APP looks at life “post(ish)” COVID-19

In two short months, the global health crisis forced Asante Physician Partners to redesign the way it delivers care — from increasing the number of video visits to establishing on-site distancing measures and new clinic workflows. With the pandemic still a looming threat, APP is examining what the “new normal” will look like.

In a recent employee forum, APP leaders detailed what changes have taken place so far, and what may be in store in the future.
“We’re now in a world where we’re postish COVID,” said Jamie Grebosky, MD, chief medical and quality officer who oversees both inpatient and ambulatory care. “How do we continue to manage patients in this ongoing new state? How do we see patients? We don’t know what the world is going to hold for us, so we need to be flexible and responsive.”

Here are some of the forum’s highlights:

• Teams are preparing for a return to higher volumes. The number of visits plunged from more than 8,000 in the beginning of March to about 3,000 just three weeks later. Volumes have slowly climbed to nearly 6,000 visits by mid-May.
• Primary care clinics will continue to be proactive in reaching out to high-risk patients to ensure they’re receiving proper care so their conditions don’t worsen. At the height of the crisis, staff members checked in on thousands of these patients, which is credited for fewer Emergency Department visits by APP patients.
• Specialty clinics are working through wait lists to prioritize and schedule patients. This includes hospital-based specialties, which saw a decline in visits due to state restrictions on elective procedures. Gov. Brown has since lifted those restrictions with some conditions, allowing Asante to ramp back up.
• On-site urgent care visits also are expected to return to more normal levels. These dropped significantly when patients were directed to the video option as a safety precaution. Patients with COVID-19 symptoms still will be instructed to call the COVID hotline.
• Patient and employee safety remains a priority. Asante Infection Prevention is rounding in clinics and leaders are educating staff on physical distancing, donning and doffing masks, how many patients should be in a clinic at one time and how team work stations should be configured.
• APP is developing immunization clinics with a potential mobile option so that children will continue to receive timely vaccinations. Clinics saw a number of no-shows related to fears about COVID-19, so they want to offer these families an alternative to on-site visits.

Dr. Grebosky also updated employees on Asante’s COVID-19 testing capabilities. The system now uses three in-house testing platforms — one for high volumes and two other rapid tests for emergent cases. Asante does not offer in-house antibody testing, but it does have access to tests through Mayo Medical Labs. For health care workers, however, these antibody tests carry a major caveat. They can register false positives if the person has been infected with another type of human coronavirus, so they’re unreliable for determining which employees can work with patients.

“We don’t know if the antibody confers immunity or protection,” Dr. Grebosky said. “We don’t know for how long, to what degree or if at all. So it is uncertain what the clinical utility of antibody testing would be. From a public health perspective, however, antibody testing likely does have a role.”