Coronavirus in Context: Role of Urgent Care in Returning to Work

Published On May 11, 2020

Urgent care centers play an important role in the COVID-19 pandemic.Urgent care centers are exploring the use telemedicine to help employers conduct real-time evaluations of workers who appear sick. A better mix of virtual and in-person visits is necessary to help urgent care centers prepare for a possible combo season of cold/flu and COVID-19 in the fall and winter.
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You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. With states lifting their stay at home orders, we're starting to talk about, how do we return to work.

To provide insights, I'm joined by Todd Latz. He's the CEO of GoHealth Urgent Care. And Jeff David, the CEO of Independent Pet Practice. Gentlemen, thanks for joining me.

Thanks, John.

Thanks for having us, John.

Todd, I want to start with you. Let's talk about the role of urgent care and what role it has played in the COVID-19 epidemic.

John urgent care has played a vitally important role in the COVID-19 epidemic. And if you think about where urgent care sits on the continuum of care, we are in between really primary care and the emergency room, or the emergency department at the hospital.

And so we've really been at the tip of the spear. We are prepared to handle serious issues. We handle everything. Every injury and illness up to but not including life threatening injuries and illnesses. And thus, we are set up for this type of immediate care.

And if you look at what's happened, there's real risk in COVID suspected or related patients going to the emergency department for care, because you have a risk of infection and exposure there, or you could take down a vitally important part of the health care system.

And there are lots of other injuries going on other than COVID-19 related right now, so you do not want to overly expose the emergency room. And from a primary care standpoint, whether it's not having enough PPE, the protective equipment to be able to handle it, and not usually dealing with this type of issue, urgent care sits right in the middle of those two and really is the best environment to try to handle and get a grip on what's going on right now.

How did you see utilization change in the past, you know, few months in terms of virtual visits, you know, actual visits to the centers, what have you seen?

From a volume standpoint, we saw a shift, especially in our New York market, to almost entirely COVID-related volume. And from a face to face or in-person visit to a virtual visit, we saw a dynamic shift.

So for us, we've been doing virtual for quite some time. We are one of the few urgent care providers that had this. We've had virtual in a number of our markets for a couple of years. And when we looked at that shift, the prior for us, it was, you know, small single digits in terms of the percentage of volume.

And we saw that go up to 10%, 15%, 20% of our clients. So we now have it live. We-- we made that move very quickly across our footprint nationally, and we are seeing quite a bit done.

And it's-- virtual is a great place to see that COVID-related patient, because we can virtually triage, evaluate that patient on the front end. It protects both the patient and the caregiver because of that virtual model. And then for us, with the ability to test, we can do curbside testing and keep everyone safe.

And Jeff, there's been some discussion on the news that the adoption of pets has actually increased dramatically during this epidemic. How has COVID-19 impacted your business?

JEFF DAVID: As an essential business for the health and well-being of pets, for the provision of food and other accourtrements to support their-- their healthy living, we've been able to stay open, which has been fantastic.

But of course, that has caused other traumas in terms of, how do you actually support customers and their anxiety around actually engaging with, you know, our pe-- our staff, our team, our suppliers, et cetera, and meet their health and well-- you know, meet their needs?

So we've-- that's where Todd has been incredibly helpful to us, providing advice and support and encouragement on all of the things we need to do to try and reduce the anxiety, keep people calm, and help them meet their needs.

Let's talk about that. As an employer, what do you need to help make your employees less anxious first, to make them feel safe that they can return to work or be at work, and then how do you get customers to come back?

Because even if the virus dissipates, the fear of the virus may not dissipate. So-- so tell us some of those things that you need as-- as an employer.

What we've found is that it's just, take one day at a time, understand the needs, you know, that are-- that are confronting us, and to make adjustments on the fly.

What we've discovered or what Todd and I have been talking about is the fact that, where, in the past, maybe 10% of my time has been on the health, the physical health and well-being of the team, and the other, say, 10% or 15% may have been on how we build a culture, how we, you know, galvanize people around a common purpose to meet customer needs.

That's moved to being now 50% to 60% of my time. And it's about, how do we make sure that they've got the equipment they need, they've got the practices in place, we're able to quickly respond to questions that they have, that we've got the right decision trees and architectures that enable decisions to be made quickly in the field without reference back to the support office so that people are feeling empowered to do the right thing.

And then that flows, then, into how we take those actions and communicate them with consumers. And in our case, impassioned pet parents, and help them understand that these are the things we're embracing and doing for their health and well-being as much as for our team.

I think that's an important point, talking about now you're concerned about employees' physical health. We have to worry about the physical health of-- of customers that come in. Todd, what's the role of-- of urgent care? That may not have been something that we would have thought about, right, six months ago. But now we are. So how is urgent care stepping up to the plate and-- and helping reduce anxiety?

John, when we think about this right now, you know, historically for us, a little bit different, obviously, than for Jeff. So that physical health and well-being is a constant for us, given the business that we are in.

But where I would say for us now is it goes well beyond the four walls of our particular urgent care setup today. And we are having numerous conversations with employers just like Jeff about how they think about the world going forward, right? What's their new normal or what is their next normal.

And it's actually moved us outside of our normal thinking on how we can help assist both patients, customers, and employers in their places of work. Because now, as Jeff just mentioned, everyone needs to be thinking, full time, about that physical health and well-being of not just their own employees, their own team members, but their customers.

And so we're having conversations with employers, with businesses, really across the spectrum. So some of them are essential businesses, like power plants and infrastructure employers. We're obviously talking to at risk patient-driven businesses like nursing homes and skilled nursing facilities and senior living facilities.

And then regular employers where most of their team members are in an office, and helping them think through, what are the steps that you need to be prepared for, and what do you work through in a progression to start to open it up, right? To get back to what this new or next normal is going to be.

And then maybe most importantly, and I think there's a lot we could talk about here is, what happens at that first instance that you've started to move people back, or in Jeff's case, he's been in business this entire time as an essential business.

But as you start to see more of your customers coming in, what do you do at that first instance of an issue where you get someone who's now become ill or symptomatic, and how do you deal with that situation, and then--

[INAUDIBLE] Tell us. That's what people want to know.

Yeah. I think it's-- it's a in evolving situation, obviously. But what we're working with employers on is, how do you think about testing, both COVID-related testing and now the antibody testing, and what does that mean for you, for your workforce.

And then how do you manage something that happens? So it could be, right, well, let's give an example. You bring back 20% at your workplace, you're social distancing, and someone comes back from lunch and they suddenly feel like they have a fever, or they are somewhat symptomatic.

And the beauty of what we've done from an innovation standpoint is, you would immediately take that employee, have them leave the premises, right? So they would return home. We could do a virtual visit and an evaluation of that employee in real time, literally as soon as they've left the office.

And if testing is appropriate, we could line that up and have that happen in real time. And it's working with employers to understand, OK, now that you've had this one thing happen, does that mean, you know, back to business as usual for everyone else?

Or, in, you know, more realistic terms, how do you think now about contact tracing, and who did that particular employee interface with, and does that mean closing the office and everybody goes back home for a couple of weeks, or can you try and limit, you know, that, and understand what the exposure is, and think about how to move forward without having to shut everything back down again?

And that's an evolving science. We don't have all the answers to that yet. We-- we don't know necessarily what the right approach is. Jeff, what are you hearing from employees? What-- what's their biggest concern?

Is it an issue of testing that they want more widespread? Is it an issue of just almost like a PTSD, that they're just so fearful of the new normal?

And what we found is that there's-- there's no single question that people are asking. Every single person has a different view based upon their personal circumstances.

Um, what we've discovered, and, you know, to follow on what-- what Todd was saying, our view is that the primary thing is for us to maintain complete transparency with out team about the actions that we're taking and the follow up actions that we'll take for their safety and health, and well-being.

On the basis that we require them to be completely transparent with us about where they've been, who they've been in contact with, what-- what their circumstances might be. And so that we can then have a dialogue, because every question is-- is different.

There are people that are looking after elderly family members that are concerned about one thing. There are other people that have young children that no longer have day care or need to be homeschooled, and they have a different set of concerns.

Our team that is in our office in New York is more concerned about having to get on the subway or the, you know, railway system to come in. So that-- it's every single circumstance is different.

What we've found is that we have to be more sympathetic and empathic and thoughtful and communicative than ever before.

And-- and Todd, you mentioned testing. Whether it's diagnostic testing or antibody testing. Can you talk just a little bit about the concern that there's not enough capacity? We don't have the ability to do as many tests as we need?

Or with anybody testing, there are some concerns about the accuracy. Is this something that's, you know, maybe several weeks away, or is it-- is it something that's going to be iterative? We're going to do the best we can right now and then we strive to do better two weeks, three weeks, four weeks from now?

John, I think the answer is yes to both. So obviously, up to now, we've had a real issue in terms of capacity for testing. So we had the benefit, through our partner Northwell Health in New York, and what we were able to do there, we've been testing from, really, day one.

We've performed, as a business, you know, tens of thousands of tests and seen a lot of positive patients. And then we also have, as I think you know, access to the Abbott ID NOW platform, the rapid testing, and we're doing that in a number of markets as well.

But-- but I would say still, on the COVID diagnosis, right, do you or don't you have an infection right now, that has gotten better. I think that will continue to get better in terms of access to testing over the next several weeks, but it's been far too limited to-- to what it should have been up to now.

As we think about the antibody test or the serology test that basically tells you, you know, have you built up antibodies, have you, in theory, had COVID-19, I think there are questions, as you just raised, around the accuracy of those tests.

We are beginning to do that type of testing as well. It-- it's really answering a different question, and I think that's one, absolutely, where time will tell what does it tell us.

Because the one open question that's difficult for everyone to deal with, and how do you answer these questions about return to work, is, from a scientific standpoint, we have not definitively proven that if you have antibodies, that then means immunity. And if you have immunity, for how long.

What does urgent care look like in the fall, and then how does urgent care look like a year from now?

You know, if we take the fall first, I think we're preparing today to be in a very similar situation as we are today. But I would, you know, I would say, certainly from a GoHealth Urgent Care perspective, we'll be more prepared.

We have learned a lot of lessons. We have innovated very quickly through this process. But as we know, come fall, we're going to have another cold and flu, and now, you know, by any stretch of the imagination, I-- I don't think there'll be something that happens between now and then that will prevent it also from being a COVID-19 season.

But as we do think about, you know, two years from now, I think there'll be a better mix of service in terms of what's virtual and what is done in person. And I think we'll see, we certainly expect this to happen, because it's already an evolution in our business, urgent care going well beyond the four walls of our particular centers.

And how we're assisting employers think through their plans and what we're doing overall. We cover a huge piece of the landscape today. I don't think that will change. But I think you're going to see, um, that continued care for our people, and what our frontline is capable of, a continued evolution, and urgent care being that much more important as we look across the whole continuum.

Especially as in our motto, where it's tied in to a health system or a broader system to care for patients. Because as you know, just because of COVID-19, all these other issues that we normally see in an urgent care business, those haven't gone anywhere.

And what's happened throughout this process is, most of our-- our people have been staying home and not getting the care they need, unless they can do it virtually. And so we have to find a way to deal with something like a COVID-19 outbreak, but not ignore all the other health conditions and issues that are present.

Well, this is an evolving situation. And-- and gentlemen, I want to thank you for taking the time to provide your insights today.

Thank you, John.
Thanks, John.

And I want to thank you for watching Coronavirus in Context. I'm Dr. John Whyte.