Historically, structural friction—inflexible, arduous access barriers or steps—in the virtual care pre-visit pathway has been a significant deterrent for vulnerable people to rapidly access care. Three of the most common sources of friction are the technological and socioeconomic barriers to access, burdensome steps when enrolling for care, and stringent eligibility criteria that may prevent those who most need the service from accessing it. NYC H+H and Bluestream Health designed Virtual ExpressCare to overcome these challenges.
Virtual ExpressCare proactively addresses common historical barriers to patients accessing virtual care
NYC H+H had to reduce the structural barriers that prevented its patients from accessing the new service—otherwise the system would become disconnected from its targeted audience, vulnerable patients. NYC H+H tailored Virtual ExpressCare to remove five key access barriers in the following ways.
1. Limited smartphone access and digital literacy: NYC H+H’s vulnerable patients are often not able to use smartphones due to their cost and the IT literacy required to use them. Virtual ExpressCare is largely web-based, meaning patients with lower IT literacy can access it and patients don’t need to be able to afford a smartphone to use the service
2. Insufficient broadband access: NYC has a significant proportion of socioeconomically deprived residents, and 30% of all the city’s residents don’t have access to broadband. Virtual ExpressCare’s audio-only option means this patient cohort could still access the service.
3. Service siloed from key referral partners: Many of NYC H+H’s most vulnerable patients typically presented to the in-person ED via community partners including homeless shelters and 911. Virtual ExpressCare directly connects with these services, ensuring the most vulnerable patients can still access virtual urgent care when they need it.
4. Communication barriers: Approximately 25% of all NYC residents aren’t proficient in English. To continue equitably serving this cohort of patients, Virtual ExpressCare’s plug-in language services allow patients who are not proficient in English or are hard-of-hearing to get the same level of access to care as other patients.
5. Wait times: Predicting demand for a new service can be difficult. NYC H+H implemented Virtual ExpressCare initially at only one provider to learn about demand for the service and match staff accordingly. Then, NYC H+H expanded the service to all their providers and can now forecast demand and match supply accordingly. There is now a 2.5-minute average wait time for patients to access the service.
NYC H+H’s “wants versus needs” framework ensures minimal friction in the pre-visit workflow
Access to many virtual care platforms is limited by the amount of patient data the platform requires. This is a major problem for two reasons. First, patients are often uncomfortable sharing their information, especially as they are often unclear where the data will end up. This is particularly true for the most vulnerable patients in society. Second, asking for a lot of information before the virtual visit starts can make the service feel transactional—it loses the personal touch of in-person care. Essentially, forcing patients to share more data than you need risks pushing them away from the system and from the care they require.
NYC H+H assess what information was absolutely necessary—separating the “need to know” from the “nice to know”. They decided that the only pieces of data they needed from patients who accessed Virtual ExpressCare were the patient’s name, date of birth, and symptoms, as well as a phone number where the patient could be reached. Other details (address, email, Social Security number, etc.) weren’t vital to patient care, so patients didn’t have to provide them. Instead, these other pieces of information could be tracked down if they became necessary later. (See the Virtual ExpressCare access form in the Supporting artifacts section on page 17 of the PDF.)
By limiting unnecessary steps to accessing care, NYC H+H proactively limited friction between patients and the health system.
“‘Three clicks or less’ was our mantra. The value was getting someone in front of the patient as soon as possible, not mining the patients for their data…We are obsessed with experience in a way that’s no different than Amazon’s obsession with the customer.”
Sr. Director, Mobile Integrated Health
Virtual ExpressCare is the first urgent care platform in the US to not use ‘ability to pay’ as a defining eligibility criterion
In some jurisdictions, including the United States, many systems limit access to a service to only those patients who can pay for it. NYC H+H found when reviewing other urgent care models that it was common for uninsured patients or patients who could not afford out-of-pocket expenses, some of whom were the poorest residents in the city, to be denied access to these services.
Virtual ExpressCare goes against the U.S. industry standard by not looking at ability to pay as a defining factor for eligibility. Virtual ExpressCare does not ask for payment or insurance information up front as a gateway for patients to access care. Instead, the service deals with payment after the patient is treated by working with payers—including CMS—to reconcile outstanding bills. NYC H+H covers the cost of visits for which they are not paid. Not only did this prevent further widening of health and access disparities, but it made the Virtual ExpressCare care pathway more streamlined and seamless for the user.
NYC H+H didn’t stop there. As part of Virtual ExpressCare and to help their patients access affordable care, NYC H+H actively helps enroll patients who aren’t covered by insurance into appropriate payment plans. These health plans can be offered through a competitor or a public option such as NYC Care, or patients are enrolled into NYC H+H’s own low-cost health plan, MetroPlus.
This concierge-like service greatly improved patient’s experience of virtual urgent care. Patients who use these services feel like the system really cares for their health and financial security. This makes patients feel more engaged with their care and with the health system as a result.