The Chicago-based health system has utilized a range of technology to connect with patients and restructured case management, social work and physician advisors.
In recent years, UI Health has taken several steps to better serve underserved communities.
Health equity has emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 health disparities for several racial and ethnic groups that have been at higher risk of getting sick and experiencing relatively high mortality rates, including Black, Hispanic/Latino, American Indian, and Alaska Native communities.
At UI Health, serving underserved communities is a priority at the Chicago-based health system, says Rani Morrison, MS, MSW, chief diversity and community health equity officer. "With our payer mix, a lot of our patients could be considered underserved—we have nearly a 50% Medicaid payer mix. So, we have to be creative in how we connect with our patients."
UI Health is utilizing a range of technology to connect with patients, she says.
"Nearly five years ago, we partnered with CipherHealth and that is how we updated doing post-discharge calls. We were doing manual calls to our patients after discharge to make sure that they understood their discharge instructions and hopefully reduce readmissions. We switched to an automated system with CipherHealth, which increased our reach rate to our patients and allowed us to have different options to reach patients. We can reach them in the language that they prefer. We can reach more people. We can reach them at different times of day. If there is a problem or an issue that is identified, we make a call with a nurse within hours to problem-solve. That is a way that we have leveraged technology to work with our patients who may not have the full range of technology or be sophisticated with the patient portal."
A new patient portal has also boosted contact with patients, Morrison says. "We switched to Epic as our electronic health record 15 months ago, and we have been proud that we have had a high level of adoption of our patient portal. We have been able to do things like send reminders to patients through the patient portal. We can take payments through the patient portal. We were able to leverage the portal heavily for coronavirus vaccines when we did our mass vaccination clinic last winter and spring."
In addition, UI Health is utilizing "soft technology" to connect with patients, she says. "You can call our call center, which we also used for our mass vaccination clinic. We did reverse calling for those who did not have the Internet and could not navigate the patient portal. We try to do a balance of outreach because we know that not all of our patients are similarly situated."
Restructuring case management
In March 2020, UI Health initiated a restructuring of case management from a dyad model to a triad model, Morrison says. Under the dyad model, a team of nurses managed both the discharge planning and the utilization review function for patients. Under the triad model, the nurses have split responsibility with a team of nurses that just does utilization review, a team of nurses that just does discharge planning, and social workers who focus on psycho-social needs and discharge planning specific to skilled nursing facilities and sub-acute rehab.
Effective case management is crucial to serving underserved communities, she says.
"The great thing about case management is that it is truly designed to serve underserved communities because case management is about holistic care. We are supposed to be assessing the patient, their environment, their supports, and what they are going to need to successfully transition from the hospital setting to whatever the next appropriate setting is. When case management is done properly, it is supposed to evaluate the people who have the least amount of resources to make sure that they can go to the most supportive environment. Case management is well-suited for those who are underserved or do not have as many resources as other patients."
The educational role of case managers is pivotal for underserved communities, Morrison says. "Education is critical, particularly for the underserved because sometimes their understanding and knowledge of the different post-acute care options may be less than other patients in terms of understanding the concepts of healthcare and health literacy. We must educate them to make sure they understand everything that we give them at discharge and their options. We want patients to be involved and engaged, so they feel they are part of the process no matter their resources and no matter their baseline health literacy."
Improving social work resources
At the same time that case management was revamped, UI Health improved inpatient and outpatient social work services, she says.
"We increased the social work complement during our restructuring effort. We drove down caseloads of the social workers on the inpatient side who are the counterparts of the nurse case managers. We also added some additional assessment tools that social workers have to better assess the psycho-social needs of patients. We have adopted some additional resources to give us information about different social service options so that social workers can access better referral information. So, if a patient needs mental health resources or substance use resources, we have more referral information and we have leveraged technology to provide referrals to the patients via text or in their discharge summary."
Revamping physician advisor program
UI Health has also improved the physician advisor program at the health system's hospital, Morrison says.
"We increased the number of physician advisors. We identified a new lead physician advisor, who was a member of the faculty. They have been able to leverage reporting and data so that they understand the trajectory of the patients. We gave the physician advisors new training to make sure everybody understood the ideal model. The physician advisors have increased their involvement—they are attending multidisciplinary rounds every day with the attending physicians, residents, case managers, social workers, physical therapists, and the nursing staff. They give feedback, ask questions, and give input into the progression of care for patients. They are also heavily involved in the utilization management committee to make sure that we are keeping an eye on the ball when it comes to our patients, how we are doing in terms of managing patients, and making sure that they understand our contracts, such as our Medicaid managed care contracts."
Physician advisors play a key role in helping to serve underserved communities, she says. "The physician advisors have been instrumental in pushing systemic changes around our patients and our patients' needs, which has been helpful to our underserved patients because the physician advisors can identify issues and take a step back to have a 360-degree view. They are also practicing physicians with inpatient and emergency department duties—they are seeing what is in front of them as attending physicians and can give feedback."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
UI Health has partnered with a technology company to automate post-discharge calls.
Effective case management is crucial to serving underserved communities.
Physician advisors have been instrumental in pushing systemic change that improves the care of underserved communities.