Providence Dr. Kenneth Kooser discusses how to to enhance patient care through remote patient monitoring
In a new episode of Cadence Conversations, Providence Family Practice Physician and Medical Director Dr. Kenneth Kooser joined Cadence Founder and CEO Chris Altchek to discuss how the health system is approaching new technology and innovation and why they are scaling up remote patient monitoring as part of their commitment to team-based care and providing the highest level of care to patients and communities.
Cadence and Providence recently announced a partnership to implement a remote patient monitoring and responsive virtual care program across Providence’s clinics. The program launched in June 2022 at two Washington clinics, St. Mary Cardiology and Lacey Family Medicine, and aims to support patients on their journey to better health through lifestyle modifications and guideline-based medication management. Early results are promising: thus far, with over 300 active patients, 89% are taking their vitals daily and Cadence is also reducing workload for clinicians. Cadence’s virtual care team is successfully managing and triaging patients, with only 0.2% of remote encounters escalating to Providence’s clinicians.
Dr. Kooser began the conversation by discussing Providence's mission of improving the health of both patients and communities and the health system's core promise of, "Know me, care for me, ease my way." He described how new technology has fit seamlessly into that vision, saying, "We're always trying to innovate and figure out new ways to deliver care." "There are not enough primary care physicians and clinicians to go around to take care of our population. And so we've really embraced team-based care models," Kooser shared.
According to Kooser, remote patient monitoring (RPM) is a natural extension of Providence's team-based care model, because it allows the health system to bring its team-based approach not just in the clinic, but also into patients' homes through remote care. "We have a pretty robust team-based care model and RPM was kind of a natural extension of that," he said. "We have patients that come to us from quite a distance. I have patients that drive two hours to come to see me. And so being able to ease those patients' way and allow them to access care without necessarily having to get in the car and drive two hours just to come see me, has been a draw for the RPM model as well."
While Dr. Kooser acknowledged that some physicians may be skeptical about team-based care or remote monitoring, for fear of giving up control over patients' care, he also noted from personal experience as a clinician, that the benefits far outweigh these types of concerns. "The trade off, I think, is that it allows us to take better care of patients and also to expand kind of a reach of the clinicians so that the clinician is not having to do everything. So I think the benefit isdefinitely there," he shared.
As far as remote patient monitoring and Providence's partnership with Cadence, Kooser shared that the partnership has proven successful thus far, producing great outcomes for patients while easing burden for physicians.
"Patients that we had difficulty getting their blood pressure under control for various reasons, using RPM has enabled us to reach some of those patients that were kind of slipping between the cracks before. It really hasn't added a significant administrative burden to the clinicians or the staff. Because the RPM model that we're using is pretty self-contained. It doesn't add any workload to us, but enables us to reach some of those patients better," he said.
For patients, according to Dr. Kooser, RPM has been beneficial because it allows for more frequent touch points with clinicians on a more regular basis. "I think from our patients' standpoint, those frequent touch points of being able to reach out and contact the patient on a regular basis and help them work through not just medication adjustments but also lifestyle management and lifestyle modification has been really, really helpful for them."
Meanwhile, for clinicians, Dr. Kooser said RPM is enabling providers to extend their practice and be able to do more to serve their patients, at a time when clinics are overburdened and lack bandwith to even accomplish their daily workload.
"It's honestly, it's stuff that we would like to do as a clinic practice, but things that we just don't have the bandwidth to do. We're not able to pick up the phone and call every patient, even though we'd really like to, just because we don't have the manpower or the bandwidth to be able to do so. And so RPM has enabled us to fill in that gap and contact those patients on a more regular basis. And I think the frequent touch points has really been a huge benefit to a lot of our patients," he said.
From that standpoint, remote monitoring has also eased some of the burden on clinicians. For example, Dr. Kooser discussed how RPM and the Cadence program has actually managed to reduce some of the messages coming into clinicians' in-baskets.
"The advantage is that those messages don't come to us as clinicians," he said. "In the long run, it'll actually be less messages that are coming to the primary care provider because the patients are asking those questions through the RPM. Those questions are not necessarily coming to the PCP anymore, they're going to the RPM team, which in the long run, I think, actually will help reduce the number of messages that we're getting."
The conversation wrapped up with Dr. Kooser discussing how RPM can help alleviate two of the most common issues that health systems are currently facing: clinician shortages as well as providing better tools for patients to be able to seamlessly communicate with their clinician. "RPM helps us expand the clinician reach, so that helps some with the clinician shortage, and then it hopefully will help unload some of those patient messages that are about the conditions that RPM is helping us manage," he shared.
Listen to the entire podcast above and to hear future episodes, be sure to subscribe to Cadence Conversations wherever you get your podcasts.
Previous episodes of Cadence Conversations include Ardent Health Services CEO Marty Bonick discussing healthcare innovation and the health system's partnership with Cadence, CEO of Community Health Systems Tim Hingtgen discussing how CHS approaches digital innovation in health, and Dr. David Shulkin, 9th Secretary, U.S. Department of Veteran Affairs, discussing the future of remote patient monitoring (RPM).
If you're interested in learning more information about Cadence and how to get involved, visit Cadence.care and please get in touch with our team.
Read the full transcript of the conversation below:
Introduction: Welcome to Cadence Conversations, where we're talking with prominent physicians, healthcare leaders, and tech entrepreneurs about their experiences driving innovation and progress. This week, Chris Altchek, founder and CEO of Cadence, had a chance to talk with Dr. Kenneth Kooser, a family medicine physician with Providence. The two talk about the critical importance of team-based care, the issues surrounding clinical acceptance of remote patient monitoring, and how to keep up with the ever-changing landscape of patient communications. So let's get to this week's Cadence Conversation.
Chris Altchek (CA): Dr. Kooser, thanks so much for joining me today and I'd love for you to start by introducing yourself and telling us a little bit about your background as a physician. Did you always know you wanted to practice medicine?
Dr. Kenneth Kooser (KK): I've been in practice for about 20 years now. I'm a family practice physician. I work for Providence. I think as far as knowing that I always wanted to be a physician, I actually was intrigued by engineering, teaching, and medicine, I think, is my three sort of branches that I was considering when I was going through undergrad. And I think the thing that really intrigued me about medicine was it enabled me to really kind of combine my interests in kind of the science and problem solving part of engineering along with the teaching and human aspect of being a teacher. So being a physician really helped me blend those two things. Being able to have that human connection, but also being able to work through complex problems and also being able to try to explain those complex problems to patients really kind of drove me into medicine and it's kind of what keeps me there as well.
How Providence Approaches Innovation and Technology to Deliver the Highest Quality Care to Patients
CA: And tell me a little bit about the role at Providence and what makes Providence a special place to be a physician?
KK: Providence is a really large organization, a seven state region that we cover, but it still has a very personal feel, which I really appreciate and enjoy. The mission really resonates with me — not just improving the health of the patient in front of us, but also Providence is focused on trying to improve health in communities and this, its vision of health for a better world. And then the Providence promise of, "Know me, care for me, ease my way" really resonates with me as well. And I think as a family practitioner in particular, that just being able to know your patient and figure out new ways to ease their way and connect with them, I think has been a real draw for Providence for me.
CA: And as you think about now the adoption of technology into that mission, what kinds of big programs have you been focused on?
KK: In my clinic, and in Providence in general, there is always a lot of projects and pilots and things going on. We're always trying to innovate and figure out new ways to deliver care. I think a big concern for a lot of organizations is there's just a shortage of clinicians. And in my area in particular, there are not enough primary care physicians and clinicians to go around to take care of our population. And so we've really embraced team-based care models. So having nurse care managers who help transition our patients from the hospital setting into the outpatient setting and help us with our complex case management, having pharmacists, the clinical pharmacists that work within our clinics to help us deliver care for chronic medical conditions, having diabetes educators.
So we have a pretty robust team-based care model and RPM was kind of a natural extension of that. Basically allowing us to take this kind of to the next level of taking team-based care, not just in the clinic, but also being able to do it remotely for patients in their own home. We also live in an area that's kind of on the border between sort of a small town plus rural areas. And so we have patients that come to us from quite a distance. I have patients that drive two hours to come to see me. And so being able to ease those patients' way and allow them to access care without necessarily having to get in the car and drive two hours just to come see me, has been a draw for the RPM model as well.
The Opportunities and Challenges of Team-Based Care Across Providence
CA: And as you've made this transition to team-based care, it's obviously one of the most important transitions that a number of healthcare leaders are trying to drive in their systems today. What have been the most exciting opportunities with that and what have been the most difficult challenges?
KK: I think one of the challenges as a primary care physician is that, like I mentioned earlier, really a strong draw is for me to know my patients and really feel like I'm really involved in their care. And I think for some clinicians, it probably feels like giving up a bit of control to transition over to team-based care. I think that's a mental shift that's necessary, but I also think it's difficult, and understandably difficult. Like I said, I've been in practice for quite a while and so that's not the way I initially trained and so I've had to actually learn myself how to work with the team and sort of, maybe operate as a captain to the team, but not necessarily try to be the only player on the team. So that's been a bit of just a mental shift, I think.
The trade off, I think, is that it allows us to take better care of patients and also to expand kind of a reach of the clinicians so that the clinician is not having to do everything. So I think the benefit's definitely there. And then also you have the advantage of being able to leverage expertise. Like I mentioned, the pharmacist, the clinical pharmacists obviously know a lot more about the ins and outs of drug interactions and things like that than I do. And so being able to put aside a little bit of my ego and involve the clinical pharmacist actually is beneficial both for the patient and myself.
CA: And as you now take a leadership role across Providence helping spearhead some of these new technologies and new programs, what are you telling your fellow clinicians about how they should be thinking about this transition to team-based care?
KK: I don't think of myself as always being an early adopter. And so I always want to kind of think things through and figure out, does this really work for me and my patients or not before I jump on board. So I think having gone through that internal sort of conversation myself allows me a little bit of credibility when I talk with my fellow colleagues.
The fact that I do see patients over half of my schedule in my administrative roles, just a portion of that, I think, allows me to also work through it and kind of feel the pain points of integration along with my colleagues and work through those. And also just being open and listening to them and figuring out what works, what doesn't work, and how do we make this interface and project better for everybody.
The Benefits of Remote Patient Monitoring and How RPM Has Positively Impacted Patients and Clinicians
CA: And as you think about remote monitoring as the next extension of the team-based care model, what have been the biggest benefits to you? What have been some of the impacts you've seen with your patients today? Why is this worth the time and effort to you and your team?
KK: We've been doing it now for almost a year, and we have pretty good data that it's really... we started with hypertension as far as the RPM, heart failure and just recently added diabetes. And so hypertension, we have the most patients enrolled in that. So we have pretty good data that shows that it has led to pretty rapid achievement of our CI metrics for the patients that were enrolled. Patients that we had difficulty getting their blood pressure under control for various reasons, using RPM has enabled us to reach some of those patients that were kind of slipping between the cracks before. I think, and it really hasn't added a significant administrative burden to the clinicians or the staff because the RPM model that we're using is pretty self-contained. It doesn't add any workload to us, but enables us to reach some of those patients better.
I think for our patient standpoint, those frequent touchpoints of being able to reach out and contact the patient on a regular basis and help them work through not just medication adjustments but also lifestyle management and lifestyle modification has been really, really helpful for them.
It's honestly, it's stuff that we would like to do as a clinic practice, but things that we just don't have the bandwidth to do. We're not able to pick up the phone and call every patient, even though we'd really like to, just because we don't have the manpower or the bandwidth to be able to do so. And so RPM's enabled us to fill in that gap and contact those patients on a more regular basis. And I think the frequent touchpoints has really been a huge benefit to a lot of our patients.
CA: And many of these patients are in their seventies and eighties, and when they ask you, "Dr. Kooser, why should I be a part of this program for my heart failure?" What is your pitch to them?
KK: I think that there's a kind of a misconception that some of those older patients, maybe they're not going to buy into doing a more of a higher technology sort of approach to medicine, but they actually seem to be more on board than a lot. I mean, they're the ones who email me all the time, they're the ones on MyChart and have access to their electronic medical record. They're much more engaged, I think, than it's commonly thought. And they like the idea of having somebody who checks on them frequently and when their blood pressures spikes and they don't really know what to do, that there's somebody on the other end of the line that can reach out to them and help them work through what to do with that high blood pressure reading. I think they really like that. I think also, it's a pretty easy pitch to discuss with them, that they know how hard it is to get in to see us. They often complain that maybe it takes a couple months to get in. And that's just an access issue that we call that a lot of people are struggling with. And so for them to be able to reach out and have a point of access to healthcare that's much more readily accessible for them, I think, is not a hard sell for them.
And then to discussing the goal of this, especially with heart failure patients, is to keep them out of the hospital and hopefully be able to identify trends and problems before they get to the point where they have to go into the emergency room or the urgent care to get seen is an easy selling point with them too.
How RPM Has Eased the Burden and Workload for Clinicians
CA: And you mentioned MyChart, many physicians have been concerned with remote monitoring historically because of the worry that it'll just create more messages for them in their in-basket. When you're talking to providers about potentially adopting remote monitoring and they're concerned about additional burden and additional workload, what do you tell them about the program?
KK: So with this program, the advantage is that those messages don't come to us as clinicians. And so if a patient has a question about their blood pressure, that's actually probably pretty neutral. But I think in the long run it'll actually be less messages that are coming to the primary care provider because the patients are asking those questions through the RPM, they're questions about their blood pressure, questions about, "What do I do with my diuretic for my heart failure?" "I gained three pounds overnight. What do I do with that? How do I treat that?" Those questions are not necessarily coming to the PCP anymore, they're going to the RPM team, which in the long run, I think, actually will help reduce the number of messages that we're getting.
CA: And have there been any patient cases or patient stories over the last year that really highlight the power of this program?
KK: One of the kind of fun ones was that my patient who was patient number 100 that we enrolled, it was just coincidentally, I was seeing him in clinic. He got enrolled and he's 85 years old and lives alone and has always, I think he's always been a bit nervous about living alone. He wants to maintain his independence, but he also realizes that as he ages and accumulates medical issues, how much longer he can live on his own, is always kind of weighs on his mind. And so he happened to be patient 100 that we enrolled for hypertension, and he actually cried when he got enrolled because he mentioned that he felt like there's somebody out there watching out for him and kind of looking out for him.
And I realized that RPM is not social work and they're not going to be out there making sure that he has grab rails in his house and things like that, but just the fact that there was somebody who was actually going to be checking on him remotely, really touched him and actually made him feel like we were really going out of our way to care for him. And that was just a really interesting sort of benefit of RPM that I hadn't really thought about, is that patients I think feel that gives them the extra touchpoint and there's somebody on the other end of the line monitoring them and keeping an eye on them and making sure they're okay.
Why Providence is Scaling Up RPM Across the Health System
CA: And now switching gears a little bit. As you think about the deployment across Providence and seven states, what are you most excited about as RPM starts to get the scale across the system?
KK: Because Providence is so large, and I'm sure other healthcare organizations are going to have the same challenge, each region, in each area and each clinic even has its own culture. And so for me, it's going to be an exciting challenge to figure out what people already have at their clinic or in their region and how does RPM dovetail with what they're doing. For instance, some of the clinics in our area have clinical pharmacists and some do not. And so how do we integrate RPM into the model that they're already using, sort of augment what they're doing without duplicating and basically want to add to what they're doing instead of having a lot of overlap.
So that part is exciting. And then just being able to give this program to a lot of the other areas that maybe are struggling with some of the same problems that we have as far as clinician shortages. How do we do team-based care? How do we reach patients where they're at? How do we move into this next generation of delivering healthcare where patients aren't necessarily having to come into the clinic for every problem, but with some of these things we can handle remotely, I think, is a really exciting sort of next step, next evolution of what we're doing in medicine.
Key Takeaways from the Recent Health Management Academy, Medical Group Leader Meeting
CA: And then you and I had the chance to present at the Health Management Academy, Medical Group Leader Meeting recently. What were a lot of the themes you heard at those discussions and how does what you're doing here plug into a lot of the challenges you're hearing from chief medical officer leaders across the country?
KK: Two of the biggest themes I took away from that conference was the clinician shortage is hitting everybody. It was interesting to hear that it's not just a Thurston County in Washington sort of issue. It's across the country that primary care in particular, there's a serious shortage across the nation. And then the other thing that seems to be overwhelming is how do we integrate new technologies into how we practice medicine? So they talked a lot about patient portal messaging is a huge challenge. It's definitely a patient satisfier because that's how we communicate in other aspects of our life. Phone calls are sort of becoming a thing of the past for a lot of people, and so how do we deal with all this influx of patients being able to access in different ways? So I think RPM plays a role in helping with both of those because as I mentioned, the RPM helps us expand the clinician reach, so that helps some with the clinician shortage, and then it hopefully will help unload some of those patient messages that are about the conditions that RPM is helping us manage.
CA: A lot of the patient communication happens via SMS, and so patients are texting back and forth with their remote monitoring teams, getting their vital results via SMS. Have you had any patients talk to you about SMS and now being able to contact their care team via text message?
KK: It becomes the expectation for a lot of our patients that, I have a question about something, I want to get a quick answer, and so the SMS feature is, I think, been a big hit. And I think, again, that probably leads to a lot less phone calls and messages that at the primary care clinic we're having to handle because the patients are getting answers in a timely manner.
CA: That's wonderful to hear. It's such an inspiration for us to spend time with clinicians like you who are leading the charge in doing the hard work of deploying new technologies into communities. We know it's a lot of work and we know it's hard to change healthcare delivery, but you're at the cutting edge of it, and we really appreciate all of your insights. As we work to making remote monitoring part of American healthcare and part of the standard of care, the lessons you've learned today are incredibly helpful. So thank you for spending time with us today and we really appreciate it.
Thanks again to Dr. Kooser for taking the time to chat with Chris this week. If you're interested in learning more information about Cadence and how to get involved, visit cadence.care, and please get in touch with our team. To make sure you get updates on our future conversations, please subscribe to Cadence Conversations wherever you listen to podcasts. At Cadence, we believe that everyone deserves to receive the best care possible, and we won't stop working until that vision becomes a reality.