Dec 6, 2023
Changing the Way Care is Delivered through More Effective Virtual Health

Excerpts from a podcast interview with Jamie Hall and The Virtual Shift host Tom Foley.

Q. Tell us a little bit about the organization and what you're doing.

Sure, Tom, thanks for having me! CirrusMD is a virtual health organization. We've been around for over 10 years, and today we serve 10 million members across all 50 states. We're available 24/7/365, and we serve customers who are generally commercial, large self-insured employers and payers. We serve Medicaid populations through managed Medicaid, and it's our great privilege to serve around 5 million of our Veterans through our relationship with the VA.

Q. Tell us a little bit about the organization and what you're doing.

I’ll start with some context. What's really unique about CirrusMD is that we meet our patients via chat as the first mode of communication, and we meet them in under 60 seconds. Actually, Tom, on average it's about 15 seconds from the time that a patient says, ouch, that hurts, or that looks weird, to they’re connected with a real doctor. It's not a bot, it's not a triage tool. A real physician is texting back and saying, I'm here, how can I help you? We think first and foremost, that's really important. And second, we keep our encounter windows open for seven days. So there's no pressure on the physicians or on the patients to speed through an encounter, which I think creates a much deeper, much richer relationship. On average, our encounters are about 20 minutes, and pulling off the time constraints really helps a lot. And what it leads to is really effective, efficient, and empathetic care.

So what Physician-first Care & Guidance seeks to do is first leverage some of those key things that we do already today. 

First, we meet a patient at their moment of need. So we're all fathers or leaders or athletes or whatever it is that we are during our daily lives, however we think of ourselves. But we're not patients unless we absolutely have to be. It’s at the moment we turn ourselves into patients and say, Hey, we need help, that CirrusMD is there in seconds. We're not there in a week, two weeks, a month, two months later. We're there when the patient is most activated. 

Second, we meet that patient with a physician. It's not an RN, it's not a nonclinical navigator, it's not some sort of a triage tool. It's actually a doctor. And we know that doctors are the authority figure with the greatest amount of trust. So we're meeting that person who's highly activated with a doctor who's inherently trusted.

Next, we’ve built into our platform a way to surface risk, which may not be the chief complaint, the primary reason that a patient came onto the platform. So we're mining information we have on our platform to surface what else might be going on [to the CirrusMD physician conducting the encounter]. We know even though we have hundreds of thousands of patients coming through our virtual front door every day, we know that around half of them are pre-diabetic or living with type two diabetes, we know that half of them have an MSK issue that probably should be looked at clinically. We know that many of them are dealing with stress, anxiety and depression. So the question is: how do you find that and engage it in the patient’s treatment? We think this medium of chat first and foremost is great because there's a degree of anonymity

associated with it. By removing time constraints, it gives patients and doctors to talk a little bit more.

What's really driving here is our clinical intelligence engine, which is surfacing information associated with the patient and their risks, to the physician in context and within their workflow. Then the really unique thing we're doing is digging into that person at a member level, at their employer or their health plan level, and pulling up benefits that may be associated with that risk. So I may come in for a chest cold, but our clinical intelligence engine sees that I’m somebody living with type two diabetes, so our physician might say, Hey, Jamie, about your diabetes, how's that going? I might say, well, I'm struggling. And they might say, do you know your employer has a solution like Livongo, for example, that's available and free to you? I'm going to drop it into the chat. I'd love you to check it out and I'll check in with you a couple of days and see how that's going.

Q. How do you create the transition of care? How does that record follow that patient into that brick and mortar setting?

There are a number of different ways.  One is what everybody else does -- you can work with health systems and build pipes into their EHRs. I think that that's sort of a zero sum game because every one version of Epic is one version of Epic, so it’s very hard to do. 

What may be most helpful -- thinking back 10 years ago, when I was first looking at these health information exchanges, the promise was great, but the data wasn't there. Now they've sort of centralized down to five HIEs (health information exchanges), and we’re finding that almost every patient that comes through. We have diagnosis data on them, we have gaps in care data on them. We have labs associated with them. So because HIEs are pushing and pulling data from most of the big EHRs across the country, when we update a patient's record, it gets automatically updated into their EHR.

So that's a really elegant way of enabling patient data, where we don't have to build, instead everybody's contributing to the same centralized data warehouse, and I really like that model. 

But here's the other thing, again, think about the way that we're interacting with our patients. It's chat. So on the patient's smartphone, they have a word for word transcript of everything that's happened with that provider, and they have a summary at the end. This addresses another problem in healthcare. We listen to our doctors and then we walk out of the treatment room and then go, what the heck did they say -- ice it or heat it or ice? I don't know, I can't remember, but now, it's all right there. And so [a patient] can walk into any other point of care and say, here's exactly what happened when I talked to the physician at CirrusMD. So we're getting to a place where that sort of portability of a patient record is going to be much more frictionless. We're not totally there yet, but there are a couple of ways to skin it.

And of course we can't have a conversation without talking about AI or generative AI, but when we think about what do these tools do for us and the way that we want to deliver care, where it's always a human interaction, a physician and a patient, we can, with the same tooling we use to pluck out a benefit relevant to a patient’s health issue, we can also pull out the most salient information about a patient from their health record.  The thing about those health records is everything's there. I'm not a spring chicken anymore, so I've got a whole lifetime of health records. So what are the things that are important? Where are the gaps in my care that need to be closed?

So we can be smart about surfacing just what the physician needs,  just when they need it. As the doctor and patient are getting into a conversation flow, the doctor sees the most relevant information for that patient. Then it's up to the physician. We really believe in our own doctors. We pay them hourly, not fee for service, so there’s no rush to get through care. We’ve built it so doctors have exactly the information they need exactly when they need it, no more, no less. But then it's up to their skill, their training, their human empathy to decide is this appropriate for me to bring into the conversation with the patient or do I not?

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