Variety Care is Oklahoma’s largest Federally Qualified Health Center (FQHC) and community health center, with 20 sites across central and western Oklahoma. Their team is committed to providing quality care to patients at every stage of life, regardless of income, residency status, employment, health insurance coverage, or ability to pay for services.
Services include family medicine, pediatrics, behavioral health, dental care, optometry, women’s health, urgent care, and pharmacy services. Variety Care is a recognized patient-centered medical home and has an Accountable Care Organization (ACO), serving approximately a thousand Medicare patients.
At eVisit, we proudly serve as Variety Care’s technology partner, building virtual care initiatives together. In our recent webinar, we heard from Dr. Lydia Nightingale (Vice President of Medical Affairs) and Robb Wetmore (Director of Digital Healthcare). Our conversation centered on addressing access challenges in rural communities, building custom workflows based on provider staffing models, achieving provider and executive buy-in for virtual care programs, and what to look for in a technology partner. This blog post is a recap of our conversation and if you’d like to view the full webinar, it’s available for download here.
Health Access in Rural Communities
During our Virtually Integrated Care webinar series, we’ve heard from health system leaders discussing rural care access challenges like geographic distance, the financial strain of buying gas, taking time off of work, or the challenge of bringing other family members to the visit (from different geographic areas). We asked Dr. Lydia Nightingale how the Variety Care team is leveraging telehealth as part of their care delivery model to combat these challenges.
Dr. Nightingale highlighted Variety Care’s strategic response to rural care access challenges, particularly regarding staffing issues. Variety Care operates both metro and rural clinics in Oklahoma and faces the common difficulty of attracting and retaining medical professionals in less populated areas.
An example is their Anadarko clinic, where a long-serving provider recently left, creating a potential patient care gap. Variety Care turned to telehealth solutions, enabling patients to continue receiving care from metro-based telehealth providers like Dr. Qin, who specializes in family medicine. Dr. Nightingale emphasized that while telehealth may not always be the preferred option for patients, it has become a vital tool for ensuring continuity of care during transitional periods.
Variety Care is also working to raise awareness among rural patients about the availability and benefits of virtual care, emphasizing its role in providing timely and equitable access to care where and where communities need it.
Which programs/service lines are seeing high adoption?
Robb Wetmore shared that behavioral health achieved the highest rate of telemedicine utilization, a trend that has continued strongly after the pandemic. Family medicine has also demonstrated success, with some clinics fully embracing the technology and one provider being dedicated solely to telemedicine services. Challenges persist in other primary medical areas, such as pediatrics and women’s health. Robb highlighted that the organization is actively exploring innovative solutions to effectively conduct virtual physical exams and determine which types of visits can be managed through telemedicine.
Dr. Nightingale highlighted the cultural and operational challenges of integrating telehealth. Despite Variety Care’s young workforce, there is notable resistance to adopting new technology in clinical practice, driven by a need for a shift in organizational culture. Early adopters in various service lines have effectively demonstrated the tangible benefits of telehealth to their patients and colleagues—such as reduced burnout, lowering costs, and enhancing overall satisfaction. Dr. Nightingale shared her personal experience of initial skepticism to preferring telehealth due to its convenience and efficiency.
By breaking the care delivery model into smaller components and assessing which aspects are suitable for virtual care, providers can continue to enhance workflows and seamlessly integrate telehealth into existing processes. This approach not only addresses immediate workforce challenges but positions Variety Care to better meet the evolving needs of its providers and patient populations.
Patient Experience – Addressing Digital Literacy and Connectivity Issues
In rural areas, technology can present its own set of challenges, particularly regarding digital literacy and connectivity issues. Dr. Nightingale highlighted a creative approach by a care manager who, when faced with a patient who was uncomfortable with telehealth, sent a community health worker to assist. This hands-on support not only addressed immediate concerns but also aimed to build the patient’s comfort with telehealth for future use.
Robb Wetmore described how Variety Care replicates the in-person experience as closely as possible within the eVisit platform. When a patient enters the virtual waiting room, they first interact with a front desk agent who handles tasks like collecting copays and verifying insurance. One of the main tasks early on was to troubleshoot technology issues, which was crucial to ensuring digital readiness and smooth connections. Variety Care is also working to expand digital readiness within the communities they serve, partnering with local organizations to improve digital literacy and broadband access and provide safe, private spaces for virtual visits.
Choosing a Virtual Care Technology Platform – Partnership is Essential
“The very first conversation I had was not a sales call whatsoever,” Robb Wetmore said. “It was, ‘What are your team’s needs? How can we support you with that?’ It was the beginning of and the creation of a partnership.”
For Robb, like many of the health system leaders we speak with, he was looking for a technology partner who wanted to solve challenges together and could deliver on:
1. Subject matter expertise in telemedicine delivery
2. Workflow creation
3. Operational acceptance
As an Epic shop, the Variety Care team had the bonus of working with two project managers on the eVisit team, both with significant Epic experience.
Dr. Lydia Nightingale noted that, despite the heavy lift transitioning to Epic and adapting to new technologies at the time, it was eVisit’s commitment to quality improvement and alignment with patient care goals that was highly valued. She emphasized the importance of minimizing additional tasks and paperwork so that providers can focus on patient interaction.
Robb underscored the need to thoroughly understand each role within the workflow, including providers, MAs, and other support staff, to ensure streamlined coordination and top-of-license time. Having a seamless integration with Epic and a flexible and user-friendly interface has been crucial for eliminating inefficiencies and aligning virtual workflows with in-person practices.
Building Provider-Friendly Virtual Care Workflows
Dr. Nightingale emphasized the importance of minimizing additional tasks and paperwork so that providers can focus on patient interaction.
“Anything you can do in a workflow that makes life better for the provider is a win,” Dr. Nightingale explained. “If you add extra steps to a workflow, are gonna be out from the beginning. When I do an eVisit, I just get on and I see the patient. And that is what you want.”
How should health systems ensure the providers’ perspectives and expectations are built into the virtual care workflows?
Robb Wetmore underscored the need to thoroughly understand each role within the workflow, including providers, MAs, and other support staff, to ensure streamlined coordination and top-of-license time. eVisit’s seamless integration with Epic and its flexible and user-friendly interface has eliminated inefficiencies and aligned virtual workflows with in-person practices.
The technology partner needs to work right alongside the health system replicating the in-person workflow and provider experience to a virtual visit.
Change Management: Provider & Executive Buy-in
With any big technology change, there will always be some level of resistance and fear of the unknown. Here’s how Dr. Nightingale and Robb Wetmore achieved both provider and executive buy-in for their new technology initiatives.
Executive Buy-in
Dr. Lydia Nightingale emphasized that successful change management requires a deep understanding of the cultural shifts needed, particularly for those accustomed to long-standing practices. The key is to shift cultural attitudes and make new methods, like virtual care, a primary option rather than a last resort. Dr. Nightingale also stressed the significance of identifying and supporting early adopters who can champion new initiatives.
With the executive team, it’s important to focus on key metrics such as provider burnout, retention, quality outcomes, patient satisfaction, and framing change as solutions to systemic challenges. The more data that can be collected on these specific metrics, the better.
Provider Buy-in
Both Dr. Nightingale and Robb Wetmore, MHR encouraged health systems to stay motivated by the core mission of healthcare—providing high-quality care to patients—while being open to innovative solutions that can enhance care delivery. They emphasized the importance of collaboration to ensure that all stakeholders feel engaged and supported throughout the process.
Robb Wetmore advised organizations to not just focus on implementing new tools but to understand the specific problems they aim to solve. He underscored the importance of partnering with experts who know the landscape and can guide effective program development, cautioning against being swayed by superficial sales pitches. Thorough research and solving specific problems with the right programs and partners are essential for long-term success.
Interested in learning how more health systems are utilizing virtual care across the enterprise? Our Virtually Integrated Care series includes NYC Health + Hospitals (virtual urgent care), Banner MD Anderson (virtual oncology), and UPMC (telestroke). 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.
