EPISODE TEASER / Anshu Abhat (guest): [caption id="attachment_25853" align="alignleft" width="215"]
Dr. Anshu Abhat[/caption]
We are bringing the navigators in to be able to fill that gap and to not only enroll our patients, because a lot of folks are engaged in enrolling patients, but actually for our patients to build the skills to feel confident to use the tool.
So, it's not just the enrollment. It's also the utilization. And that's truly where we think we'll get sustainability, and we'll get more impact. So, if our patients can also come back and talk to that navigator, "Oh, I tried to join my video visit, but I couldn't figure it out. Can you help me?" That's the type of relationship building that we want to do in the clinic so that our patients have real true navigation resources, not just a one-off around enrollment.
Jessica Ortiz (CCI, host):
Hello, everyone. I'm Jessica Ortiz with the Center for Care Innovations. Today, we're talking about one of the exciting projects that Los Angeles Department of Health Services has been developing for several years and has launched about a month ago. Our hope is that by sharing the highs and lows of this solution, safety net organizations can apply the lessons learned to their own challenges. I'm here with Dr. Anshu Abhat and Mayra Ramirez, two members of our Tech Hub learning network, which is a community of 14 tech-forward, California-based community health centers, clinic coalitions, and primary care departments and county health systems that are working to accelerate the adoption of innovative technology. We partner with our hub members to vet, pilot, evaluate, and spread innovative digital health solutions, targeting Medicaid markets and historically under invested communities.
Jessica Ortiz:
We're happy to have you both today. Would you introduce yourselves to our listeners, starting with you, Dr. Abhat?
Anshu Abhat (guest):
Yes, absolutely. So, my name is Anshu Abhat. I am a primary care doctor at Harbor-UCLA and the Director of Patient Engagement in the Office of Patient Access here at Los Angeles County Department of Health Services. And just to tell you a little bit about us as an organization, we care for over half a million patients in Los Angeles County. We have four hospitals and 25 multi-specialty clinics. We cover from the High Desert down to Long Beach. So, we know Los Angeles is a large place, and we serve a lot of different patients here within Los Angeles County, primarily vulnerable populations and those on Medi-Cal.
Jessica Ortiz:
Great, we're happy to have you. And Mayra?
Mayra Ramirez (guest):
Hi everyone. My name is Mayra Ramirez, and I am a Staff Analyst Program Manager for the Office of Patient Access with the Patient Engagement Program. And I assist Dr. Abhat in the different projects, specifically the Health Tech Navigators program that we launched a month ago.
Jessica Ortiz:
So, tell us more about your program. Where did you get started?
Anshu Abhat:
So, I think, as we know, in the time of COVID, and also before COVID, we've all been working on Patient Portal and trying to get our patients plugged into Patient Portal and get access to their health information, appointments, and other features that are available on Patient Portal. And we began this work, as many did, around 2015 when we launched our new electronic health record and as meaningful use came into effect through the federal government. And I think that was a lot of organizations' first experience with Patient Portal. But what we found in that time is that a lot of our patients in the safety net were asking for more navigation. So, the tool itself was useful when we did demonstrated it. But as we tried to work with our clerks and nurses, providers, staff, everyone was very, very busy seeing patients, taking care of patients, and often, it was difficult to have that additional time to really help patients understand "What's the value for me? How does this improve my care? How can I access my care 24/7?"
Anshu Abhat:
And it's a very, very different model than 20 years ago in a county health system. A lot of things have changed. A lot of access has changed. So, we began to understand that there was really this need for enhanced navigation, and our patients were continually asking for more and more in-person help to get familiar with the tools and to get confident with the tools. So, that was our initial thoughts about, "Hmm, we have this technology tool. It is useful. It's very useful for those who use it, but a lot of our patients don't feel confident and comfortable to access it."
Jessica Ortiz:
And what was the process like in planning for this program? And thinking about technology broadly, we at CCI suggest the framework of making sure there's a mission fit, operational fit, sustainability. This might be a little bit different with the program that you were thinking about, but what was your framework and process for making this decision?
Anshu Abhat:
Yeah, so we have now about six years of experience with Patient Portal, and the mission fit and operational fit were a little bit more clear. I think mission fit was pretty easy. We wanted our patients to be able to access their information and their care teams very easily online and really avoid having to come into the hospital or the clinic for things that were not necessary. A lot of that is accessing my lab results, accessing my radiology results, reading my doctor's notes. So, that mission fit was clear. One thing to support the mission was our work around OpenNotes. So, we were a very early adopter of OpenNotes, the largest county health system to adopt OpenNotes in 2018. And the reason we did that is because we wanted that information to be accessible to our patients. We wanted there to be more transparency and accessibility for our patients to read their notes online.
Anshu Abhat:
On the operational side, I think that's something that we continue to work on, but we know that as our patients can do more around self-service and spend more time getting to know their health information, they come back with very good questions. They come back very engaged in their care. I have patients who come and ask me about their diabetes numbers that they have already reviewed online. So, this level of engagement and activation has really changed, even in the operational sense. There's always things to work on around operations. One in particular, I know, a lot of safety net organizations are working on is messaging. "How do I handle the volume of messaging or requests that are coming in?" But it does fit with the direction of where we want to go operationally. Then, sustainability is the hardest part. And that's the piece where we have been trying to focus more and more and where I think this navigator program became a clear necessity.
Anshu Abhat:
So, how do we have our patients have the resources they need to feel confident in using these digital tools? A lot of our patients tell us, "I don't feel that comfortable. I don't feel confident. I'd like to build skills, but can you do it with me in person?" And the reality is, our clerks and nurses and providers are very busy in the clinic, a 30-minute session on navigating the Patient Portal was just not something that was really sustainable for our staff. So, we are bringing the navigators in to be able to fill that gap and to not only enroll our patients, because a lot of folks are engaged in enrolling patients, but actually for our patients to build the skills to feel confident to use the tool.
Anshu Abhat:
So, it's not just the enrollment. It's also the utilization. And that's truly where we think we'll get sustainability, and we'll get more impact. So, if our patients can also come back and talk to that navigator, "Oh, I tried to join my video visit, but I couldn't figure it out. Can you help me?" That's the type of relationship building that we want to do in the clinic so that our patients have real true navigation resources, not just a one-off around enrollment.
Jessica Ortiz:
And a follow-up question to your navigators. Do they have a panel of patients that they typically support, and if they do, how many patients can one navigator support?
Anshu Abhat:
So, our navigator model is not as focused right now yet on the longitudinal support of patients formally. So, if you think about other community health worker programs, you might say a community health worker can have 20 patients that they're engaging with at any given time or some particular panel or rotating panel. Our navigators in this case are actually working with patients in the waiting room and also with the clinical teams to be able to do the initial piece around helping the patient get comfortable to enroll, but then also being able to help with additional features, making sure they can navigate the Patient Portal. So, we are in the realm of community health workers, but I think that the Health Tech Navigator is a little bit of a different role.
Anshu Abhat:
Over time, I hope that we can develop more longitudinal relationships, and we're actually exploring some opportunities for that right now. Could we add a Health Tech Navigator into chronic disease management so that it's not just the initial feature of the portal? Of course, getting enrolled, being able to use it for the majority of tasks, but, "Can I submit my blood pressure to my provider on the portal?” Or, “Can I review my A1C and come prepared to my provider visit to talk about my diabetes?" That, I think, is the direction we'd like to move in over time. But right now, the navigators are really trying to approach a large amount of patients. And we think that each month they will interact with several hundred patients.
Jessica Ortiz:
And have you developed a process or a measurement tool to find out where the patient might be on their digital journey and where they might need this navigator support?
Anshu Abhat:
That is a great question. And it's a question, actually, I get asked a lot. We had done an initial study, using the eHEAL survey. So, an electronic health literacy survey, but it's quite a long survey. So, if you're approaching one person to talk to them individually, you can't really go through a 20-question survey. So, we're still in the process of figuring that out and actually curious if you have any resources that you have been hearing about on this great podcast that others are using. I know we've had some discussions within the CCI Hubs group. We haven't landed on a particular model. Sometimes, we have a couple of questions that we ask, but we don't have a formal model that we've been using for quick assessment of both health literacy, electronic, or digital health literacy.
Jessica Ortiz:
And Mayra. Do you have something to add?
Mayra Ramirez:
Yeah. So, prior to even, I think, launching this program, there has been a lot of research in terms of the digital divide among Americans. And so the PW research center, they did a survey as to how many patients in our county use smartphones. And results do show that lower-income Americans have lower levels of technology adoption. And so, we have used research done by other entities to influence and to create impact in our program. And so, though we don't have something developed, there are a lot of tools already informing our systems.
Anshu Abhat:
And I think that's a point that Mayra's bringing up. So, we certainly understand some of the trends. I think that's what's influenced us a lot. And I think what Mayra mentioning is that we see trends across income groups in some of these national surveys that have been done. And we see, also, the trend that I think a lot of us know well in the work that we do around smartphone dependence. So, we know that our patients are typically more likely to depend on their smartphones for internet access versus cable internet, which typically, it's very, very, very expensive. And therefore, that's also been a big part of our design.
Anshu Abhat:
So, a lot of the way that we assess and that we design is around mobile because we know 80% of our patients actually access on mobile. And if we talk to the neighboring health systems here in Los Angeles, that's actually very different than the neighboring health systems. That may be changing a little now because mobile apps have become more advanced, and more people are accessing their Patient Portals or other apps like video visits through their phone. But we have always had more smartphone dependence than our neighbors.
Jessica Ortiz:
And how difficult or easy is it to support multiple languages?
Mayra Ramirez:
We are really intentional about how we deliver services to our patients. And we do have access to a multitude of language translation services through our call center. And so, right now, all of our patients, no matter what language they speak are getting serviced in this, in getting information about the portal. It's super easy to connect to our translation services that the county has actually put a lot of attention to in the last recent months. And so, we are proud to say that we're probably one of the few entities that does try to do a very holistic approach to patients, not only from listening to patients' needs, but also catering to the language gap that exists often in healthcare settings. And so, even in person, once our staff is providing these services to patients on site, they also have access to this call center. And so, our approach has been that if a patient needs an Armenian translator, a Chinese translator, we can access this service really fairly quickly. So, that has been going on, and it's been working really well, as well, so far.
Anshu Abhat:
And one piece I think to add on to the language side is we do have our Patient Portal fully available in Spanish. And one thing that we've tried to work concertedly with our electronic health record vendor on is that that portal is truly the same as the English portal. And there's still, I would say, challenges around that, but we want our patients to be able to access their portal and language. Now, right now, we support English and Spanish, and we would need some technology improvement to be able to support other languages. And for us, those languages would likely be Armenian and Mandarin Cantonese, but we have made a lot of progress, I think, on our Spanish portal, but continually need to improve that and do testing around that.
Anshu Abhat:
So, that's been one of the great boons of the program, the Health Tech Navigators, is that a lot of our program staff are bilingual. And so, even this morning, we were in troubleshooting around a link that was going out in the Spanish email. And so, sometimes that attention to detail can really help inform our vendor that might not have as many Spanish speaking patients or folks to test products to be able to send that feedback back and hopefully improve it for everyone who uses some of these services nationally.
Jessica Ortiz:
And how have you involved your EHR vendor in your vision? How much of that is kind of a partnership and how much of that is work that you have to do on your own?
Anshu Abhat:
So, we are in a county health system. And so, one of our challenges... If I had my menu of options, I would have a whole developer team that would create the solutions exactly of what we need, but that's very hard to do. And especially in these public health settings. So, we have to work with our vendor quite a bit and work with our vendor to take on some new products and new solutions. So, I will say, and they know this very candidly, as well, that there's a long way to go on the vendor side in understanding our patients and understanding our language diversity. And so, that's something that we continue to try to work on together, but really, I really think that it's an opportunity for co-design from the get-go with our patients and community members and those that are limited English proficient.
Anshu Abhat:
So, I do think that's a gap in a lot of the technology that's being created is that co-design is often not happening. So yes, that's a big opportunity. It's something we continue to work on with them. Of course, there are certain needs that we have that we would like to be able to do a little differently, like self scheduling is one of those things, through our particular solution. But we just continue to work together and chip away at things and get the feedback of our patients. And I think that's the most useful is our patient experience, patient feedback, engaging our patient family advisory hub, and trying to bring that to our vendor to do testing from the get-go or co-design from the get-go.
Jessica Ortiz:
And to clarify for listeners, EHR is electronic health record.
Can you share a little bit more about your program, your Health Tech Navigator program? And we can start with you, Mayra.
Mayra Ramirez:
Our Health Tech Navigator program aims to enroll patients into our Patient Portal that has recently been renovated into what it is now. And prior to having our Health Tech Navigators, we were having staff in clinic and hospitals enroll patients, but like Dr. Abhat mentioned earlier, there's been some challenges with patients getting the full scope of what the portal is, understanding truly what they can access. And so, our Health Tech Navigator program came about the need to increase utilization of the portal and to increase the healthcare accessibility gap that exists within our community. Our navigators were selected based on skill sets, based on communication, adaptability, cultural humility, cultural competency. And so our program truly caters to our community's needs. And it's kind of a sense of for the community, by the community model. And the reason I say that for one, all of our tech navigators are coming from the communities that they serve, and they truly understand the needs that our patients are in dire need.
Mayra Ramirez:
And so, our program caters to that part of the healthcare need or the healthcare gap. In addition, our navigators are trained by me, Dr. Abhat, and our other tech leads to truly understand how the portal works in and out. We are innovating our ways of communication through phone calls, text messaging, emails, in-person services. So, this program is meant to increase all of our enrollments, but also it does more than just talking to patients. It truly caters to the needs and experience for the patient. And so, our goal is to not only enroll, but also make sure that patients are using the portal from now on. And our portal is truly very easy to navigate. We made it into a very patient user-friendly portal. So, we hope that the changes that Dr. Abhat has pushed through are truly making a difference in accessing information for the patients.
Jessica Ortiz:
And a follow-up question to that. If another organization wanted to follow in your footsteps, would you advise them to recruit from existing staff or go out into the community and recruit members of the community?
Mayra Ramirez:
When I joined Dr. Abhat's team, I came from another program that was called Whole Person Care. We had done a community engagement strategy to increase our services for reentry for folks who were exiting the system to reintegrate them into community. And so, when I came and I joined Dr Abhat's team, I knew that when this opportunity was presented, that the best way to recruit or to truly have engagement in our healthcare system for our patients was to recruit outside of the organization. For one, because our community health worker model, it encompasses a strategy to recruit from the community. And so we look for certain skill sets and for cultural competencies that make the community health worker a very special person that can truly engage patients. And though our staff are more than competent to engage patients, we truly feel that our navigator role cannot be fulfilled more perfectly than our community members.
Mayra Ramirez:
I am a social worker. So I feel like me and Dr. Abhat have a really good combination, her being a doctor, me being a social worker. I bring the community perspective of things, Dr. Abhat brings more like the data and the healthcare system needs. And so, when we both put our minds together, we were able to come up with the idea of recruiting community members that represent their communities. And though it wasn't easy to put it forward into the community, when we got applicants, we were looking for certain skill sets. And by certain skill sets, I mean someone who can speak the language, understands the patient needs, understands the barriers that exist within healthcare and the community, understands know how patient engagement can be complex due to our patient complex needs, and who is willing to put in the work to understand. And so, our staff, most of the time, is engaged in their own day-to-day jobs, and they do amazing jobs within the healthcare setting. So, we needed someone that didn't come from that so that they can be fully present for the patient.
Jessica Ortiz:
It's also just really wonderful to hear that the two of you make such a powerful team that complement each other so well. Yeah. Is there anything else that you'd like to share about the ins and outs of the program with listeners before we go into some of the top highlights and challenges?
Mayra Ramirez:
I want to share something before we move on to the other question. I want to just inform listeners that even though this program is not perfect because we are working through challenges and we're going to go into that more later, we do take pride in the fact that we are doing something different for patients. We're going on out of the norm, as to what the county can provide. And so, I'm so thankful and appreciative to Dr. Abhat for really pushing through this grant. And I'm so excited for what's to come and what can resolve from this. I think that just us putting this forward has been very revolutionary for our patients. We're showing the community that we truly care about their healthcare and their accessibility to healthcare. And I can't wait to see our patients be more involved in their care, hopefully increasing our patient health and communication. And so, more to come in the next few months.
Anshu Abhat:
Yeah. And I just want to add, we've seen a lot of different versions of navigator programs, and we have iterated a lot of different versions of navigator programs. So, I can tell you the number of volunteers, I have trained personally at my site, and we learned a lot from it, and a lot of that was the sustainability piece, but a lot of it was also the intention piece. And I think that's something I learned over time, but that I think it's truly very special with Mayra and her role and the experience that she comes in with as a community member, as a social worker, as someone who's very tied to the community. I think that's the secret sauce. I think that's what's different about this versus what I have seen in other places and programs.
Anshu Abhat:
Sometimes, people come at it from a tech lens. They say, "Let me hire some people onto the IT staff." And they will go around and they'll talk to patients because it might actually be easier to hire people that way. I think logistically it's easier, but I think that that lens that Mayra was talking about cultural humility and really being a member of the community, that's the success we are already seeing. We have a couple of navigators that just landed on site last week, and they're already... The numbers are amazing.
Anshu Abhat:
And, of course, I like the data, so I like to see the numbers. I like to see our enrollments, but more than that, the feel we will get with our patients over time of feeling supported and feeling supported in something that they don't feel as confident in. And I know that's where we will go with this. So, I totally agree with Mayra. There's just some sort of... Maybe it's a combination of our skill sets and forces and mission and drive, but the piece around community doesn't always come forth in technology adoption. And I think she's done a really excellent job of bringing that into the program.
Jessica Ortiz:
Yeah. This is incredibly exciting work that you all are doing and making something that, I think, for folks can be really intimidating sometimes with technology, having someone that is more relatable, more relational, to get through those next steps.
Mayra Ramirez:
Absolutely.
Jessica Ortiz:
So with that, what has been the top highlight so far? What is something you really want to shout out about the program?
Anshu Abhat:
Well, I would say for me, it's been a very joyful time to be able to see our navigators getting trained and starting to make their way to our clinical sites and something about it, it's a lot of young people who are bilingual, who are of the community, who really bring a tremendous energy that sometimes you don't feel in technology adoption. And so, I think that's just been a great joy for me to meet these team members. A lot of them will be doing a lot of different things in their careers. And so it's very exciting to meet them at this point in their careers. And they may be post education or they maybe thinking about a health profession or thinking about public health, thinking about social work. We get to have all these great conversations with these young minds who are really, really committed and dedicated to improving care in their communities.
Anshu Abhat:
So for me, that's been a tremendous highlight, the people part of things that I think sometimes we were really in the pandemic, is that human connection and getting to know each other and getting to know each other outside of our comfort zone. They're just a fantastic group that Mayra has recruited and hired. And so, it's been a joy already to work with them.
Mayra Ramirez:
Aside from us seeing already an increase in enrollments through our onsite staff and navigating the troubleshoot questions that do come up and providing that support, I think another highlight to recognize is the fact that we are a very tight group in terms of communication. So, our navigators are not going to have all the answers, and neither will I, but we are always able to communicate with one another and find out answers. So, it very does seem like our program is working because everyone is in sync and everyone is in communication with one another. In addition, all of our Health Tech Navigators are very tech savvy. So, they have even taught me and other people, other navigators, on how to even make things better.
Mayra Ramirez:
You know, we have one of them who came up with the idea of even giving patients their information through a card, and even though we don't want that to be the case, but he's just very innovative, creative. It's really, truly nice, and it feels so good to know that our staff is really going out of their way to make this work for the patient. So, that just goes to show that they're invested in the care of our patients and that this is beyond just enrollments, it's truly to bridge that gap. And so, that's something that I've ingrained in them when the training happened, reminders here and there.
Mayra Ramirez:
And I do want to highlight that I also am very big on self-care, so I do emphasize that on our Health Tech Navigators, that if they need to take a break from patient engagement because it can be overwhelming, to please do take that break. Come back strong. And so, I think that realization of taking care of yourself first and taking care of your needs has been working really well in them feeling motivated and continuing to put in a hundred percent in what they do.
Anshu Abhat:
And one other highlight, I know we have lots of things that we're excited about. It's been really fun, also because this workforce is very flexible. And so, trying new things is pretty easy, which is really fun. So, one thing we're even doing now, and Mayra and I are exploring with this group is bidirectional texting around Patient Portal support. And so, how do you better utilize when you have a patient on the phone? Let's say you try to enroll them, or they're in the clinic and they're going into the room to get their blood pressure checked, trying to create more of a relationship that might be through a bidirectional text, which might be more convenient for the patient or through other mechanisms.
Anshu Abhat:
And so, we have been wanting to explore these technologies for a while. We needed both the staff to be able to support it, and also a better understanding of the technology. And we are really figuring that out now. And so we've made some progress even today, which is very exciting, but it's been great to see how do we extend a relationship through technology, that in-person contact that you make in the waiting room, but there's just not enough time? How do you extend that? And our navigators are teaching us that as they're in the clinical spaces and they're coming up with ideas. And so, that's been a lot of fun to see and certainly a highlight.
Jessica Ortiz:
That's really exciting, lots of highlights here. Right? Really joyful, important work. And for folks that are thinking about maybe trying this approach and starting their own program, could you share with folks what your biggest challenges have been in getting this program started and implementing?
Anshu Abhat:
This program has been six years in vision. So, for anyone who feels like, "How will I get this up and running?" Do not feel bad. It will take time. That is okay. I think the hardest thing for us was probably around funding. Funding, I think, for everyone is a challenge, especially around something that is not as typical in the playbook, right? I think that primary care has really evolved and the support of primary care and the safety net, especially in the State of California, we're very, very, very fortunate. I recognize that, that we have behavioral health integration and that we continue to iterate on that model, that we have Care Managers, but we don't have as much of a framework around technology adoption. Though we know it fits into chronic disease management, it fits into mental health, that it is a key supporting tool to be able to have patients access care.
Anshu Abhat:
We don't really have a framework for it, so I would say, I think that creating that framework in your health system and getting some of that buy-in and bringing the funding along with it, I think that has been the biggest challenge, and that's why we tried to do so many different versions of this program before we landed where we are now. That work was informative. It was helpful. But at the same time, I think that impact will be much larger with this dedicated approach and intensive training and such. So I would say from a challenge perspective, just trying to get up and running from a logistic and finance perspective was my biggest challenge.
Jessica Ortiz:
And I know that you've been planning for this and iterating for a long time. I'm curious, how did COVID-19 factor into this program, and what was it like to innovate in the middle of a pandemic?
Anshu Abhat:
Yeah, so, you know, when you look nationally, a lot of Patient Portal numbers increased significantly during COVID as patients were trying to access care, but that number was less so in the safety net. And I think a lot of it is around navigation confidence, and that's not entirely true. I think there are a lot of safety net organizations that really were able to increase enrollment. You will notice some differences across vendors, actually, if you look at data, and I think that tells you a little bit about the friendliness of the product. One thing that we were able to do during COVID is say, "Look, we want to be able to deliver a better experience of our Patient Portal. We want to have our own organization app. We want a LA Health Services app, so it's much easier to find in the app store so that our patients know that it's us." It's a cleaner product.
Anshu Abhat:
And we want to deliver video visits through that app. So, we were able to use some of that momentum of what we learned during COVID. Look, access is number one. Access is king. How do we improve access in a situation where patients can't necessarily come in to the clinic to access services? So, of course, like everyone, we did phone visits and video visits, but there was a more defined need access point for other types of services, like getting your health information, checking your appointments, filling out forms, those types of things. So it just, I think, became much more obvious than when we were previously talking about it over the few years prior to the pandemic. So, that led to our virtual healthcare project. And that's where we were able to launch our new LA Health Portal, which we actually just launched on November 30th [2021].
Anshu Abhat:
And that, I think, is part of the alignment, also, with the navigators program. Sometimes you need something new to get people excited, and you need an enhancement to get people excited. And I think that our own app and improved interface and integrated video visits is a lot of good new things to get people excited and also to bring staff along and then bring the navigator support along. So, in some ways, we launched on November 30th, and we're kind of chasing, if you will, with our navigators so that we have a new product, but we're actually putting in-person support for our patients into the clinic.
Anshu Abhat:
And, of course, they're not just in-person support for patients. They're really a lot of in-person support for staff because we know during the year of COVID-19, and I think Mayra and I can both attest to this because we're both providers, I'm primary care and hospital and did a lot of hospital work this year. Mayra's a social worker. And we're both clinical in some capacity. And so, we understand burnout. And we understand that it's not fair to put on new technology and not actually provide staff support for understanding that technology. So, a lot of the motivation with our navigator is, yes, it's patient support, but it's also staff support.
Anshu Abhat:
It's also getting our staff confident in using these tools because our staff and patients are not always that different. Our staff don't feel good if they say, "I don't know what the portal looks like. If somebody asks me a question, I don't feel like I can answer that question." We don't want our staff to feel that way. We want them to feel like, "I've seen it. I know the tool. I have the test login. And if somebody asked me a question, I would be able to answer it. I'm more inclined to sell it or to promote it because I know what it is and I know how useful it is." So, that's also how COVID has woven into some of the work that we've done, but how we're trying to approach it with both patients and staff.
Jessica Ortiz:
All right. And as we wrap up here, any last advice that you have for folks that are thinking about implementing a similar program?
Mayra Ramirez:
I would say that in order to see changes in healthcare accessibility and increase utilization of systems and to truly cater to the population you serve, you need to try new things. Though they may seem hard to pull forward due to, obviously, funding and just what the process looks like to onboard folks, I would suggest you do just do it because a lot of great things can come up from new ideas. It's always a good challenge to push yourself beyond your borders or beyond what the boundaries that are set. And so it's not easy, but if you have a good team, anything is possible. Just alone, I think, Dr. Abhat and I have accomplished doing new things that we never thought or the county didn't think it was possible to do. And so, I think it's very exciting to do this for our patients. And yeah, I think it's 'do it, strategize.' Takes a lot of planning, but it takes one small step to get going.
Anshu Abhat:
I agree. I think with when it comes to technology adoption, especially with our patients, I agree. I think it's, “do it.” If you have the gut sense that you need more navigation, you need more navigation. If you think that's one of the barriers, it's not just the technology, but it is the confidence around it. I would say really lean into that and figure it out. Talk to your patient and talk to your patient family advisory council and really get to the core of it because it's an expectation in healthcare now, and it should be across all sectors. And I will say we have much more to work through in our setting, but we can work through it. So, I would say lean into it, figure it out, and try to get something started.
Anshu Abhat:
As far as the future, I think we really have the vision that we can provide a lot of services and a lot of access to our patients online or through the mechanisms that they are most comfortable with. So, yes. We're taught talking about a digital tool right now. We're talking about an app or something that's on a website, but part of why we want to do that is because we know some of our patients need high touch, and some of our patients need high tech. We were actually just having this discussion with the whole CalAIM, which is a new Medi-Cal waiver and enhanced care management. Typically, those patients need a lot of high touch. The high tech can supplement the high touch for the right patient, but as we get more of our patients having access, we'll say 50% of our patients have good access online, that starts to free up our phone lines for our patients who really need to call us.
Anshu Abhat:
It also frees up our care managers to be able to focus on patients that need things like more enhanced support. So, what we're trying to do is spread out the access in the ways that our patients want to access us, and that it's truly patient-centered. As a human being, I prefer to text rather than call a lot of the time. I can't right now text my health system about that appointment that I need changed. We want to be able to do that. We want to be able to deliver services that are truly human and patient-centered, where patients are stating their preferences, and that we are engaging in that manner.
Anshu Abhat:
So, that's the direction that we're trying to move in is really understanding our patient, understanding their individual needs or their family needs and supporting that so that healthcare is not as hard as it honestly is right now. We really want an “easy button” for healthcare. If you are trying to access care and become more healthy or modify your risk factors, it doesn't have to be really hard. It should be really easy. So, that's the direction that we're tough in public settings and tough in, sometimes, Medi-Cal settings, but we aim to get there, and I think we've made strides, so we'll continue on that mission.
Jessica Ortiz:
Great. Well, I know that we're all really excited to follow up on what you're doing now with this program and into the future. Thank you so much, Dr. Anshu Abhat and Mayra Ramirez for joining us, sharing your experience and expertise and your passion for taking care of the communities that you serve. We've been really grateful to have you.
Mayra Ramirez:
Thank you for having us.
Anshu Abhat:
Thank you. 