Pain of social distancing paid off for Minnesota health care providers

HealthPartners has to live in the same dual reality as other Minnesota businesses, by getting through the early COVID-19 crisis while at the same time figuring out how to keep working after its peak.

Its thinking has to include how to refine the patient treatments that were invented more or less on the fly during the first — and hopefully worst — phase of the COVID-19 pandemic.

A year ago, for example, it likely wouldn't have occurred to anybody to try to do a dental exam over a Google Duo video chat. But that happened, HealthPartners CEO Andrea Walsh said last week in one encouraging story of problem-solving.

"It doesn't mean it's not hard," she said, of the current crisis. "But I think resilience comes from people feeling bound together by a common cause."

HealthPartners has both a multistate health plan side as well as a health-care provider one, with eight hospitals and dozens of clinics and other sites. So it first has to serve patients with the disease, amid well-publicized challenges like tight supplies of masks and other equipment.

As with the state's other providers, Bloomington-based HealthPartners has had to tweak facilities, make plans for staffing and a host of other big tasks with so much still unknown about the disease.

A forecast of COVID-19 cases is treated a little like the weather report, Walsh said. It's useful for planning the week but not very helpful much beyond that.

And while she's confident that the social-distancing requirements have made a big difference reducing the spread of the coronavirus, it's too soon to say a big surge in COVID-19 patients won't come.

One indication that HealthPartners was in crisis mode last week was that the phone conversation with Walsh originated from an incident command and communication center in Bloomington.

Her daily routine now includes a midmorning call that rounds up the most pressing issues across the organization, from new developments in state policy down to why some coffee pots were turned off.

"We've got all these questions, none of which have a playbook or an answer, but we've got a great team of people equipped to be super-good problem solvers," Walsh said. "And we figure it out. The only thing that's not an option is to try to punt that problem to somebody else."

The situation with COVID-19 remains so fluid, Walsh explained, that daily reporting is one way clinical staff coming to work after days off get up to speed.

She recalled that standardizing some processes in pediatric clinics a couple of years ago was a great project, but one that took two years. Now the organization might assign a relative handful of people to quickly make the call when new information emerges.

One part of the COVID-19 response in Minnesota was to push out nonemergency surgeries, both to preserve supplies of protective equipment for medical staff as well as have fewer vulnerable people recovering from a surgical procedure that suppressed their immune systems.

Walsh described the organization as "much more disciplined" in understanding its stock of equipment and has been working with 3M Co. to clean and reuse high-end N95 masks. Even so, the resumption of nonemergency surgeries will require a balancing act.

Part of the challenge now is figuring out how to best continue treating those patients, when they are understandably reluctant to pop in to a clinic.

HealthPartners decided on the Google Duo video conference app for patient visits. Most of HealthPartners' physicians and other clinicians signed up for an optional training session.

Thousands of video consultations have already taken place, with the mental health teams concluding that just as many visits with patients happened during the stay-at-home order as would have normally taken place.

A small child with ear pain was also examined over a smartphone video call, Walsh said, as a parent had found an otoscope and was directed by the physician how to position it to allow a good look into the ear.

Walsh described how even dentists have made video exams work, and the first virtual dental visit included an American sign language interpreter on a third screen.

"We had talked about technology and that personal device, your phone, being a bridge and not a replacement for relationships." Walsh said. "One of the lessons for us in the COVID pandemic is that in fact technology is a relationship tool. Our patients and members expect it, and our care teams do as well. Our job now is how do we create that as a sustainable model, because for many patients, that's the way they are going to want to get care."

Things like routine screenings for cancer like mammograms and colonoscopies, even teeth cleaning, can't be put off indefinitely, she said. Yet another task in this phase of the COVID-19 crisis is encouraging people to continue seeking care for their chronic conditions, even though it's not going be done the way it was last year.

The pain caused by social distancing practices — from job losses and business closures to being cut off from parents and grandparents living in elder-care centers — has been so great that it's easy to forget the goal of it has been to keep health care systems up and running to treat COVID-19 and everything else.

"People in our communities stepped up," Walsh said. "The distancing is working. It's given us more time to prepare for a surge. And frankly, it's kept our caregivers safe and we are super grateful for that. That has not happened in every community."