Guide Your Hospital Successfully Through the COVID-19 Crisis: 4 Strategies

The actions healthcare leaders implemented to manage their organizations through this watershed year offer an inspiring blueprint for leadership during a crisis.

This article appears in the November/December 2020 edition of HealthLeaders magazine.

Healthcare leaders faced incredible challenges this year due to the COVID-19 pandemic, which has wreaked havoc upon the healthcare industry. The cancellation of elective procedures caused a financial burden on hospitals and health systems and resulted in staff furloughs and layoffs. There were national supply chain shortages, patient surges that overwhelmed hospitals, and patient and staff safety concerns. Rural and underprivileged communities suffered from lack of access to healthcare, while mental health concerns for doctors, nurses, staff, and patients skyrocketed.

To deal with these complexities and keep their organizations afloat, healthcare leaders rose to the occasion by innovating, scrutinizing their balance sheets, and becoming the voice of wellness and safety for their communities. Telehealth and digital health initiatives flourished. Open communication led to enhanced collaboration within organizations, as well as outside the walls, with communities, local government, and even competitors.

HealthLeaders spoke with executives about four areas that were impacted at their hospitals and health systems due to the COVID-19 pandemic and the strategies used to handle them. The strategies they implemented to successfully guide their organizations through this watershed year offer an inspiring blueprint for leadership during a crisis.

1. Innovate in the Supply Chain

Sentara Healthcare, a system with 12 hospitals, a broad array of ambulatory services, and medical groups, serves communities in Virginia and North Carolina. Like other hospitals and health systems, Sentara Healthcare had to get creative when it came to protecting the inventory of their supply chain.

Before the pandemic hit, Sentara Healthcare was operating in "just-in-time" inventory management.

"Like most health systems, we were focused on finding a way to manage supply chain in the most efficient way possible. Healthcare costs are under tremendous pressure, and supply chain is an obvious area of focus from a cost-management point of view," Sentara Healthcare President and CEO Howard Kern says.

"We have a large GPO affiliation, but we felt like we needed to get even more efficient through the relationship with a contract supply manager who would deliver to our warehouse and maintain our warehouse, [in an] almost just-in-time manner," Kern says.

"That is one of the challenges of the pre-pandemic environment that hospitals were in. They were focused on trying to keep supply costs to an absolute minimum, minimizing the amount of inventory they absolutely had to maintain, and in counting on supply purchasing from a pipeline perspective as a pretty reliable kind of activity, without any concern for major interruptions either domestically or overseas."

The health system organized a command center to "coordinate our action plan and monitor the impacts of the virus, going back as far as January," Kern says. "In establishing that command center, we focused on the traditional things that we always tended to focus on in any kind of a disaster planning agenda—mostly logistics: monitoring supply levels, managing policies and procedures, communications, making sure we had adequate staffing where we needed it. It was logistics-driven."

"We did have classic logistics challenges around supply chain. We were struggling, as many were, with issues around access to PPE and monitoring our supply levels," Kern says. "We found quickly that our distributor was unable to meet Sentara's needs for PPE and related supplies. They had no contingency plan. Their supply sources overseas quickly disconnected, and we were left to fend for ourselves. We went through a range of solutions to try to purchase our own supplies."

A new direction

The health system saw an increase in COVID patients in March and managed them through April and into May.

And although they didn't see patient surges like major metropolitan areas saw, they were worried about supply chain levels, specifically around PPE, ventilators, ventilator supplies, testing equipment, and reagents.

"We found a number of local sources, domestically and in Mexico, that we thought were reliable. Prices were going through the ceiling. N95 mask costs [were] 50 cents [then] became $5, and then $10 per mask. We obviously didn't purchase at that level," Kern says. "But we made several orders through our national purchasing GPO arrangement. And what we found was as soon as we were able to contract for a particular supply in PPE delivery, the federal government was pre-empting it based on the priorities they had for the major cities. So, FEMA would come in and basically take away our order five days before it was going to be delivered to us. That became a very frustrating challenge that we found ourselves in."

To acquire supplies, the health system came up with a new plan and implemented three solutions.

1. Transporting supplies through unique means

Sentara Healthcare found a local company in eastern Virginia, where retired Navy Seals "were doing international transport and flying missions" to procure supplies for local hospitals and health systems, Kern says.

"They agreed on a voluntary basis to help us. We sourced some credible Chinese supply companies. We did it very carefully to make sure that they were credible supplies and suppliers. We were able to fly there, courtesy of this company in eastern Virginia, and they were a tremendous resource for us."

The local company made trips to China via a 747, which allowed Sentara to fill their supply warehouse. "We spent $10 million purchasing PPE. And then we went out and purchased an additional shipment, and then an additional shipment. We wanted to make sure we had plenty of supply for future rollouts of this pandemic, and we didn't want to be caught short.

"It was an interesting challenge. We had to arrange for air freight deliveries at 2 a.m., in the dark of night, for fear that FEMA would try to reprioritize our supply deliveries to other locations. We got them in our warehouse and everything went great. So that's the way we had to go about acquiring PPE," Kern says. "It was really not an ideal way.

"I think many of us look back on that experience and recognize that's a key issue from a national disaster preparedness level that needs to change. We looked for help from the [Strategic] National Stockpile, and we got a distribution [that was] equal to less than a half a day of our supply needs," Kern says.

2. 3D printing

Sentara Healthcare has a supply of ventilators but wanted to be more prepared in case there was a patient surge. The healthcare system teamed up with the engineering department at a local university "to create, using 3D printers, necessary attachments for our ventilators to allow them, in a crunch, to be utilized by two patients at once."

3D printing is a cost-effective medium and would enable the health system to essentially double the number of patients who could simultaneously use their ventilators.

"We immediately went about procuring the necessary tubing and attachments and did some quality checks on it to make sure that it was safe, and we weren't going to have cross-infection issues," Kern says. "[We] found that to be a very effective and safe approach; [but] clearly only done if there's a crisis."

3. Reprocessing PPE

Another avenue of keeping up with supply chain demands was to sterilize and reuse the PPE the health system already had. Through the command center, they were able to set up "recycling technology using hydrogen peroxide, and also ultraviolet light to sterilize equipment, and more importantly, certain types of PPE, masks and gowns, so they can be reused," Kern says.

"We did not know how much we'd be able to get in from our outside sources, [and] we wanted to make sure in a pinch that we could re-sterilize a number of our PPE items and reuse them fairly regularly. And we've put that capability in place as a contingency," Kern says. "That was something that we were glad to have, and depending on the availability of in-house supplies, we could put that into play as needed."

Sentara Healthcare also reviewed how much PPE they were using and found ways to make the number more sustainable.

"We did a study within our own facilities where we were using 27 pieces of PPE per patient [every] day in our critical care units. We then took, as a part of that study, a look at how could we make more efficient the way our clinical staff entered infected patients' rooms, did all the things that were necessary for that patient, and came out in a more organized fashion," Kern says. "We were able to reduce that statistic of 27 pieces of PPE per patient day to 9 [per patient day], just batching and bundling the activities that nurses were doing in a critical care patient room."

The health system restructured what the nurses needed to do in each patient's room. "They stayed longer with the patient, got a lot more done, interacted with the patient as needed," Kern says, without having to reenter the room multiple times, which saved them from having to don new PPE each time. The nurses also utilized "video and communication with the patient, and telemetry monitoring of the patient's vital signs."

Post-pandemic strategies

Sentara Healthcare is also creating new strategic approaches to their supply chain.

"As healthcare systems, we have a responsibility to our communities to maintain a safe inventory of excess supplies in these critical areas, so [that] we're prepared should we have to face a renewed pandemic on a sudden basis," Kern says. "We cannot afford the luxury of depending on outside supply sources. Healthcare organizations have to maintain, in-house, a critical buffer of supplies. We will be doing that long term."

"We maintain a totally unique warehouse, separate from our main warehouse operation, just for PPE stockpiles. N95 masks, gowns, face screens, a whole host of personal protective devices, that are just for these kind of events," Kern says. "And we will maintain that warehouse and supply items for this kind of scenario. We're going to try to utilize them more efficiently, and we're going to look at the future in terms of bundling activities together, so that nurses donning PPE to take vitals, deliver medications, deliver meals, address patients, take out trash, whatever is necessary to be done, is done more efficiently."

"And then lastly, we'll utilize technology that we pioneered here in Sentara," Kern says, including "virtual visits in eICU as ways to stay close to the patient without having to be in the room."

"Those are critical learnings for the future, and how it will affect supply chain usage for us for many systems," Kern says.

"The COVID experience for many of us, certainly Sentara, is a lesson in learning. We all learned an amazing amount in preparing for and living through COVID in 2020," Kern says. "You need to be able to structure a process where you continually learn. And you can use those learnings to improve the delivery of care and the efficiency and the effectiveness of your logistics for the benefit of your patients and your community."

2. Prevent Capacity Issues Through Community Partnerships and Communication

Minnesota-based Winona Health, the only hospital in Winona County, was able to avoid patient surges during the pandemic. The hospital used its partnerships with the community to circumvent overwhelming its 49-bed capacity.

"[We] leveraged our relationships across the community, and I think this is a critical piece for rural communities," says Winona Health President and CEO Rachelle Schultz. "We have limited resources to start with, and our community stepped up, our partners stepped up. … We wanted to be really prepared, but part of that preparation is knowing what you're dealing with."

Winona Health immediately began to plan how to receive waivers to increase hospital bed numbers, how to redeploy staff, and how to obtain needed equipment including ventilators and beds. They also used modeling of what a potential patient surge could look like, and what resources the hospital would need.

"Our physicians had a medical task force specifically looking at all of this, reading any of the research that was starting to come out about treatment, the disease process, how it shows up, and testing," Schultz says.

Crucial partnerships

Once those aspects were in place, Winona Health turned to their community partnerships to work together to prevent patient surges and capacity issues.

"It was clear we had to be aggressive and upfront with a lot of communication. … We decided to do weekly calls with all of the area congregate facilities. So, the nursing homes, the assisted living group homes, any kind of type of congregate living facility. And we continue this even now."

"We could figure out where they stood," Schultz says. "Did they have PPE, were they doing visitor restrictions, did they have testing issues, all of those kinds of things. Everybody understood in those vulnerable populations the importance of what we were all doing. If there were any gaps, we could find resources or support to help them out."

Communication was key among Winona Health and the surrounding congregate facilities. "We've got 300–400 people in nursing home beds in our community, and we're a 49-bed hospital. And as fast as that virus can move through a nursing home, that would have easily overwhelmed our capability to take care of them in the hospital setting," Schultz says.

"It did take us being very proactive at the front end in getting these facilities engaged, to ensure we didn't have a surge. And so, throughout this whole thing, we have had patients in the hospital, both in the ICU and in our medical beds, with COVID, but we have not had a surge," Schultz says.

Widespread testing to keep surge at bay

To fully gauge how much the coronavirus had spread in their community, Winona Health used testing to plan for surges.

"We were doing testing, but at the very beginning, there were limitations," Schultz says. "[The patients] had to be symptomatic, and it was only if they were in the hospital in the ICU. Eventually [testing] did get extended out into long-term care facilities or congregate living."

"Our first positive [case] in the community showed up March 27 and it was in a local nursing home. Right after that, for the next week and a half or so, there was another positive, then there were three positives. Then there were some staff that were positive," Schultz says.

"We determined we were going to go and test everybody in the nursing home, all of the residents, all of the staff, to see if we could get a handle on what [we were] looking at. We sent one of our physicians over to that nursing home, so she was managing those patients and getting support for her colleagues via the phone. We had daily meetings of this task force to really understand what was happening."

"When we did the testing, we identified 21 people who were asymptomatic," Schultz says. "That shifted our thinking that there's an invisibility piece about this virus. And we started thinking about how [can] we protect the hospital and our staff from the surge [and] from being overwhelmed."

About 14 residents ended up testing negative for COVID. "We worked at that facility to relocate those residents onto our campus for the duration to give them the best chance to not become infected," Schultz says. "And we were successful in doing that. About a month later, we moved the residents back."

"Our next step was to do testing of all congregate facilities, and all of the staff and residents in these facilities. We don't operate the vast majority of those, so this was an ask on our part for them to do this, and every one of them said yes," Schultz says. No other positive cases were found at that time.

"When we reflect back, for us, that was a really important role for us to play; to protect the most vulnerable people in the community from contracting this virus," Schultz says.

Open communications

Schultz says she also communicated with community officials about the hospital's perspective on the spread of the virus and testing.

"It's easy to assume our county public health should know what's going on, because all kinds of results get reported to the Minnesota Department of Health. And we think that there's a communication channel that was happening there," Schultz says. "But, there really wasn't. Our county was a bit out of the loop, and then our city was concerned … about the spread for the whole city and the impacts on businesses and so forth."

"From there, we decided [to] do a weekly phone call every Friday. I would give them an update about what was going on, our preparedness plans, where we were with our ICU, positive testing, what we were doing with moving those nursing home residents, and so forth," Schultz says. "And they would share with me if there were things that they were hearing out in the community as well."

Schultz also shared information with the public. One way was through educational videos posted on the Winona Health website and social media profiles. These five- to 10-minute videos covered topics such as "masking, and handwashing, and infection prevention. [And about] testing: what is a PCR test, and what is the serology test, and who can get tested, what do the test results mean," Schultz says.

In addition, Schultz wrote a number of editorials for the local newspaper to "provide information and direction because, in the early days, there were so many rumors and there were so many imaginations running wild about what COVID could do, and what was happening. [I had] to take that fear out of it, and to share what the community could do to protect themselves," she says.

"We all need to shift our thinking to how do we get a robust surveillance in place in our respective communities; certainly in rural communities. We're a smaller facility, and so it's important we're working with all of these community partners," Schultz says. "It's about testing, it's about surveillance, it's about understanding who is the most vulnerable, who is going to succumb to the virus if they're infected or need hospitalization."

"We can't sit back as hospitals and wait for it to show up on our front doorstep," Schultz says. "We need to get outside of our walls, [see] where it's moving around, and work with our employers, our cities, our counties, other partners out in the community, to understand what's happening and to help manage that effectively."

3. Cross-Train the Workforce

Unlike other hospitals and health systems that had to lay off and furlough staff due to financial issues caused by the pandemic, University Medical Center Health System (UMC), a health system with 62 care locations across Texas and New Mexico, didn't furlough or lay off a single worker due to the pandemic.

According to the health system's website, it employs over 4,600 employees, staff, and residents and distributes more than $278 million in payroll.

"We're intentional about who we hire, who we keep. And retention is less costly than recruitment and turnover. Certainly, we're going to need these people when [the COVID-19 pandemic is] over, and so we wanted to make sure that we retain them," says UMC Senior Vice President of Patient Care Services Tim Howell, DNP. "They're part of us."

Yet, UMC experienced a slow-down in services as other hospitals and health systems did at the start of the pandemic.

"In March, the model said we would have a surge in May, which didn't happen. The emergency center census dropped [around] 50%, and [we experienced that] all over the building. We had units that didn't have a whole lot of census," Howell says.

"We expected a surge of patients beyond our capacity. The various models were giving us various predictions with regard to what our surge would look like. To date, that really has never happened to the degree that it was predicted, and so that's good for us."

Three-part plan

To work around decreased operations in some sections of the hospital, and increased operations in others, the health system came up with a cross-training plan. The approach was to take staff and cross-train them or move them to other areas of the system based on past and current work experience. There were three phases.

"There was a lot of opportunity to redeploy people," Howell says. "And so, we did that to take care of our staff."  

Phase 1: Redeploy intermediate care and med-surg nurses

"The elective procedures stopped. That was a large, significant part of our census, and so these nurses needed a place to work," Howell says.

The first phase "was [a] ramp-up between the intermediate care and the med-surg floors."

• Intermediate care nurses were cross-trained to help in the ICU
• Med-surg nurses were cross-trained to help in intermediate care
• Nurses were also redeployed to perform patient temperature checks at care location entrances
• Nurses were cross-trained to provide support at a community call center, where they would answer questions from the community about COVID

Phase 2: Redeploy procedural unit nurses

"The next phase was [redeploying] the procedure folks who no longer had elective procedures. We investigated their history. Let's say they were an OR nurse that came from an intensive care unit, so we would send them back to the intensive care unit for training and get them ramped back up to be able to help in that scenario," Howell says.

Phase 3: Redeploy the nonclinical workforce

"The third phase is we took the nonclinical people—[the] case managers, performance improvement nurses, nurse education department, those kinds of people. Typically, they had history of clinical experience, and so we tried to match that [and] reoriented [staff] to go in and help [in those departments]," Howell says.

"As far as the percentage [of] COVID patients in the building, the top number was around maybe 20% of our population," Howell says. "We have a large medical ICU, which is 32 beds. We augmented it with staffing to try to keep the patient ratio low. We also deployed nurses in there to make sure we had 'dofficers.' "

The dofficers helped clinical staff with donning and doffing PPE. This was to ensure the clinical staff were "not leaving anything exposed, and when they came out of the COVID rooms, they were sprayed down with solution on their uniform," Howell says. "There are also runners as well, [to] run and get something that was needed in the room, so that nurses [didn't] have to come in and out a lot."

Financial rescue program

If a staff member couldn't be redeployed, UMC offered a financial Rescue Program that CEO Mark Funderburk created to help staff during COVID. If all positions were filled and "[the staff member] couldn't find a place to work, then we would guarantee they would maintain 75% of their salary for PTO augmentation as needed," Howell says. "Once the employee exhausted their PTO bank, the hospital made certain they received 75% pay for what they were normally scheduled."

One hundred twenty-five employees out of the 4,600 employees utilized this program, totaling $29,173.48.

Due to operations slowing down during COVID, "we lost quite a bit of money because of just the monthly operations," Howell says. "But we were paying our employees through savings."

"Our service culture really set us up to respond. Because we are a county hospital, we certainly take care of a lot of co-funded care. With our customer service culture, we have a lot of attraction for patients with insurance as well. Over the years we've done pretty well in that regard. I think we can respond or weather any storm that comes," Howell says.

4. Build Upon Existing Initiatives to Expand Virtual Care

Like many health systems across the country, Advocate Aurora, headquartered in Downers Grove, Illinois and Milwaukee, needed to dramatically increase its telehealth utilization due to the COVID-19 pandemic. What helped its ability to expand virtual health capacity was the groundwork it had laid down prior to the pandemic.

"Virtual health was always one of our four landmark initiatives that we've been focused on as an organization. We had a goal of completing 25,000 [telehealth visits] … for the entire year," says Advocate Aurora Chief Marketing Officer Kelly Jo Golson.

When the pandemic hit, the health system "began to see the numbers surge, as many of our colleagues across the country have seen," Golson says.

As of early October, the health system has "over 4,000 providers and clinicians that are providing virtual visits now" and they "have now completed 750,000 virtual visits," Golson says. "It's quite astonishing." The number of virtual visits include "any type of care [in which] a visitor has been seen through virtual means," which could be video, telephone, or email.

The health system's new telehealth visit goal is 770,000 for the year. "I would not be surprised if we surpass that, but we continue to push our flag up the pole as we're seeing the numbers continue," Golson says.

A number of steps were taken to enable the health system to increase its telehealth visits. "Some of the things we had started before the pandemic, and we certainly have accelerated and expanded," Golson says.

• Launching the "Live Well" app. "We wanted virtual health to be a seamless, integrated experience, so one of the things that we had launched—and has now grown by leaps and bounds—is a single digital ecosystem. So, our Live Well app was created," she says. The app, which has almost 500,000 app users to date, gives patients the opportunity to keep track of communication from the health system, as well as receive virtual care through the app.
•  Embedding virtual care within Advocate Aurora's delivery model. "We pivoted from a more APN-powered model for quick care virtual visits into embedding them into our medical group and expanding into scheduled and specialty care," Golson says. "By capturing real-time user experiences, we were able to uncover barriers to use the technology and create tutorials for both consumers and clinicians that addressed those barriers."
• Integrating video capabilities within the health system's portal.
• Partnering with its government affairs team to work on telehealth reimbursement. "That's something that's been an important barrier to remove," Golson says.

According to the HealthLeaders 2020 Telehealth Survey, of 144 healthcare executives who were surveyed about what the biggest obstacle is to implementing telehealth at their organization, 44% say reimbursement is their top barrier.

"Reimbursement continues to evolve, and we feel it is important that our consumers continue to have covered access to this important healthcare modality to both manage and improve their health and wellness," Golson says.

Through a partnership with its government affairs team, the health system has "been able to remove some of the pressures and expand reimbursement around virtual visits. And we feel like that's vitally important that continues; that has to be a mainstay going forward," Golson says.

"Our government affairs team was able to quickly tell the story of consumers and importance of virtual care during the pandemic. As we have all seen the adoption of virtual care expand not only by consumers, but by clinicians, our government affairs team has been able to share the importance that this coverage continue as it has proven to be a key part of the future of health and wellness," she says.

Investment costs in technology

"Our technology investments were made in early 2020 as part of our larger consumer-first strategy," Golson says. "This foundation allowed us to expand our [virtual health] resources for 24/7 access and paved the way to scale the program."

The health system first invested in its technology team, including "cloud engineers, digital architects, all of those type of technology roles, [to create] that team that allowed us to innovate, and transform, and create in the technology space," she says.

The organization also invested in data and analytics on the front end that "inform a lot of what we're doing," Golson says. It also made investments for the creation of the Live Well app.

"There's several different channels of investment in technology and innovation that have enabled our go-forward strategy," Golson says.

Telehealth expansion and training the providers

In January, the health system already had about 300 providers performing virtual health visits. "When we were starting the year, the focus for our virtual visits was [on] what we were calling 'quick care visits.' It was for those low-acuity cases where consumers or patients would call in and be seen in an on-demand virtual appointment," Golson says. "What we shifted to was truly embedding the virtual visit into our care delivery model."

"Early on, some of our clinicians were a little resistant," Golson says. There was some worry around whether the patients would be willing to adapt, and whether the physicians would be able to make the same connections with the patients through technology as in person.

"It's significant change. In the early stages, we were finding consumers were more apt to adopt into trial than perhaps our clinicians were. And that's really flipped," Golson says. "Now, as you can see from our numbers … we've been able to advance due to the partnership and the adoption of our clinicians."

This was an important change "because even early on, when consumers were telling us they were willing to trial, when we would ask them what's the No. 1 thing that would cause you to be more willing or more likely to select a virtual visit, [it] was almost always having it being recommended by their physician. They wanted to know that their physician trusted this is a source."

To expand physicians' telehealth use, the health system was able to "activate clinicians through our two medical groups in Illinois and Wisconsin," she says. "We have a multidisciplinary task force within our broader consumer-first effort and it is heavily populated by our clinicians. They became the ambassadors to tell the story of virtual across our entire enterprise. Partnering with those clinical ambassadors is how we onboarded.

"A lot of the [physician] training was done through webinars, so we were using our virtual capability to do that training [and] to onboard them. It was a heavy partnership with our HIT, our consumer-first team, and our medical group," Golson says.

"Our existing team of talented physicians and APNs rallied around this new method of care as COVID forced us all to reimagine how, when, and where we provide care to our patients," Golson says. "While there will always be times and conditions that require in-person visits, our team has integrated virtual visits into their daily practice model as a way to enhance care for their patients."

Implementing personalized communication best practices

To help patients adopt and understand telehealth, Advocate Aurora provides personalized communication.

"When it comes to communication best practices," Golson explains, "the ability to deliver a personalized message and have individuals inform us on the best modality to use to give them that information is absolutely best practice. … Depending on what they're using the virtual visit for, the messaging looks a little bit different. Are they using it for a pediatric visit, is it for behavioral health, for a primary care for follow-up? Our goal is to be able to push that communication and the preferred modality of the consumer to receive it. They might have already told us that they prefer to get an email, a phone call, a written letter, so we're used to all of the above.

"One of the critical things was making sure that we had a platform that allowed us to be efficient and agile. As we're running this parallel path of ensuring that we help all of our patients to remain healthy and help our community members live well, being able to get real-time information was critical. That was equally as important [as] ensuring that we had the process in place that we could push and get communication," she says.

Advocate Aurora's personalization also takes into consideration its markets in urban and rural communities.

"The strategy in the communication and how we educate and inform and provide outreach to these community members differs across all of our markets, because the ability for us to be personalized is so vitally important," Golson says. "What we're seeing is a closing gap based on communities where individuals live, as far as the adoption of virtual care."

When the health system was working on its mobile strategy, they "were concerned that maybe some of our rural communities were going to be slower to adopt to the digital mobile access points. And we actually found in some of those rural communities, it was the highest amount of adoption. So, I think that one of the things that we've seen is as technology has gone from needing to have a desktop at home or a tablet, now you can actually do something from your smartphone. It's opened up the world of possibilities across all the communities we serve," she says.

Telehealth's future

When asked whether telehealth will stick, Golson's immediate response is "absolutely."

"It's here to stay. The success has been seen, and our experience of the ease of use and the engagement with consumers, physicians, and clinicians has been so strong.

"The exciting thing is what that means for the ultimate health and wellness of patients—perhaps the patients that have been putting off care, perhaps patients with high-acuity disease that we're not getting into the office often enough, and perhaps this is something that allows our physicians and clinicians to stay connected remotely to patients to track progress and to help guide them on decisions in between those live appointments," Golson says. "It is an exciting time for possibilities for the future of health and wellness."