Why Memorial Hermann Is Expanding a Cancer Care Partnership
Texas-based Memorial Hermann Health System is expanding its relationship with Reimagine Care, which offers patients access to a team of clinical oncology specialists via text, phone and video to address symptom concerns and side effects of therapy. Memorial Hermann and Reimagine Care executives recently discussed the expanded partnership with Healthcare Innovation.
Sandy Miller, R.N., is vice president of the oncology service line at Memorial Hermann, which has eight accredited cancer hospitals in the Houston area and sees about 14,000 new cancer patients each year. Dan Nardi is CEO of Reimagine Care, which supports patients during their cancer treatment while they're outside of the four walls of the clinic with a suite of services.
Healthcare Innovation: First, could I ask about Reimagine Care’s business model? Do you participate in some kind of shared savings with the health systems, or do you bill directly for your services that occur outside the walls of the health system?
Nardi: Our current model is more of a subscription model. We'll help support, a certain number of patients for a flat rate. Patients come on to treatment and then transition off, some in only a couple months, some longer. There is a concept of an open number of seats that we are able to support with the work we do, and because we're charting right in the EMR, right alongside Sandy's team, a lot of that work we're able to do then helps drive their ability to code for it, whether that’s the new navigation codes, whether it be the CCM, PCM, the new SDOH codes, telehealth visits. Each of our clients has the opportunity to bill for those codes, if they choose.
HCI: Sandy, could you talk about some of the issues that Memorial Hermann's oncology service line sees with patient engagement outside the four walls of the clinic that the Reimagine Care service helps with?
Miller: Reimagine Care delivers real-time at home support for patients who are experiencing either symptoms of their disease or side effects of their treatment. There are multiple ways the patient can engage with Reimagine Care, and also Reimagine Care is proactive in monitoring patients and communicating with patients. For example, I'll give you a patient story: A 27-year-old woman with a serious sarcoma, undergoing very aggressive therapy. Young person, lots of stress, lots of concerns, lots of worries, both physically, mentally, emotionally and financially. The patient herself wanted to avoid hospitalization, if at all possible, to ensure her financial health could remain strong. The nurses from Reimagine Care monitored her at home hourly, provided her guidance and education about how to utilize her prescribed medicine, continue to assess her, to see that she was remaining stable and or whether or not she would need to, in fact, go to a hospital or emergency room. The woman was supported over a period of about three days with all of the care that she needed via telehealth and telephone, and was able to be supported through that care journey when she really wasn't feeling well and was experiencing significant side effects from her treatment, and so she was ecstatic at still feeling safe and secure and supported and getting great care while she was in her home.
From the hospital side, that patient would have been in and out of the clinic, probably daily, or be calling her provider clinic four or five times a day. And you know, in the milieu of a very busy clinic, it might be an hour or two hours before a patient would get a call back. So the difference is that she gets very timely attention and coaching and support to be able to take really good care of herself at home.
HCI: Does this also take part of the load off of your staff in the clinic of having to respond in a timely fashion to those questions, as well as deal with the people who are right in front of them?
Miller: Yes, it certainly helps with those callbacks that sometimes can pile up for the doctor and for the nurse at the cancer center. It also creates capacity in the clinic so that patients who are newly diagnosed or waiting to be seen can actually get on the schedule sooner and get in to be seen sooner.
HCI: Dan mentioned the Reimagine Care folks were charting right in the same EHR with your staff. Was that something that you had to think through the workflows on and get approval for?
Miller: I think we learned from Reimagine Care that they were able to do that with other institutions, and we pursued that internally to ensure that we were allowed to do the same thing. In fact, we were. So really it's an extension of our clinic, if you will. And our patients see it as an extension of our clinic. It's like we have this magnificent, contracted extension of our clinic. So they're integrated in our EMR. They're integrated with our providers and our other staff, and their work is visible to the providers and the clinic staff. They have connectivity with the treating physicians in case anything needs to be escalated to a physician, so they're very much an integrated part of our team.
HCI: Did you have it for an initial period during which you wanted to look at certain figures to measure the impact and decide it was worth it to expand the program, and are there some patient engagement or patient satisfaction measures you looked at?
Miller: We are very concerned about the patient experience. The Net Promoter Score for these patients has been 85 or better. Patients love it. They are very satisfied with the care, and they're telling us that in their surveys.
HCI: Do you track like the number of issues that were able to be resolved by Reimagine without having to escalate to the clinic?
Nardi: It's between 86% and 87% depending on the the month, with thousands of interactions collectively and across our entire book of business. That’s the the percentage that we and our team are able to fully resolve, either through our AI virtual assistant, or through our care team as well.
HCI: Did Memorial Hermann pilot this in one of its hospitals or clinics, and is now expanding it system-wide?
Miller: We piloted it in one of our clinics with just one of our providers. We are currently going to expand it in our largest facility. We’re going to have probably 12 medical oncologists who will participate, and we'll be expanding it to our radiation oncology patients as well.
HCI: Do the oncologists have questions for you about how this is going to work? Are some of them skeptical of it at first or are they all eager to try it?
Miller: I would say that the majority of them are eager to try it, and certainly, once a patient or two has participated, they are convinced of the value and the benefit of this for their patients. We also have one or two that are a little reluctant and not quite as sure, but with ongoing communication, education and the evaluation and feedback from their peers, they're seeing the value of it. We want to respect their process and their outlook, but we continue to work with providers and provide updates and education to all providers. I fully anticipate that as we expand our enrollment, we will have all the providers participating.
HCI: Dan, does the company have experience working with other cancer centers?
Nardi: Yes. Some of our earliest clients included the University of Colorado. We actually did a feasibility clinical study with them. We also are currently live with City of Hope, and then some community practices as well. We have some additional ones that have signed and will be announced in the coming months as well. Our clients span everything from large, comprehensive cancer centers to health system community practices.
HCI: Is there any challenge for you in scaling the company up as you get more clients? Is hiring to keep up with the pace difficult?
Nardi: There's obviously a growing shortage in the clinical workforce. We know that there are a lot of nurses and clinicians that have chosen to leave the workforce over the last couple years, and that is predicted to only increase in the coming years. But I see a little bit of an interesting phenomenon. When we post a position for one of our virtual care teams, we have hundreds of qualified candidates that apply within a week or two. What we're seeing is that there are a lot of very talented clinicians who want to still practice. They're just burnt out of being in clinic sometimes, but they want to work in virtual settings like this.
Obviously, in growing a business, especially the rapid growth that we're experiencing, there are always some hurdles, and you want to make sure that you're bringing the right people in at the right times. But so far, we've been very lucky in how we've been able to scale the team. We are an entirely remote workforce. And as we scale up with certain organizations, we're actually looking to hire a clinical lead that would be in the Houston area. So as we have great partnerships like Memorial Hermann. We might put someone in that geography to help make sure that we build those strong relationships.
HCI: Are there value-based care models, like the Enhancing Oncology Model (EOM), that might play into what you're doing?
Nardi: Absolutely. There are like six core requirements for for EOM. With our program as it's being implemented right now, we're able to very easily check the box on four of those six and five without a whole lot of extra work. So we do help support those clients that are in EOM or want to be getting into it.
