies to engage directly with payers.
"But this idea of the virtual-first provider being a full-service, standalone provider in and of themselves and integrating with the health system and sharing data with the health system is not quite as common," she said. "So that's really where we're pushing the boundaries here."
Kivo Health not only met Stanford's care quality and patient experience criteria but also its integration expectations.
Rosengaus explained that the latter included technical integration so that Stanford clinicians could identify and refer patients to the virtual-first provider through the EMR, as well as payer integration in the local market to ensure patients could access the virtual pulmonary rehab program as a covered service.
"This is really honoring and recognizing the work of the virtual-first provider under their own brand and really integrating them into our network just like we would our brick-and-mortar partners," she added.
STRATEGIES FOR A SUCCESSFUL IMPLEMENTATION
Stanford Health Care has endeavored to integrate the virtual pulmonary rehab program as seamlessly as possible into its network. This is helping bolster uptake among clinicians and patients alike.
For example, the technical integration of Kivo Health included the addition of built-in capabilities in Stanford's EMR that alert clinicians to patients who may be eligible for the program, Rosengaus noted. This means that clinicians don't need to dig to find the referral option.
"Even if [patients] haven't seen us in a while, but their labs and their condition are indicating that they might benefit from the service, we can provide a recommendation or encouragement to look into virtual pulmonary rehab," she said.
Once the patient is referred, the Kivo team reaches out to enroll them. The program includes a one-on-one appointment with a Kivo breathing specialist to establish a care plan and a small group program with nine weeks of virtual sessions to learn breathing techniques and complete exercises. Patients also receive a kit with a tablet, oxygen monitor and exercise bands.
Ensuring a warm handoff and maintaining patient trust is critical as the patient's care moves outside the health system, though Stanford clinicians can still monitor their patients' progress.
"We make it very clear this provider isn't a Stanford provider, but we are aware of them," she said. "We're aware of what the quality and experience will be for you. We will actually get some data back from that virtual-first provider, so we can see and track how you're doing in your program."
Rosengaus pointed out that this level of transparency isn't always possible with referrals to traditional brick-and-mortar rehab centers, but given the integration of Kivo Health as a virtual-first provider, Stanford clinicians have access to their patients' data as they move through the program.
Another vital aspect of program implementation is advancing health equity. Though early data for the virtual pulmonary rehabilitation program has not yet revealed any pervasive care gaps, Rosengaus noted that the health system plans to track adoption rates and investigate areas where they see lags to ensure health inequities are not keeping patients from accessing the program.
Adoption rates will also serve as a critical metric for Stanford Health Care to assess patient uptake and engagement, and thereby, the program's impact.
"If the solution or the care is recommended to them, do they actually schedule? If they schedule, do they continue to engage with their rehabilitation? And how strong is that engagement?" Rosengaus said.
Additionally, the health system will examine pulmonary rehab outcomes, including improvements in lung functional capacity, symptoms like shortness of breath and overall quality of life.
But the most significant indication of the program's success will be expanded care access through the integration of virtual-first providers. Rosengaus highlighted the potential for collaborations like the one with Kivo Health to create new, more convenient ways for patients to receive healthcare.
"We know that nationwide, across many specialties, patients are unique in the ways that they may want to access care," she said. "And so, what we're really trying to do here is provide alternative pathways and give patients options to choose care the way that works best for them and to make that care timely."
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
