As the largest municipal healthcare delivery system in the United States, NYC Health + Hospitals operates an extensive integrated network of hospitals, community-based health centers, long-term care facilities, correctional health services, home care, and the MetroPlus health plan. The system serves as a safety net to over a million New Yorkers annually, offering comprehensive, personalized care across 70+ locations in all five boroughs. With a deep commitment to addressing social determinants of health and advancing health equity, their team is dedicated to ensuring that healthcare is accessible and affordable for all. 

eVisit proudly serves as a technology partner of NYC Health + Hospitals. In our recent webinar, Erfan Karim, AVP of Mobile Integrated Health and Executive Director of ExpressCare at NYC Health + Hospitals, shared insights into the success of the Virtual ExpressCare platform. Erfan was recognized as a 2024 Modern Healthcare Innovator Award honoree for his leadership of the initiative since its launch in early 2020.

Virtual ExpressCare leverages eVisit’s virtual care solution to offer New Yorkers round-the-clock access to prompt, confidential, and comprehensive physical, behavioral, and reproductive care within minutes. With over 90,000 urgent care virtual visits annually, NYC Health + Hospitals has implemented innovative strategies to reduce avoidable emergency department (ED) visits, minimize unnecessary ambulance transports, and bridge critical access gaps in historically underserved communities. 

Addressing Language and Digital Barriers

Erfan discussed the need to enhance the healthcare experience for patients while reducing the impact of barriers to access, including language or digital literacy. Powered by eVisit, Virtual ExpressCare offers 24/7 access to timely and appropriate care in over 200 languages, expanding access to underserved communities. 

Erfan highlighted eVisit’s role in providing multiple entry points for patients to connect, such as audio/video and audio-only phone calls. These options cater to patient populations who are not familiar with smartphone technology or lack broadband access—an issue affecting approximately 30% of NYC households, particularly among Black, Hispanic, low-income, and senior communities. ExpressCare and eVisit have developed strategies to guide patients through their health literacy journey, seamlessly converting from audio to video visits as needed. 

NYC’s linguistic diversity underscores the critical need to address language barriers that often prevent patients from connecting to a healthcare professional. NYC Health + Hospitals facilities have key healthcare information available in the top 13 languages spoken across NYC. Erfan Karim described how a proactive approach guarantees accessibility to vital information—from medical consents to discharge instructions—for all patients, irrespective of their primary language. 

eVisit’s robust technology allows clinicians to swiftly add professional interpreters from preferred partners, covering over 200 languages—including ASL—to virtual visits. Erfan Karim emphasized the continued need to integrate diverse language service providers into workflows, ensuring comprehensive support at every step of the patient journey. The increased visibility of professional interpreters ensures more effective, equitable, and culturally responsive services that keep New Yorkers safer and healthier. 

Innovative Staffing

Erfan also highlighted the importance of optimizing staffing to meet patient needs efficiently across NYC Health + Hospitals’ ExpressCare program.

“The only thing that’s important is that interaction between that patient and that physician or clinician,” Erfan emphasized. “That’s what all of this is about. How do we make that painless? How do we make that shine in a way where the physician and the patient doesn’t feel overwhelmed?”

Utilizing data-informed projection methods, staffing levels are adjusted dynamically to match demand to virtually cover vast geographic breadth of New York City. The bunkered staff model, with multiple concurrent providers and support staff per service line working remotely, not only improves efficiency but also enhances provider satisfaction and retention. 

Erfan highlighted that in a hypothetical scenario where all of these interactions were in-person, the system would need two to three times more staff. As demonstrated during the height of the COVID-19 pandemic, hybrid and remote models proved the most efficient and allowed NYC Health + Hospitals ExpressCare to flexibly allocate resources to serve all New Yorkers.  

Emergency Department Impact 

Erfan discussed how the Virtual ExpressCare program is a valuable solution for diverting lower acuity cases away from ambulances and overwhelmed EDs. NYC Health + Hospitals serves over 1.2 million New Yorkers annually, including a substantial number of uninsured and underinsured individuals. Its emergency departments are among the busiest in the nation, often facing challenges such as longer wait times for less emergent cases, as priority is given to more urgent situations like trauma or heart attacks.

Consider this scenario: it’s 10 p.m., and someone is experiencing a cold, cough, or dental pain without access to their primary care physician or urgent care. They call 911 for medical attention. Instead of dispatching an ambulance immediately, NYC Health + Hospitals has partnered with the city to route that 911 call to Virtual ExpressCare. Many times, a trip to the ED can be avoided, resolving the issue via a virtual urgent care visit. This approach prevents unnecessary ambulance transports, freeing them up for higher acuity situations like heart attacks or strokes.

During a Virtual ExpressCare visit, providers can determine if an ED trip is necessary and call for an ambulance when needed. For non-emergent cases, alternative transport options such as taxis or for-hire vehicles can be utilized. Additionally, patients discharged from the ED are informed about Virtual ExpressCare for future non-emergency situations.

Erfan emphasized optimizing healthcare processes and enhancing patient-doctor relationships by making interactions “quicker, better, and stronger.” By integrating these innovative solutions, NYC Health + Hospitals aims to improve patient outcomes, reduce unnecessary ED visits, and ensure timely care where and when it’s needed.

Service lines on ExpressCare 

With an average wait time of less than 5 minutes and access in over 200 languages, Virtual ExpressCare offers timely care to all New Yorkers. 

Erfan Karim highlighted the program’s ability to provide immediate access to clinicians for assessments, thereby preventing care delays and addressing critical access challenges. The service allows patients to access high-quality care on their terms in a comfortable, private setting — whether it’s their home, a public library, a shelter, or another partner-established location.

Virtual ExpressCare’s diversified offerings cater to the varied needs of New Yorkers, providing timely access to essential physical, behavioral, and reproductive services: 

• Virtual Urgent Care: Patients are connected to an emergency medicine-trained physician within minutes from any location for an initial assessment, determining if they need testing, long-term care, or emergency transport.
• Behavioral Health Services: Services expanded to include 24/7 access to psychiatrists, social workers, addiction counselors, and support staff for brief interventions, assessments, and stabilization, including treatment for substance use disorders to meet patients’ needs when they are ready.
• Reproductive Health: An initiative was launched last year to make sexual and reproductive health more accessible, particularly in underserved neighborhoods. Patients receive a full assessment, make informed decisions with providers, and have medication kits mailed to their homes within 48 hours.

“We think about how do we interact with that patient,” Erfan explained. “How do we get them to be engaged with our providers, and how do they do it in a manner where we don’t take too much out of their busy lives.”

Centering patient engagement is at the core of NYC Health + Hospital’s approach. Erfan Karim highlighted the importance of enhancing patient-provider interactions while minimizing disruption to their daily lives. By eliminating the need for patients to take time off work, spend money on transportation, or delay their initial appointments, the Virtual ExpressCare program ensures equitable access to high-quality, patient-centered care. 

Interested in learning how more health systems are utilizing virtual care across the enterprise? Our Virtually Integrated Care series includes Banner MD Anderson (virtual oncology), UPMC (telestroke), and Variety Care (increasing rural care access). And if you’d like to schedule a call with our team to discuss some of your virtual care goals for the year, we’d love to hear from you. You can schedule a call with our team right here.