Enhancing Specialty Care With Technology Postpandemic

Shirley Lee, CRNP-FNP, MPH, cofounder and vice president of clinical strategy, Preveta, shares how the pandemic impacted specialty care as well as how technology can close gaps for patients with complex conditions.

I'm Shirley Lee, nurse practitioner at Genesis Healthcare Partners and public health enthusiast. I also direct a patient navigation team at Genesis Healthcare Partners. I've had over a decade of clinical experience, always one foot in the exam room seeing patients and another foot leading programs to see how we can improve both the experience of patients and our business as well.

This ultimately led me to founding Preveta, the care navigation platform for complex specialty care environments, and that's where I serve as VP of Clinical Strategy.

What are some examples of complex conditions and what unmet needs exist for patients with these conditions?

A complex condition is anything that's not an acute one-and-done encounter. We can think of anything that requires longer term management of a condition. It requires more time and check-ins because we want to see how these conditions are developing, when there are certain flare ups, and make sure that the patients are well informed and educated about their different options.

The more common complex conditions would be diabetes and hypertension, for example. Medicare has reported that over two thirds of the American population have 2 or more chronic or complex conditions. Because there's routine follow up care, oftentimes it means multiple specialists are involved, multiple providers, check-ins, diagnostics, labs, things like that. Therefore, it requires a more integrated orchestration of the patients and the care team.

There are so many unmet needs for patients with complex conditions. We could be here all day talking about them. I'd say that there are really 2 larger priorities around the unmet needs for complex conditions.

On the patient side, it's about offering better patient education so they're informed and ultimately empowered about their condition and their symptoms. And on the clinical side, it's about making sure that patient treatment plans are executed safer, faster, and with better outcomes across the entire care journey.

What that means is surfacing up the patients so those who need help get it fastest, and just that assurance that we're tracking patients in a longer-term continuum. As an industry, with complex conditions specifically, we're focusing on how to make those patient conversations easier with faster diagnosis and treatment, and how to improve the patient experience and support them in treatment adherence and behavioral things that can help outside of medication.

It's important to make sure that the patient and their caregivers are really well informed and supported.

Can you comment on how the pandemic has impacted specialty care?

The pandemic has greatly impacted specialty care. It's estimated that total cancer screenings just in the last year are lower than historical baselines. Breast cancer screenings are down by 13%. Colon cancer screenings are down by 25%. This equates to an estimated over 350,000 missed breast cancer screenings and 300,000 missed colon cancer screenings.

If we don't address the imperative for patients to more effectively manage their specialty care, it will likely be us sitting on a ticking time bomb of later stage cancer diagnosis with potential for poorer prognosis in the years to come.

How can technology be used to improve care for this patient population?

What we need in specialty care right now is technology that can essentially help us touch specialty care patients more frequently without actually touching the patients. What I mean is if we have the opportunity to have more data on the patient—and ideally this is collected virtually through the phone or patient portal—we can better track how the patients are doing between their appointments, what their medication adherence is like, what care barriers are so we can eliminate them in real time, how their symptoms are showing up, etc.

This would lead to more effective triaging and tracking of patients with complex and chronic conditions. Technology that can help us make these patient conversations easier to give insight into candidates for second- or third-line therapies are leading to improve patient outcomes and experiences.

If the right technologies are integrated as a seamless part of the care journey, it can also help us offer new revenue streams for providers and practices too. So it's a win for all.

What should stakeholders keep top of mind when integrating technology into patient care?

As an industry, what we've seen success with is technology that both considers how to improve patient outcomes and meet business needs simultaneously. When integrating technology into patient care, stakeholders should really consider how the technology integrates into current workflows ideally as seamlessly and unobtrusively as possible. Stakeholders should also consider all the user data, so that we're able to see the business metrics and know what levers to push and pull to improve our business metrics.

Where do you see the future of specialty care headed?

There are 2 realities that lie in the future of specialty care, and admittedly, the train's already left the station for both. The first would be virtual care. There's a critical need to integrate virtual care into specialty care, whether it's a hybrid model or however it's done. It's just essential that we meet this patient and consumer need. As an industry, we can agree that there's absolutely a time and place for a clinician to put their hands on the patient, properly examine them, and have a more effective assessment of how the patient's doing. But there are also plenty of times where that same amount of patient safety and assessment can be done virtually without a physical exam. The telehealth wave is going to continue. We need to adopt the right technologies if we haven't already to help guide us through this transition.

And the second is the physician shortage that we're all very aware of. Not only is there shortage, but there's increase in physician burnout and in staff shortage that's greatly impacting the health care industry right now.

If we're aiming to empower patients and effectively triage them, we must deploy the right technology to maximize potential for everyone in the care team to support and impact patient care. The right technologies can equip staff with standardized protocols and guided questions to support effective triage while allowing clinical flexibility at the point of care. This allows for clinicians to be able to have a more sophisticated conversation with patients, pick up on nuances, and basically know that their team is surfacing up patients who need to be treated and can be treated at the right time, and could be potential candidates for second- and third-line therapies as well.

Is there anything else you would like to add today?

Sure. Today, providers are short on time. We are all experiencing a staffing shortage and patients need more virtual care and touch points. Activating our office staff with the appropriate technologies will give us a more holistic patient profile. It has the effect of essentially turbocharging our care pathways, which is a win for both business and patient outcomes.