Atlanta-based SCP Health is developing a model that embeds virtual care into emergency operations to improve efficiency and reduce delays. Ken Heinrich, M.D., chief medical officer for emergency medicine at SCP Health, recently spoke with Healthcare Innovation about why the integration of virtual care into emergency operations has such great potential. 

HCI: Dr. Heinrich, can you give a brief description of SCP Health?

Heinrich: Emergency medicine, hospital medicine and critical care are SCP Health’s key service lines. We partner with hospitals to manage those clinician groups and those departments. We now work with well over 300 emergency departments in 31 states. When we bring in hospital medicine and critical care, we're over 500 programs in 38 states.

HCI: Do they tend to be smaller or rural health systems or do you also work with bigger systems and academic medical centers? 

Heinrich: It is a mixture of both. We have everything from rural critical access hospitals all the way up to very large academic medical centers and high-acuity, urban, non-academic centers. I will say we have a higher proportion of underserved populations than most other people in the industry. That's something we don't shy away from. We're actually quite proud of the fact that we are partnering and supporting hospitals in those areas. And when I say underserved, it may be a rural healthcare designation or it may be underserved within an urban setting. 

HCI: Let’s talk about the idea of embedding virtual care into emergency operations. What are some of the challenges that the EDs face that this effort is aimed at?

Heinrich: As you're probably well aware, healthcare continues to have to find ways to innovate and even transform in order to become more cost-effective. Given the dynamics in our country, we are trying to make our healthcare dollar cover more people more effectively, and a part of that is really tied to efficiency. How do we deliver the highest quality care to all patients in a way that gets the care done in a timely fashion and in the most cost-effective way?

HCI: So is part of that increasing patient flow through the emergency department, and getting people to the right place in the system faster?

Heinrich: Yes, and it's also improving access to care in many situations. When we talk about flow and efficiency in the emergency department, I talk about capacity management. If we think about staffing in the emergency department, the number of hours of coverage for physicians and nurse practitioners relative to the volume, there is a capacity curve that happens based on patient arrivals. There are some times where we have not enough capacity. We need more clinicians for the volume. And there are other times where we have overcapacity. We have clinicians who are, quite frankly waiting for things to do. Those fluctuations in the capacity curve are efficiency killers on both extremes of the curve. We are looking at how to leverage technology to flatten that capacity curve.

HCI: Does that involve doing virtual triage and and adding virtual support when you have those big surges of patients?

Heinrich: Yes, absolutely. It's using telehealth in order to put in place a dedicated process and system where we have more virtual clinicians who can support multiple emergency departments, thereby flattening the capacity curve. It may be that we use a virtual clinician to support an emergency department during a surge. So rather than calling somebody into the ER in person and often waiting hours and hours until we find someone who can come in, we have someone who can remote in right away and help with that surge. We also looking at AI to improve capacity so that we can help decrease the administrative workload on the clinicians, so that they actually have more capacity to be at the bedside.

HCI: Have you built up a team of virtual emergency physicians and nurses who can fill these roles?

Heinrich: Yes, we have teams built. We're in the process of scaling. We’ve been developing this for the last several years. I think the pandemic was the catalyst. We had to lean into technology and especially telehealth during the pandemic. Coming out of the pandemic, we recognized how much we could do to improve emergency care in general, so we've been really developing and scaling that over the last few years.

HCI: Does the person on the virtual end need to have access to the EHR and communication system of the ED they are collaborating with?

Heinrich: Yes, the way we've been approaching it, it has to be integrated, so that everybody who's virtual is in the EHR, and they're able to see the tracking board, and work in combination with the on-site team to ensure that the highest quality care is delivered. So yes, EHR integration is essential, as well as the platform that they're using to communicate with the nurses and the docs in the ER. They have to be looped into that whole circle.

HCI: One of the things we hear people talk about in emergency medicine is patients needing a behavioral health or mental health consult in the emergency room. Is there a way to make that part of what's virtual, and have a psychiatrist on call to to handle those cases?

Heinrich: Absolutely, I would say that that there is a tremendous need right now for mental healthcare throughout our entire system, but especially in the emergency departments. All over the country there are instances where patients are boarding in EDs for days and days waiting for treatment. We have hospitals that are looking at behavioral health observation units within EDs and utilizing telepsychiatry in order to really guide that care.

HCI: Would SCP Health hire your own telepsychiatry specialist or would you partner with another company that already does that?

Heinrich: We would partner. We're very careful at SCP not to expand into other service lines too quickly. We don't want to stretch ourselves too thin. We focus on what we do well, but we're always looking for really good partners who can help us with other areas.

HCI: Are you looking to measure the impact of adding virtual care to the emergency department? Can you study the impact it has on throughput or avoiding unnecessary admissions?

Heinrich: That's what we are doing, and we've already seen some impact. We always do this in conjunction with our hospital partners. We don't ever establish an e-triage program or a tele-surge program alone. As an example, we work with Ballad Health, a regional hospital system in northeast Tennessee and southwest Virginia with 20 emergency departments. We've been doing a combination of both e-triage as well as tele-surge throughout Ballad, and we've actually seen that through our efforts, our “left without being seen” numbers have dropped tremendously. Our arrival-to-clinician time has dropped tremendously. Our efficiency in terms of of how many patients the clinicians are able to treat in a given period of time has improved. Our quality metrics at those sites have improved. So we are seeing meaningful differences, and we're rolling it out with other hospital partners right now.

HCI: Are other health systems with large numbers of EDs doing similar things in terms of focusing on virtual health to improve efficiencies or do you feel like what SCP Health is doing is pretty unique?

Heinrich: I would say both. I think a lot of hospitals are looking at telehealth to support what they're doing on site. In many cases, those are what I would call the standard — like tele-neurology to offer support for strokes. Tele-psychiatry is another example. But the way that we are incorporating telehealth as a standard in operations of the emergency department — there are some others that have been kind of playing around with it, but I think we are unique in how we are really leaning into that, how much we're investing in developing that technology and that innovation, and we’re really proud of that.

HCI: So today is Sept. 30, and kind of an interesting day to be discussing this, because there's this telehealth payment cliff we have just reached because Congress did not pass a law extending telehealth expansions. Is that a problem for SCP Health in this particular case?

Heinrich: I asked that question of our revenue cycle folks. I always rely on the experts to guide me. What they say is that because the patient is in the emergency department, and it does not involve direct care to a patient at home, this area of telehealth should be OK. And I say should be okay, because we never know until the dust settles. 

HCI: Is there anything else about this approach you're looking forward to fine-tuning or adding in the next year?

Heinrich: I'm pretty passionate about this. I'm going to share an observation with you that I have shared in conversations with other medical directors and emergency physicians. If we think about emergency medicine, the majority of the care that we provide as emergency physicians is cognitive, meaning it doesn't require someone to be in person with the patient. Most of what we're doing is thinking and then ordering interventions. So that cognitive care is where we can really leverage technology and virtual care. If you think about how we can really flatten the capacity curve by using virtual care, that creates the opportunity to transform how we deliver emergency care throughout the country. And that's what we're looking at as we continue along this pathway and this evolution of leveraging technology in emergency medicine.