As a provider that largely makes its money through a value-based care model rather than getting paid per service, Oak Street Health leaders have always prided themselves on the company's connections in the community and their ability to have regular in-person interactions with patients.
But when the COVID-19 pandemic began spreading around the country last month, requiring social distancing and shelter-in-place orders, the Chicago-based primary care company had to quickly retool.
One of the biggest challenges: The company focuses on treating Medicare patients—many of them moderate- or low-income seniors who have at least one co-morbidity—making the bulk of the patients Oak Street serves among the most vulnerable. Researchers have found those who are 60 and older and have at least one co-morbidity are most at risk of having poor outcomes from the virus.
"No. 1: We had to do everything we could possibly do to keep [patients] sheltered in place, make sure they’re educated on what to do, make sure we're helping to enable that to happen," Oak Street’s CEO Mike Pykosz told FierceHealthcare.
"But No. 2: Our patients have health needs. They can’t just not access the healthcare system," he said. "So we need to be there for them for the management of chronic illnesses so they’re not going to the hospital for an acute event because of their diabetes or other chronic illness."
Among the changes Oak Street prioritized was figuring out a way to deliver telehealth to a population that largely doesn't use smartphones. They're now offering about 90% of their visits over the phone or through video visits, Pykosz said.
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Here's a look at the changes Oak Street has been trying amid the COVID-19 pandemic.
- Shift to telehealth: When it came to shifting to telehealth, Oak Street had to confront the challenge that many of its patients were not comfortable with certain technology or might not have access to it. "We really had to meet patients where they are," Pykosz said. "With the standard telehealth portal most people picture, you download an app on your phone, you create a login, you enter your preferences and access that app and sign on when you want to access your visits. That is not something that the vast majority of our patients would be able to do."
Instead, Oak Street began offering telephone visits. "There's a lot you can accomplish over the phone," he said. "This is where the Oak Street model is so powerful because we're not driven by fee-for-service economics, we don't care if something is billable. We don't care about the reimbursement model. We just want to help our patients stay healthy."
The group is also doing video visits using a third-party vendor called Doxy.me that Oak Street selected because the simplicity of the platform provides a link patients can click on to access the video visit. "It's an easier user experience for them," Pykosz said.
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- Changing up shifts: Oak Street kept its centers open for the approximately 10% of appointments that couldn't be accommodated via telehealth. The centers are also trying to minimize the risk of an entire staff getting COVID-19 at once by using shift staffing. "Since we've gone to having 90% of our patients using telehealth, you can have very few patients in the health centers at any given time," Pykosz said. "There are five shifts for every center. Those shifts never overlap so you don't have cross-contamination of team members which allows us to extend the life of our PPE supply."
- Retooling its team: A large number of employees, such as members of the community outreach team, aren't able to do their typical jobs because of the changes from COVID-19. "With that team, we are getting them to do outbound wellness checks," Pykosz said. That means they are calling patients to check in and make sure they have accurate information about sheltering in place and that they know Oak Street is still open with new ways to connect via telehealth as well as to learn whether there are challenges that are making it difficult for patients to maintain their health such as the ability to safely obtain food.
The group, which has a small fleet of bright green vans it typically uses to shuttle seniors to in-person primary care, has begun using the vehicles to deliver food from food banks to seniors. "It's trying to figure out how do we move what we do and our approach very quickly to meet those needs," Pykosz said. "The last thing we want is our patients needing food and taking a bus to try to go to a food pantry or a grocery store."