Penn Medicine OnDemand

A virtual primary care practice

Opportunity

Seeing a primary care physician (PCP) urgently isn't always easy, especially if the practice is not close to where you work, you work long hours that are not conducive to daytime appointments, or you're not an established patient. 

At the start of this project, one in five employees at Penn Medicine visited the emergency department (ED) each year, with a significant percentage of those visits qualifying as avoidable.

Self-insured employers like Penn Medicine are interested in reducing avoidable ED visits. Directing employees to higher-value care can improve satisfaction and outcomes, decrease unnecessary utilization, and reduce benefits costs.

Intervention

Penn Medicine OnDemand (PMOD) is a fully scaled virtual telemedicine practice operated by Penn Medicine’s Center for Connected Care. Providers are available 24 hours a day, seven days a week, 365 days a year.

PMOD makes it easy for users to obtain care when they need it, regardless of physical location, using video visits. When an in-person, office-based appointment with a care provider is required, PMOD providers help users schedule an in-person appointment at a time and location that is convenient for them.

Impact

In its first two years serving the 60,000 covered lives under the Penn Medicine insurance plan, PMOD conducted more than 7,200 clinical encounters, saved the health system over $1.5 million in avoidable ED or urgent care visits, saved employees over $425,000 in copays, and substantially increased the number of employees establishing primary care within Penn Medicine.

On January 1, 2020, PMOD began offering service to the general public. 

COVID-19

PMOD is a critical tool used by Penn Medicine to keep patients and providers safe during the COVID-19 pandemic. At the outset of the pandemic, the team adapted in real-time to handle the increased volume - with daily calls skyrocketing from 50-60 to more than 400. Individuals who feel their symptoms are concerning for COVID-19 can use PMOD to obtain a virtual evaluation. Patients with upcoming appointments can participate in virtual visits with physicians or advanced practice providers on the platform.

Phase 3: How we work
Collaborators

Penn Medicine Center for Connected Care
Office of the Chief Medical Information Officer
The Wharton School

Innovation leads

Krisda Chaiyachati, MD, MPH, MSHP
Katy Mahraj, MSI
Christina O'Malley, MHA
David Asch, MD, MBA

Awards

UPHS Quality & Patient Safety Award, 2018
Milton W. Hamolsky Jr. Faculty Member Scientific Presentation Award Finalist, SGIM National Meeting

Innovation Methods

Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
 
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
 
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
 
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.
Fake back end
We launched and marketed a simple landing page offering Penn Medicine employees access to free virtual care and engaged a pool of clinical partners to triage appointments over three months. 
 
When requests came in, we manually routed phone calls to providers based on a preset schedule. 
 
Piloting the service as a fake back end helped us learn about demand, feasibility, and viability. It also enabled us to collect insights about user needs, behaviors, and what kind of staff would be needed to support a permanent service. 
 
Finally, findings from this pilot helped us secure executive support for PMOD and informed the design of the program at scale.
Vapor test
A vapor test offers a product or service that does not yet exist. Vapor tests will help you answer the question, "Does anyone want this?" and generate credible evidence for demand.
 
Vapor tests require carefully designed soft landings to protect against poor user experience. An example of a vapor test would be showing a product or service on a website to see how many people express interest by clicking on it.
 
In this case, a soft landing would involve showing an "out of stock" or "not accepting new clients at this time" message when users click on the offering. 
Vapor test
We ran a vapor test in the initial pilot to learn more about how people wanted to connect with care providers. Specifically, we wanted to test our hypothesis that patients would prefer video visits.
 
The pilot landing page offered Penn Medicine employees the option to call, video conference, or chat with providers. At the time, we were only equipped to treat patients over the phone. 
 
If a user requested a video conference or chat, a message popped up, notifying them that the service they selected was not yet available but that they could be connected immediately with a provider for a phone encounter.
 
During the pilot, 56 percent of patients chose the chat option compared to 26 percent for video and 18 percent for the phone call. 
 
However, follow-up surveys revealed that 67 percent of patients were satisfied with the phone encounter after speaking with a provider. 
 
During debriefs, pilot providers indicated that they felt that video visits would very rarely have changed treatment plans for patients. These insights helped the team discern what functionality was necessary for the program's first iteration at scale.

Commentary

Key lessons from rapidly scaling a virtual telemedicine practice

In piloting, developing, and scaling PMOD, we learned several key lessons:

  1. Most large health systems that are self-insured and manage their employee health benefits have an opportunity and motivation to improve health care value for their employees that may align with strategic visions for more general patient populations.
  2. Employers who are also health care providers can aim for value by directly providing clinical services.
  3. Innovation and design methods can be systematically applied to health care problems to guide decisions about solutions that should or should not be scaled.
  4. A virtual, on-demand urgent care service provided by a health care provider organization to its employees can reduce unnecessary ED visits and decrease the total cost of care.

In the context of the COVID-19 pandemic, PMOD prepared Penn Medicine to have the infrastructure, experience, and know-how for rapidly scaling virtual care services for all patients.