Provider well-being has long been a critical challenge for Corewell Health West, a division of Corewell Health operating in Western Michigan. However, addressing this issue came to a head in 2023 as the organization navigated the post-pandemic era.
"Many of our providers were experiencing not just burnout, but many of them were looking to transition out of healthcare," Erin Inman, PharmD, vice president of primary health and regional specialties at Grand Rapids-based Corewell Health West, told Becker's. "We were seeing this trend nationally, and it was also evident in pockets of our organization."
With that in mind, team members, including leaders and providers, came together for a retreat dubbed "Project Reboot." It allowed attendees to discuss ideas, solutions or possibilities to better support provider well-being.
"We spent three days together and came up with three buckets that we felt might be areas in which we could develop tactics," Dr. Inman said. "One was in technology, one was in staffing and one was in workflows. All of those ideas brought forth different tactical ideas."
One of those ideas revolved around using workers and their talents, competencies and skills, and clinical expertise differently.
"We knew that there were organizations out there that were looking at how the arduous work of documentation could possibly be alleviated by different team members that could support our providers — both physicians and advanced practice providers — and we know that there are models out there, whether it's [Oakland, Calif.-based] Kaiser [Permanente] or [Salt Lake City-based] Intermountain Health, where they do use different team members to help in some of the [digital] in-basket work," Dr. Inman said.
"But what we wanted to do was to create something that could be sustainable, something that could live into the future."
The organization particularly wanted to lift some of the documentation burden related to patient medical advice requests, which increased from 600,000 messages a year to almost 3 million a year during the pandemic.
This prompted the launch of a pilot program in 2023 at two Corewell Health West primary care locations, which introduced a new in-basket triage system. Under this system, a registered nurse manages the initial triage, while an APP serves as an "inboxologist."
"We piloted an inbox model where in-basket messages — phone calls, patient advice requests, prescription requests, second-level triage requests, all of the MyChart messages that were coming in — would actually be triaged in two ways," Dr. Inman said.
"First of all, by an RN with clinical competency that would kind of scrub things, and anything that needed to go to a provider would then go to an APP pool. Anything that needed to be really handled by that individual provider would be that last level."
Corewell Health West's pilot program demonstrated significant success. Primary care providers managed 41% fewer in-basket messages than before the pilot and spent, on average, 47% less time on the messages they did receive, according to an article by Dr. Inman and colleagues published in NEJM Catalyst. Additional outcomes highlighted in the article include:
- A 37% decrease in average self-reported time spent on in-basket messages during office hours and a 32% decrease after hours.
- A 14.2% increase in the number of messages resolved by non-physician staff who initially triaged them.
- A 93% reduction in time to resolution for patient-generated messages, resulting in improved patient satisfaction scores.
Even with this success, Dr. Inman acknowledged the work involved and that there was initial skepticism from physicians. It took about three months for each practice to reach full stability with the program, and leaders within the organization spent time building the protocols needed to train RNs and APPs in the program. She said physicians also initially were skeptical about being asked to take on additional appointments to create better work-life balance.
While it is a trade-off, once their in-basket messages decreased, "they recognized that this was a service, a program that they could not live without, and that the ask to see an additional patient or two patients was not a big ask," Dr. Inman said. "And we built it that way with the intent to help cover the investment."
She noted that while physicians initially expressed skepticism about APPs managing their patient records, this concern was alleviated once they witnessed the effectiveness of the program and recognized APPs as integral care team members.
Given the success of the pilot, Corewell Health West plans to expand the program in 2025 to more than 50 primary care sites and selected specialty practices (supporting more than 400,000 patients).
"It's been such an incredible journey," Dr. Inman said. "I don't know that we would have done anything different because we've learned so much along the way."
"We let providers know on the front end, the work that was being done, how we were piloting it, how we would look to expand it. We were very clear and transparent in the very beginning around the need for additional patient volumes to support this. But that transparency was so important because then it did not feel like it was, we give something and we take something. It really felt like it was a partnership with the providers. We've continued to iterate, and there are things that we will continue to iterate on. But I don't know that I would have done anything different, because if we had, we might not have gleaned all of the good, rich learnings along the way. And when this is fully implemented, we'll continue to learn."