Understand how we got here — and how to move forward.


Case Study

Creating an equitable virtual urgent care service

20 Minute Read


The challenge

Telehealth’s growing popularity is changing how a wide range of specialties deliver care, and health systems are rushing to launch telehealth services that promise to scale access while reducing costs. But systems continue to implement telehealth models that are disengaging, friction-filled, unfamiliar, and worst of all, inequitable. This suboptimal experience not only turns patients away from telehealth but also widens disparities in patient care.

The organization

New York City Health + Hospitals (NYC H+H) is the largest public health system in the United States, serving more than one million patients annually across New York City (NYC). It has 11 acute hospitals, 39 primary care practices, and 5 post-acute/long-term care facilities. Their health plan, MetroPlus, offers low-cost health insurance to over 500,000 patients.

The approach

In March 2020, NYC H+H launched its virtual urgent care service, Virtual ExpressCare, to provide virtual urgent care to patients while their ED’s were closed due to Covid-19. The service enhanced patient experience for all their patients and did so equitably, as it was built around those from the most vulnerable communities. NYC H+H accomplished this through three strategies: selecting a telehealth vendor whose offerings matched their patients’ needs; removing unnecessary steps at each stage of the pre-visit pathway; and structuring their staffing model so the new experience felt familiar.

The result

To date, Virtual ExpressCare has treated over 35,000 patients and holds a 95% patient satisfaction rating. The service improved access, with 20% of all treated patients being new patients to the system. Virtual ExpressCare prevented over 2,300 avoidable ambulance transports to hospitals. In addition, the service’s staffing model led to increased engagement and top-of-license practice.



How NYC H+H used patient experience tactics to create an equitable virtual urgent care service

In March 2020, the Covid-19 pandemic forced NYC H+H to close its busy EDs and find a way to continue treating urgent care cases virtually. Any solution had to maximize uptake from the patients it sought to serve. That meant using patient experience tactics to enhance access, engagement, and useability of the model, especially for the most vulnerable communities.


The three strategies

In just five days, NYC H+H formed a partnership with local tech vendor Bluestream Health to implement their new virtual urgent care model, Virtual ExpressCare. NYC H+H used three patience experience strategies to ensure their new virtual urgent care model was both equitable and patient-first.

  • Strategy

    Select a telehealth vendor whose offerings match your patients’ ’experience imperatives’

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  • Strategy

    Remove access friction at every stage of the pre-visit pathway

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  • Strategy

    Structure your staffing model to ensure the new experience feels familiar to patients

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How we know it’s working

Since Virtual ExpressCare’s rollout in March 2020, NYC H+H has seen over 35,000 patients through the service, including 2,400 redirected 911 encounters. The service has greatly improved access to the health system and continues to satisfy patients and staff.

  • 95%: Overall patient satisfaction rating for Virtual ExpressCare
  • 2,300: Unnecessary EMS transports prevented by Virtual ExpressCare, for savings of approximately $2.8 million
  • Five in six: Patients that were able to stay at home and avoid in-person urgent or ED care within seven days of their virtual appointment
  • 20%: Proportion of patients treated through Virtual ExpressCare who were new to NYC H+H

The successful rollout of Virtual ExpressCare has allowed NYC H+H to expand the service to incorporate behavioral health and substance use disorder treatment using the same telehealth vendor, staffing model, and equity pillars that Virtual ExpressCare uses. NYC H+H is also using the core elements of Virtual ExpressCare to expand the model into community kiosks. These are telehealth-enabled booths enabling walk-in access to Virtual ExpressCare across New York, specifically targeting vulnerable communities. NYC H+H plans to scale a hospital-at-home service by 2025 that uses the same staffing model as well as the same partnership with Bluestream Health.


Supporting artifacts

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