Ep 125 – Value-Based Care as the Fuel for Virtual Care Delivery Transformation, with Dr. Carrie Nelson

One of the silver linings of the pandemic has, in fact, been, the expansion of telehealth services and virtual care delivery. The pandemic has also accelerated the healthcare industry’s transition from fee-for-service to value-based care. The continued growth of telehealth is fueled by providing incentives for care delivery in the lowest cost settings, identifying and interacting with highest-risk individuals before disease onset, managing care teams with more efficient workflows, and taking advantage of digital remote technologies. Virtual care is an easy and cost-effective path to achieve value-based care, thereby improving health outcomes and patient satisfaction across a broader population of patients.

Our guest this week, is Dr. Carrie Nelson, the Chief Medical Officer for Amwell, a leading digital care and telemedicine company.  Dr. Nelson is a seasoned physician leader committed to healthcare transformation. She has demonstrated success in innovation and change management, physician engagement, solution development and deployment, value-based care, managing and coaching other leaders and delivering results.  Before joining Amwell as Chief Medical Officer and President of their Amwell Medical Group, she served as the Senior Vice President and CMO for Population Health and Health Outcomes at Advocate Aurora Health.  She also served as the Chief Clinical Officer for Advocate Physician Partners, a benchmark organization known internationally for delivering value-based care in collaboration with about 5000 employed and independent physician practices. With more than 28 years’ experience as a Family Medicine provider, Dr. Nelson is an innovative physician leader with a proven track in quality improvement, patient safety and population health.


01:30     The silver lining of the pandemic is the expansion of telehealth services/virtual care delivery and the acceleration to value-based care.

02:15     Introduction to Dr. Carrie Nelson, the Chief Medical Officer for Amwell, a leading digital care and telemedicine company.

05:00     Dr. Nelson’s recent career transition from Population Health leadership at Advocate Aurora Health to a national leadership role in digital transformation and virtual care enablement.

06:00     A career in driving healthcare transformation in population health, quality, and patient safety.

06:30     The influence of “Crossing the Quality Chasm” and “To Err is Human” on awakening a healthcare transformation.

07:00     The pace of change across the country is still insufficient due to over-dependence on fee-for-service.

08:00     The consequences of poor disease control during the pandemic as a result of ineffective healthcare delivery.

08:30     The multifactorial limitations in the capacity for healthcare systems to change (e.g. culture, failure to adapt to technology)

09:00     Strong technology partnerships needed to prevent health systems from regressing back to their pre-pandemic care delivery model.

09:30     Workforce burnout in healthcare prevents sufficient time to think about system transformation.

10:30     Telehealth improves patient health, reduces overall costs of care, and improves health equity in medically underserved communities.

11:00     The plunge of telemedicine usage since the peak of the pandemic.

12:00     “During the pandemic, we largely moved brick and mortar care to online.  If that is all we ever achieve, we will have fallen far short of the potential for a technologically-enabled model.”

12:30     Shawn Griffin (President and CEO of URAC) and his analogy of COVID-19 telehealth deployment to only “watching the dancing baby online” when launching the Internet.

13:00     Dr. Nelson discusses Amazon Care’s recent departure from telehealth and itsrecent acquisition of OneMedical.

13:30     Wider uses cases for telehealth and recent trends in claims activity.

14:30     Inserting new tools into the virtual visit creates healthcare transformation that improves quality and lowers costs.

15:00     “The office visit is a dinosaur. It is an insufficient touch-base in managing a chronic condition.  We need more digitized touchpoints to help support health behavior change.”

15:30     Optimism for the future of digital care delivery due to opportunities for automation and customization.

16:30     Delivering a concierge-like experience to patients, a Virtual Primary Care solution can facilitate an even stronger relationship with a PCP and  dramatically improve care management.

17:45     The challenges of rural communities in accessing health care and the shortage of providers in both rural and urban areas.

19:00     Dr. Nelson shares a patient story of how virtual care delivery improved the health of a chronically ill patient.

21:00     Distinguishing between a technical problem and a complex adaptive problem in the primary care setting.

21:45     “Patient noncompliance is an indictment of how the healthcare system is not setup to deal with a complex adaptive problem. We seem to offer only technical solutions in the form of a treatment plan.”

22:45     The purity of the value-based care model in improving health outcomes and how to approach deployment of limited care intervention resources.

23:30     Value-based care reduces the logistical challenges of virtual primary care, whereby improving adherence to a customized care plan.

24:00     The healthcare system spends $32 billion annually on avoidable emergency room visits that could be treated by primary care physicians.

24:45     Emergency department visits for people with at least one chronic condition contribute to nearly 60 percent of all annual visits (over 4 million ED visits each year that are potentially preventable).

25:30     Dr. Nelson discusses how virtual primary care and urgent care models are effective ways to lower unnecessary emergency visits.

26:45     Helping patients navigate the healthcare system through emergency department follow-up programs and virtual primary care.

28:00     How Advocate Aurora utilized virtual engagement to manage patients safely at home when there were capacity constraints during the pandemic.

29:00     Results with the Spectrum Health automated ED follow-up visit program in lowering inpatient admissions and unnecessary costs.

30:15     2 out of 3 Medicare beneficiaries have 2 or more chronic conditions, and 1 in 3 patients living with 4 or more chronic conditions!

30:45     Chronic diseases are the leading cause of death and disability in the United States, accounting for seven in 10 deaths.

32:00     The opportunity costs in our society due to the high spending on ineffective care models for managing chronic disease.

33:00     Dr. Nelson explains the function of care management, how it is not reimbursement in FFS, and the variability in patient outcomes between different programs.

34:00     Taking advantage of what we know about patient behavior change to impact clinical outcomes.

35:00     The importance of the human relationship between patients and their care teams and how technology interventions can further enhance patient activation.

36:30     Dr. Nelson provides an overview of Remote Patient Monitoring (RPM) and its two forms (remote physiologic monitoring, remote person monitoring)

38:00     Telemedicine can do a lot to alleviate the relative misdistribution of providers and bring healthcare to rural areas of the country and areas that are less resourced.

39:00     14 million homes in urban settings and 4 million homes in rural communities lack broadband access (and 75% of them are people of color).

40:00     50 million adults experience mental illness (and 56% are not getting adequate treatment)

40:15     How Amwell is partnering with healthcare providers to ensure access to virtual care in underserved and rural communities.

41:30     “The emergency room is the worst place in the world for people with mental health issues – it actually exacerbates their condition.”

42:30     Telemedicine enablement in the behavioral health setting and how it empowers the workforce.

44:30     Between 2000 and 2019, the portion of beneficiaries seeing five or more physicians annually increased from 18 to 30%, and the mean annual number of specialist visits increased by 20%.

46:00     The shortage and poor distribution of specialists and how telehealth presents and opportunity to make specialty care more responsive to patient care needs.

48:00     Specialist access challenges for Medicaid patients and the lack of PCP/SCP coordination in the traditional “brick and mortar” care model.

49:00     Referencing the Penn State hybrid cardiac rehab program

50:45     The passage of H.R. 4040 (the Advancing Telehealth Beyond COVID-19 Act) to extend vital telehealth flexibilities enacted during the COVID-19 pandemic

51:30     “You can’t put the genie back in the bottle.  Telehealth is here to stay.”

52:00     The need for sound policy and the importance of leadership in hardwiring education in telehealth to drive clinical transformation.

52:00     Prior experiences where physicians have been burned by technology advancement and why we can’t repeat history in scaling tele-driven models of care.

53:30     Patients overwhelmingly want to preserve telemedicine in the healthcare industry.

55:00     As care becomes more virtualized and procedures shift more and more into the ambulatory setting, the “hospital of the future” will be asset-light.

56:00     Health systems often see telehealth as a major competitor—82% of health systems surveyed reported that telehealth companies like Teladoc or Amwell are competitors.

57:00     Dr. Nelson describes the opportunity for traditional healthcare systems and health plans to partner with virtual care enablers to improve care delivery.

57:45     Referencing the work of Barbara Starfield and how virtual care delivery can realize the potential of advanced primary care.

59:00     Supporting health systems with workflow adoption of telehealth and urgent care solutions.

60:00     Referencing the electronic intensive care (eICU) model at Advocate Aurora as an example of asset-light care delivery that improves sepsis management

62:00     Hospital-at-home care models as a future trend.

63:30     Telehealth can minimize hospital-acquired infections by keeping people out of the facility.

65:00     Dr. Nelson provides her parting thoughts on how value-based care will serve as a catalyst to drive digital transformation for the future of healthcare delivery in our country.