HealthLeaders Strategy Editor, Melanie Blackman, interviews Luis Garcia, MD, FACS, MBA, FASMBS, the president of Sanford Health Clinic. During the conversation, Garcia shares insights into his...
The innovation arm of Henry Ford Health is going national with DromosPTM, a tech platform designed to improve specialty pharmacy operations.
Henry Ford Health's innovation arm is going national with technology designed to improve specialty pharmacy operations.
Henry Ford Innovations has announced that the DromosPTM patient therapy management platform is now being used in seven health systems and specialty pharmacies across the country, and others are planning to integrate the technology in the months ahead.
“These partnerships allow increased functionality and provide patients across the country a better experience and care,” Lisa Prasad, the health system's chief innovation officer and leader of Henry Ford Innovations, said in a press release.
Developed in 2013 to help Henry Ford Health's own specialty pharmacy, Pharmacy Advantage, DromosPTM "fills a long-existing gap in the specialty pharmacy industry by offering efficient patient-focused care and service," officials said in the press release. It includes tools to help pharmacies take advantage of patient portals, find financial assistance for expensive prescriptions, improve medication monitoring, and identify best practices.
The licensing agreement for the technology is one of more than 30 that Henry Ford Innovations has enacted since its launch in 2011, representing more than $100 million in potential revenues for the health system.
Health systems and payers are forging partnerships with paramedics and other community health providers in mobile integrated health programs that bring home-based care to high-risk, high-expense patients.
The growing value of healthcare in the home is creating some interesting new partnerships for health systems and redefining the house call.
Sometimes called mobile integrated health (MIH) or community paramedicine, these programs give health systems and payers an opportunity to address gaps in care and reduce ER traffic by sending specially trained paramedics to the homes of selected patients—most often those identified as high-risk or who often call 911 or their doctor. Hospitals or health plans can partner with local fire or EMS departments to offer the service, train their own paramedics or contract with a vendor.
"It allows us to create an integrated system of care," says Patrick Mobley, president of Bright HealthCare, a six-year-old payer operating in 14 states, which launched a partnership in 2021 with MedArrive, a San Francisco-based startup offering MIH services. "We were looking for an in-home solution that provides more proactive care."
While each program is unique, most begin with a provider or payer identifying a population in need of home-based care – most often high-risk patients with chronic care needs who aren't following doctor's orders at home or so-called "frequent flyers," who often call 911 for non-urgent care needs and treat the ER as their primary care provider.
Once that population has been identified, a plan is drafted to send specially trained paramedics and/or home health aides to the home. These providers can perform primary care services and wellness checks, coordinate more specialized care, screen for social determinants of health, even just sit down and chat for a while with someone who's lonely.
"We're the glue between the patient, the provider and the payer," says Dan Trigub, who co-founded MedArrive in 2020. "Healthcare is a lot more than just acute care treatment. The continuity of care is absolutely critical."
Critics of these programs say the cost outweighs the benefits, and the challenge does lie in identifying the ROI and proving sustainability. Aside from patient engagement and improved health and wellness, payers and providers are balancing the cost of these programs against expenses tied to hospital and ED visits, as well as reduced hospitalizations.
In a 2021 study published in the Journal of the American Medical Association (JAMA), researchers at Canada's McMaster University analyzed some 1,740 calls by an MIH program operated by Niagara EMS (NEMS) of Ontario in 2018, and found the program reduced ED transports by roughly 50% (compared to emergency transports in 2016 and 2017) and slashed the mean total cost per 1,000 calls from roughly $297,000 to about $122,000.
"This economic evaluation’s findings suggest that MIH delivered by NEMS was associated with reduced ED transport and saved substantial savings of EMS staff time and resources compared with ambulance for the matched emergency calls," the study concluded. "This service model could be a promising and viable solution to meeting urgent healthcare needs in the community, while substantially improving the use of scarce health care resources."
California-based payer Molina Healthcare launched an MIH service earlier this year in Texas, also partnering with MedArrive.
"The mobile integrated health program will provide more efficient in-home care to members by bridging the gap between the hospital and primary care services, assisting in authorizations, ensuring medication reconciliation, and identifying social disparities that may affect care," Chris Coffey, plan president for Molina Healthcare of Texas, said in an e-mail to HealthLeaders. "Molina members currently have access to services that provide referral to in-home healthcare services; this program goes the extra mile in offering Molina members special after-hour access to Mobile Integrative Health (MIH) caregivers."
Coffey says the program helps Molina by reducing and preventing unnecessary ED visits and hospitalizations and ensuring that resources are directed to members who need them the most. It also allows members to be treated in the comfort of their own home, rather than travelling to a doctor or hospital.
Eventually, he says, the program will expand to other states, and could be broadened to address other populations, such as the elderly, and offer such services as remote patient monitoring, behavioral health and substance abuse care, and hospice care.
"The business model can be used for implementation of a variety of change management projects," Coffey says. "Mobile integrated health services are meant to challenge current systems that underserve populations, specifically elderly patients, and can be used to close quality gaps, provide non-emergency in-home assessments, vaccinations, education, and overall care."
In New York, the Arc of Rensselaer County, a residential support program for people with developmental disabilities, has launched an MIH service to give its target population access to primary care services at home. The organization is partnering with UCM Digital Health, which offers "a digital front door platform with a 24/7 emergency medicine treat, triage, and navigation telehealth service."
Don Mullin, the Arc's CEO, notes that the 150 or so patients they serve "have the same healthcare issues that we have," yet a trip to the doctor's office, clinic or hospital is much more challenging.
"We would be paying [ambulance or EMS services] to bring them to the ER, where they might spend five or six hours, and then they'd bring them back, and Medicaid would be charged for the entire visit," he says. "This reduces a lot of that time and effort and stress. We can see $300,000 a year in Medicaid savings alone."
In addition, he says, "a lot of the individuals we support have high anxiety. Going out into the community is a real challenge for them. And a phone call [with a doctor] isn't always great for folks who can't always communicate that way."
Mullin says the service, which sees about 150-175 visits a year, is coordinated with each patient's primary care provider.
"We've probably reduced primary care visits as well," he says. "That's another savings we haven't considered just yet. These savings are coming out of different pockets."
The Pip Care app, developed by a company spun out of the Pittsburgh-based health system, improves care management for patients before and after surgery.
Three UPMC hospitals will be testing out a new digital health app designed to improve care management for at-risk patients before and after surgery.
The app was designed by Pip Care, a new company spun out of the partnership between UPMC Enterprises, the innovation arm of the Pittsburgh-based health system, and Redesign Health. It uses what's called Enhanced Recovery After Surgery (ERAS) processes, workflows, and protocols to help patients prepare for surgery and manage their recovery at home after the procedure.
“Surgery can be incredibly difficult on a patient’s body; in some cases, it can have the same toll as running a marathon,” Aman Mahajan, MD, chair of anesthesiology and perioperative medicine at the University of Pittsburgh and executive director of UPMC Perioperative Services, said in a press release. “If we can help patients make healthier decisions – like losing weight or quitting smoking — before they have their procedure, then we can lessen their time in the hospital and speed up their recovery."
The app will be tested at UPMC's three Centers for Perioperative Care (CPCs), located at UPMC Shadyside and UPMC Presbyterian in Pittsburgh and UPMC Horizon in Greenville. The CDCs, which use multidisciplinary teams to help high-risk patients, such as those with chronic diseases, improve their health and wellness before surgery, account for some 10% of the health system's surgeries with inpatient stays.
The digital health platform could be a model for most pre- and post-surgery care plans, as it helps patients access resources, communicate with and share health data with their care teams, while allowing those care teams to better monitor patients after hospital discharge.
"It is a service that all patients could benefit from, not just those who are at a higher risk for complications," Mahajan said.
“While patients understand a planned surgery can reduce pain, improve mobility, and change their quality of life, questions and fears about surgical procedures can lead to delays or even no-shows," added Kathy Kaluhiokalani, founder and chief executive officer of Pip Care. "Having a personal health coach to guide you along each step of your journey is key to ensuring patients complete surgery with confidence and have a smooth recovery.”
The Seattle-based provider is now offering same-day telehealth appointments for a flat-rate membership fee in California and Texas.
A Seattle-based virtual care provider aimed specifically at the Latino population has expanded to California and Texas.
Zócalo Health, which launched in Washington earlier following a $5 million seed funding round, offers virtual care visits and care navigation services in what the company calls "an improved and long overdue healthcare experience built on trust, relationships, and culture."
Latinos experience disparate barriers to healthcare access, especially in primary care, where the average wait time to see a doctor is 24 days. This long delay, combined with fewer in-person appointments, high-deductible plans, and high out-of-pocket fees, results in many Latino patients avoiding treatment, using informal networks (family/friends), or waiting for hours in expensive emergency rooms to seek care.
The COVID-19 pandemic and resulting economic impact exacerbated health inequities for the Latino community, particularly when it comes to accessing high-quality primary care and preventative services.
Members can access various services and care options familiar in primary care settings, including evaluation of mental health conditions, preventative and lifestyle needs, chronic disease management, and more specific health conditions, as well as urgent care.
Zócalo Health's primary care model employs community health workers (CHWs)--known in the Latino community as promotores de salud. They're hired from the community to foster patient engagement and community health.
Company officials site research showing the crucial role of CHWs in connecting patients to local resources and care. They work one-on-one with members to coordinate care with a team of physicians, nurses, and mental health therapists, and connect members to useful resources across the community.
Once a relationship has been established with Zócalo Health, members have 24/7 access to care and can receive individual guidance on personal health goals and needs.
"As a kid, I remember the long waits in the community health clinic to see a doctor who often did not speak Spanish," Zócalo Health CEO Erik Cardenas said in a press release announcing the virtual care service. "I had to act as a translator for my mom about my own care and help her navigate next steps. I felt guilty that my mom had to take time off from work for my appointment and pay for any prescriptions or additional care needed. For my family, no work meant no pay, so a doctor’s visit was a heavy burden on everyone."
Zócalo Health memberships start at $40 per month or at a discounted rate of $420 a year when paid in advance. The provider has plans to expand to other states in 2022 and later.
Research by Brigham and Women's finds that more time spent on the EHR can improve primary care quality outcomes, but there's a fine line between the right amount and too much.
New research out of Brigham and Women's finds that more time spent on the electronic health record platform can improve quality outcomes in primary care, though providers still need to make sure they're not overdoing it.
As reported in the Journal of the American Medical Association (JAMA), researchers at the Boston-based health system tracked ambulatory quality measures for 291 primary care physicians affiliated with either B&W or Massachusetts General Hospital in 2021. They reported "significant associations between EHR time and panel-level achievement of hemoglobin A1c control, hypertension control, and breast cancer screening targets."
The research team, led by Lisa Rotenstein, MD, MBA, and Michael Healey, MD, both of Brigham and Women's and Harvard Medical School, and A. Jay Holmgren, PhD, of the University of California at San Francisco (UCSF), noted that they tracked EHR time not only during the day, but also after hours and during what is called "pajama time" (evenings and weekends). They also separated and tracked time spent on clinical matters and "in-basket" tasks.
"It is notable that among all metrics of EHR time examined, there was the greatest numerical association between daily time on the in-basket and daily time on clinical review and ambulatory quality outcomes," the study noted. "Although time spent on clinical review on the day of a visit can now be accounted and billed for under the 2021 Evaluation and Management coding changes, time spent on the in-basket is typically not compensated. Rather, in-basket work is performed in addition to visit-based, revenue-generating work, often outside of scheduled clinic hours. In addition to substantially increasing since the COVID-19 pandemic, time spent addressing in-basket content has been associated with an increased likelihood of burnout and intent to reduce clinical hours."
That said, Rotenstein and her team pointed out that more time spent on the EHR "may represent a level of thoroughness, attention to detail, or patient and team communication that ultimately enhances certain outcomes."
The challenge, then, is to find a balance between spending meaningful time on the EHR and ensuring it isn't negatively affecting care quality or the caregiver's health.
"These results underscore the need to create team structures, examine PCP and office workflows, and enhance EHR-based technologies and decision support tools in ways that enable high quality of care, while optimizing time spent on the EHR," they concluded.
In addition, Rotenstein and her colleagues wrote, "Future studies should seek to identify the specific work patterns that contribute to the associations we have identified and characterize payment strategies, workflows, and technologies that can facilitate PCPs delivering high-quality ambulatory care while minimizing EHR burden."
The New Orleans-based health system is seeing improved clinical outcomes in a pilot Medicaid program targeted at patients living with hypertension and type 2 diabetes.
Ochsner Health is reporting strong results from a pilot remote patient monitoring program targeting Medicaid patients living with type 2 diabetes and hypertension.
Billed as one of the first in the country, the program, coordinated by Ochsner Digital Medicine, saw nearly half of participating patients dealing with uncontrolled hypertension bring their blood pressure under control within 90 days, a 23% improvement over traditional care management. And almost 60% of those with poorly controlled diabetes were able to improve their blood-glucose readings and A1c levels.
“So meaningfully moving the needle among Medicaid patients with type 2 diabetes and hypertension is unprecedented," Denise Basow, MD, the New Orleans-based health system's first and current chief digital officer, said in a press release. “We are confident this program can be scaled to improve the lives of others across the state and around the country to mitigate the impacts of chronic disease.”
The RPM program was launched in June 2020 at Ochsner LSU Health Shreveport, and has enrolled more than 4,400 patients. Health system officials noted the program addresses a serious gap in chronic care management in Louisiana, where roughly 40% live with hypertension and 14% lives with diabetes.
RPM programs hold great potential in bringing care management out of the hospital, clinic and doctor's office and into the home, where providers can monitor a patient's daily health and habits and adjust care (including medication) accordingly. With digital health technology, they can capture relevant data to identify trends and support treatment plans.
Ochsner is one of the top health systems in the country with regard to digital health strategy, and has been gradually building out several programs on a national platform. Data from the RPM program could be used to support arguments to the Centers for Medicare & Medicaid Services (CMS) to improve Medicare and Medicaid reimbursement.
“As clinicians, we are always working to improve patient outcomes and the overall patient experience, and this program shows that we can use home-based technologies to accomplish both," Lauren Beal, MD, Ochsner's medical director of primary care and community clinics for northwest Louisiana, said in the press release.
One of the keys to a sustainable RPM program is sustainable clinical outcomes, and Ochsner officials noted that those living with hypertension continued to show positive results after 18 months. In addition, the program was well-received by patients, with a net promoter score greater than 91.
Ochsner officials said they'll continue to work with payers and employers to improve reimbursement, which would allow the health system to expand the program to other parts of the state and, eventually, other parts of the country.
“Over 30,000 patients have benefited from Ochsner’s Digital Medicine chronic disease programs,” Richard Milani, MD, Ochsner's chief clinical transformation officer and vice-chairman of the Department of Cardiology, said in the press release. “We're offering patients compassionate human care combined with the power of technology, and we’ll continue to expand these programs to help more patient populations.”
Recent wildfires are a fresh reminder of the value of the real-time dashboard, which allows health systems to manage resources and transfer patients as needed.
The wildfires flaring this week are a reminder that Oregon is one of the only states in the country with the technology to provide healthcare officials with a real-time, statewide dashboard of staffed hospital beds, ventilators, and resources such as negative pressure rooms.
For Staci Sparks, vice president of nursing at Asante, a three-hospital system in southern Oregon, the dashboard is a welcome tool. Just two years ago, the evacuation zone for one wildfire included Asante Rogue Regional Medical Center.
"At that point, we were trying to figure out if we need to evacuate people," she says. "There was nowhere else for them to go here. We were in a high-capacity situation, and we're somewhat geographically isolated. This system gave us a state look to see what hospitals had beds and capability, and where to get them to the right place."
Staci Sparks, vice president of nursing, Asante. Photo courtesy Asante.
The system was established in 2020, using GE Healthcare Command Center technology to address hospital capacity issues during the COVID-19 pandemic. With funding from the state, it has not only continued and grown past the peak of the pandemic, but was spun out of its incubator at Oregon Health & Science University to become Apprise Health Insights.
The company continues to seek funding from Oregon and the US Centers for Disease Control and Prevention (CDC), says CEO Andy Van Pelt, who also serves as executive vice president of the Oregon Association of Hospitals and Health Systems (OAHHS), under which Apprise Health Insights is operated as a for-profit subsidiary and data arm of the organization.
The real-time dashboard facilitates the quick transfer of patients to appropriate facilities as needed, and is gradually replacing the state's older tech platform. So far, Van Pelt says, the new system has automated 85% of the 300 data fields in the legacy system.
That migration speeds up all reporting, while freeing up staff previously dedicated to the manual reporting processes in the older system, he adds.
"The governance committee is made of health system patient coordination and patient flow folks that represent the seven trauma regions around the state of Oregon," Van Pelt says. "They meet regularly with the state, we come up with policies and procedures and workflows, and how and when the data can be used, and for what purposes."
Apprise Health Insights hosts the system and online dashboard, monitors all data feeds, and conducts all education and onboarding of users of the dashboard, he says.
And that's been a relief for Asante.
"Getting through the pandemic was a little bit easier than post pandemic, because there was this burning platform," says Sparks. The end of the staffed bed crunch "gave us some time afterwards to go back and say, how would we do this differently from a local perspective and also from a state perspective? And learn those lessons and apply them to other scenarios that could occur."
Part of that is understanding what a system driven by data uploads from electronic medical records can offer, and what its limitations are.
"Electronic medical records don't always have the best reputation in the industry," Sparks says. "In the future, we need to view technology as a tool, which is what it is. The intent is to make it easy to do the right thing for patient care, and to make it easy to do the right thing for our employees' workloads."
"This is really an exercise in trust building," Van Pelt says. "It creates an actionable data set that at the end of the day really impacts a patient's care [to make it] quicker, more efficient, and more appropriate. … During the Labor Day fires in September of 2020, we had to evacuate five hospitals in a 24-hour period. We were grateful to have the first version of this."
Andy Van Pelt, vice president, Oregon Association of Hospitals and Health Systems, and CEO, Apprise Health. Photo courtesy Apprise Health.
Apprise Health Insights is talking to about a dozen states about adopting this technology. In addition, Van Pelt says, Oregon Senator Jeff Merkley has introduced legislation to modernize real-time data for hospital data and emergency response nationwide.
Alaska's chief medical officer Ann Zink "is a good friend of ours and is looking at potential legislation to modernize capacity-type data around the country," Van Pelt says.
As for Sparks, the dashboard helps her grow into her new role as vice president of nursing at Asante, the first such vice president over the entire system.
"My learning curve has been steep for the first four months," she says. "It's doing more listening and observing than acting or decision making. In six or 12 months, that will shift. You need to understand what you're working with before you can ask people to make changes or before you can make decisions that really impact their work."
Jennifer Bollinger says healthcare organizations are paying too much attention to technology and not enough on the people and processes that make virtual care work.
To Jennifer Bollinger, the patient experience shouldn't be defined by technology, but by the value of interactions with the care team. For that reason, she's ditching the term "digital health" in favor of "connected health."
"Digital really isn't our strategy," says the senior vice president and chief consumer officer at Ochsner Health. "It is one of the key levers for transformative care, but it's just one part of [an equation] that includes people and processes. Connecting them and making those connections seamless and personal is our goal."
Bollinger's work in digital consumerism with the New Orleans-based health system highlights another underlying challenge as well: connecting with the consumer, rather than the patient. As healthcare organizations move toward value-based care, they need to look beyond the idea of connecting with patients of the health system and focus more on connecting with consumers of healthcare services.
That ecosystem is much larger and more complex, encompassing not only the individual moments that require healthcare interactions but the whole journey.
Jennifer Bollinger, senior vice president and chief consumer officer at Ochsner Health. Photo courtesy Ochsner Health.
"Consumers really don't know how to figure out that they don't want a lot of choices," she points out. "They want ease and guidance. They want someone to guide them."
In the midst of this shift from periodic to value-based care, healthcare providers have been undergoing a change of perspective as well. The emergence of telehealth and digital health tools and strategies has given the consumer more control over healthcare choices, which in turn has flooded the market with new healthcare locations and opportunities. Healthcare organizations can no longer sit back and expect the consumer to come to them; they need to reach out and market their capabilities, competing with other hospitals and health systems, health plans and telehealth vendors with their own providers, retail health clinics, and large companies like Amazon.
In this atmosphere, health systems have to see the consumer, or everyone within reach of their healthcare services, rather than the patient, or someone who has used their services. And the strategy is shifting from 'You're going to need healthcare services and here we are,' to 'We're better at this than the others.'
And part of being better is using technology to make healthcare more intuitive.
"The pandemic was certainly an enforcing factor" in identifying the value of virtual care, says Bollinger, noting the nationwide shift to telehealth and digital health tools to facilitate easier healthcare access at a time when in-person care was risky. And now that the pandemic is waning, she says, health systems are asking themselves, "Are we going to be able to cash the check that we wrote?"
At Ochsner, which has forged a path in digital health that goes back long before the pandemic, the key isn't highlighting these new tools and platforms, but showing their value. An RPM program works if it improves medication adherence and reduces trips to the doctor's office; a messaging program works if it boosts scheduled wellness visits or vaccinations or reduces no-shows for appointments; and a patient portal is effective if it channels patients to the right place without the need for extra clicks or a phone call.
On some of those occasions, "if I have to pick up the phone and talk to someone, something has broken down," Bollinger says. "Now there are times when talking to someone is a positive, but not when you're just trying to do something quickly."
In many cases, consumers already know about patient portals, messaging platforms, and virtual care, Bollinger notes, but they haven't seen how it can help them. The health system has to connect the dots.
"We've done a lot of 'one-size-fits-all solutions," she says. "Now it has to be made personal."
Bollinger points out that consumers have seen how technology improves the experience in other businesses, like banking, travel, and shopping. But how does that translate to healthcare? Making a bank deposit, planning a vacation, or buying a jacket isn't the same as conferring with a doctor about a health concern.
"It's sometimes hard to get them to articulate their expectations for healthcare," she says.
That's where connected health comes in, and where consumer strategy is important. Health systems need to focus not on the technology but on the people and processes that make it work. Instead of talking about the digital ecosystem of consumer tools, talk about the connections that these services offer with providers and care teams, and the opportunities those connections offer to improve health and wellness.
"We aren't paying enough attention to the up-and-coming generations," Bollinger says. "The pandemic offered them a lot of choices, and they’re taking advantage of that."
The Delaware-based health system's Helen F. Graham Cancer Center & Research Institute has received an award from the Association of Community Cancer Centers (ACCC) for a program that integrates cancer care with primary care.
ChristianaCare's cancer care program has earned national recognition for a unique program that integrates primary and cancer care.
It also addresses a gap in cancer care management spotted by the health system.
"We conducted an informal survey that found as many as 15% of our patients did not have their own primary care provider,” Cancer Program Clinical Director Cindy Waddington, MSN, RN, AOCN, said in a press release, which includes a link to a recent podcast on the program. “Having a primary care provider onsite working closely with the entire cancer care team helps ensure that essential patient care beyond cancer treatment is not delayed."
The health system pointed out that patients undergoing cancer treatment are often dealing with other health concerns, especially chronic issues like diabetes, heart problems, COPD, and high blood pressure, and that cancer treatment can exacerbate those issues. To facilitate comprehensive care, the program enables oncologists to refer their patients to primary care services for any non-cancer concerns.
"Primary care in oncology has been a long-standing challenge for cancer patients and cancer programs,” Family Nurse Practitioner Debra Delaney, RN, MSN, ACNS-BC, FNP-BC, who provides primary care services at the Graham Cancer Center, said in the press release. “Thankfully, we’ve been able to solve that challenge by addressing the whole person and promoting healthy living for the long-term.”
As part of the process, Delaney helps patients who finish their cancer treatments transition to a primary care provider for ongoing care management.
"Earning the prestigious ACCC Innovator Award for our primary care practice is an accomplishment that belongs to our entire cancer care team, which has worked long and hard to develop this unique program designed to improve our patients’ long-term health,” Nicholas Petrelli, MD, the Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute, said in the press release.
