At Hackensack Meridian, AI is supporting hybrid primary care

Primary care is in desperate need of a redesign in America, where rural hospital closures and the provider shortage are driving a dangerous lack of access to a much-needed service for nearly one-third of the population. Advanced technologies, like virtual care modalities, have helped healthcare provider organizations significantly expand primary care access. However, the overarching preference for in-person care persists, which means providers must integrate virtual and in-person services to create a hybrid model of care that meets patient needs.

Hackensack Meridian Health has turned to an artificial intelligence-based solution to establish this hybrid care model. Through a recent partnership with K Health, the Edison, N.J.-based health system aims to create a patient care journey that seamlessly moves between virtual and in-person services as needed.

According to Daniel Varga, MD, chief physician executive at Hackensack Meridian Health, the partnership resulted from the in-person care challenges posed by the COVID-19 pandemic, which hit New Jersey hard.

"What we found is right before the pandemic, we were doing zero virtual visits in our offices," Varga said in an interview. "By the time we were in the full-blown stages of the pandemic in early 2020, we were doing several thousand a day. And what we realized is there is a real market for it, but we didn't have the inherent skillset to execute against that."

Now, with K Health, Varga believes the health system has access to the skills and technology necessary to integrate AI-supported virtual care services to enhance primary care across its network of 18 hospitals. However, technology integration challenges must be addressed to create a successful hybrid care model.

Details of the AI-supported virtual care service

The partnership between Hackensack Meridian Health and K Health has two components, Varga explained. One is to operate a 24/7 virtual care service, and the other is a professional services agreement between K Health's doctors and the HMH medical group.

The first component involves the implementation of K Health's AI-driven virtual care platform.

"The idea of our AI is to learn from data," said Ran Shaul, co-founder and chief product officer of K Health, in an interview. "So, we train the AI on clinical data -- very different from training AI on scraping the web. The AI is being clinically validated and highly accurate."

The platform allows users to input information about their symptoms and then combines that information with data from the patient's EHR. The AI analyzes the combined data to give the primary care provider a detailed view of the patient's health history and how it may influence their current concerns.

According to Shaul, the EHR integration sets the platform apart from a run-of-the-mill symptom checker.

"[The physician is] not coming to a random environment; [they're] not typing something in [Chat]GPT and getting an answer," he said. "We know about you, we know your chronic condition, we know about your visit yesterday, we know whether you did or did not do that mammogram last year -- everything in one place. And we are able to facilitate a much more highly accurate, much more targeted medical chart we call it, as opposed to a symptom checker that is out there."

The second component brings K Health's virtual care physicians and the Hackensack Meridian Health medical group under one umbrella. Varga noted that the combined clinical team will have the same tax ID number, document in the same EHR, and present itself to the market as one entity. This will ensure care continuity between virtual and in-person settings.

One of the biggest challenges folks have when they see patients in the ED or get ready to discharge somebody from the hospital is a lot of these folks don't have a primary care doctor. And the [virtual service offers the] ability to immediately go into Epic and book a virtual appointment for a patient with 24/7 as they leave the hospital, as they leave the ED.

"If we have a patient who, at 2 o'clock in the morning, has concerns about a cough or fever, and they see the 24/7 [virtual] doctor, the next morning when I show up in the office, I have the 24/7 notes sitting right in front of me," Varga said. "I don't have to look for them, ask for them to be shipped in, get a fax or anything."

The service is available to all types of patients, from brand new patients to those who were discharged from inpatient care at Hackensack Meridian Health and require follow-ups.

Varga believes the service will help the health system increase the number of patients seen without increasing the clinician burden.

"We know that there's a demographic of patients out there who, by and large, would prefer to have virtual interactions in healthcare," Varga added. "And now we can say, well, you can do that with the HMH Medical group."

Strategies to support implementation

Implementing the AI-based virtual care service across an 18-hospital system is no easy lift. Varga highlighted the various strategies Hackensack Meridian Health employed to ensure a smooth deployment.

First, the health system provided consistent training to its 36,000 team members to ensure that each employee was familiar with the platform and the service's role in care delivery across the system. Second, Hackensack Meridian Health created a team to examine and enhance the relationship between the bricks-and-mortar medical group and the virtual medical group. Third, health system leaders focused on establishing a workflow that connected hospitals and 24/7 virtual care services to ensure care continuity.

"Because, as you probably know, one of the biggest challenges folks have when they see patients in the ED [emergency department] or get ready to discharge somebody from the hospital is a lot of these folks don't have a primary care doctor," Varga explained. "And the [virtual service offers the] ability to immediately go into Epic and book a virtual appointment for a patient with 24/7 as they leave the hospital, as they leave the ED."

Shaul echoed Varga, adding that the service "is going to be intertwined and sprinkled through the entire [Hackensack Meridian Health] ecosystem."

Further, the convenience afforded by the new virtual primary care service can help the health system break down barriers to care access. Shaul stated that the ability to schedule a virtual visit at any time of the day or night means patients do not have to take time off from work or travel long distances to see their physicians. The service also takes into account patients with limited English proficiency; specifically, patients will be able to interact with the platform in Spanish and request appointments with Spanish-speaking clinicians.

Additionally, Varga noted that allowing health system staff to connect patients with primary care if they do not have a usual source of care is another way the virtual service can help close care gaps. Primary care access is vital to boosting health equity because the number of Americans with a usual source of care has dropped 10% in the last 18 years, with Hispanic people, those with less than a high school education, and those who are uninsured being less likely than their counterparts to have a usual source of care.

Varga emphasized that Hackensack leaders are hopeful that the expanded access the new virtual primary care service can provide will enable the health system to achieve its goal of meeting patients where they are.

"The reason we have the number of sites of care we have, the reason we have the geographical spread, the capability diversity that we have is we strongly believe in meeting a patient where they are, meeting the community where they are," Varga said. "And if meeting them where they are in terms of preference and geography is through a virtual visit, then we want to meet them there. If it's within the No. 1 ranked hospital in New Jersey, that's where we meet them. If it's in a brick-and-mortar medical office, that's where we meet them."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.