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When planning, collaboration and crisis merge - a medical practice's successful response to COVID-19

When the COVID-19 public health emergency hit New Jersey in 2020, Vanguard Medical Group (Vanguard), a primary care practice with 10 offices in northern and central New Jersey, was in a unique position to quickly adapt and respond to the crisis. A busy provider group treating more than 67,000 patients a year, Vanguard identifies two key areas that helped them successfully manage the crisis: disaster recovery planning that began the prior year, and their foundation as a value-based partner. The practice had the infrastructure, relationships, data and technology in place to not only stay open and treat patients, but also to work with the state to distribute the COVID-19 vaccines.

A little planning goes a long way

Little did the practice know that when they began disaster recovery planning in 2019 for a potential flu epidemic and natural disasters like hurricanes, they'd face a worldwide health crisis like COVID-19 just a year later.

“It's not the plan, it's the idea and how you practice the planning. It's doing the exercises that prepares you,” said Thomas McCarrick, MD, Vanguard Medical Group. “What we did was small compared to the size of the actual problem. COVID-19 is not something you can predict. We didn't have huge foresight, but our planning certainly prepared us to take action and take care of our staff.”

The staff's disaster recovery planning included preparing for possible issues with communications, staffing, infrastructure and technology. They asked themselves various what if questions such as “What would we do if we had to shut down” or “if our staff was unable to work?”

Vanguard also had been working on developing telemedicine capabilities.

“We had seen a need for telemedicine and had a goal to be able to do 10 to 15 percent of our visits through telemedicine. We were already going in this direction. The pandemic accelerated this and the payment model changed to allow this to happen,” said Dr. McCarrick.

Vanguard's planning prepared the practice to quickly shift to crisis response mode and problem solve more effectively. Vanguard made a commitment to stay open and continue to see patients. Because they had prepared for a flu epidemic, they had enough personal protective equipment to keep their staff safe until they could secure additional supplies.

Also, due to Vanguard's telemedicine planning, they were able to care for 85 percent of their patients with telemedicine visits during the initial peak of the crisis, between March 2020 and June 2020, before patients started going back into the office.

“It was fortunate we were doing these things and were proactive about them. We turned telemedicine on within days,” Dr. McCarrick said.

Vanguard also made several hundred “COVID kits,” each containing a pulse oximeter and thermometer, to give to patients who tested positive for COVID-19 so they could self-monitor their oxygen saturation and temperature at home.

Once COVID-19 testing became available, the practice was able to provide needed testing to patients through their relationships with labs. When rapid testing became available, they purchased five testing machines and set up drive-through rapid testing sites outside their offices.

Later in 2020, in anticipation of giving out the COVID-19 vaccines when they became available, Vanguard practiced giving flu shots outside, successfully offering drive-through flu vaccinations in their offices' parking lots.

From testing to vaccinating

Early in 2021, when the state began accepting applications from health care providers for the New Jersey Vaccination Program, Vanguard had an edge. As a Horizon BCBSNJ value-based partner, the practice had significant experience monitoring, treating and coordinating the care of high-risk patients with diabetes, heart disease and other health complications. And as a patient-centered practice, Vanguard had the infrastructure, data and technology required to identify and reach out to these high-risk patients. The practice would be able to leverage its technology, used to identify gaps in care with high-risk patients who have co-morbidities, to identify vulnerable patients with medical issues who would be at higher risk if they contracted COVID-19. This capability was a strong selling point for the state.

“We were approved for our detailed capabilities, as a primary care practice that pays attention to population health and knows how to prioritize patients,” said Dr. McCarrick.

The state looked at Vanguard to vaccinate not only it's own patients but also others in the community, starting with front-line personnel, followed by people with high-risk medical issues. Vanguard was able to reach out to first responders, police and firefighters through their community relationships. The fact that Vanguard could target and reach first responders and so many of their own patients, and that those who would be getting vaccinated already knew and trusted Vanguard, were added benefits.

Vanguard exemplifies how value-based care looks at population management and focuses on patient care in holistic and multi-faceted ways.