The NICE nurse program helps bring new grads into critical care, says this nurse leader.
On this episode of HL Shorts, we hear from Dr. Natalie Nicholson, associate chief nursing officer at Denver Health, about the impact of travel nursing and how the health system is supporting staff. Tune in to hear her insights.
Healthcare leaders are eager to move services out of the hospital and into the home, but many aren’t taking into account how they impact patients and caregivers.
Amid the move to patient-centered care, healthcare organizations are moving more services and programs out of the hospital and into the patient’s home. But are they really putting the patient at the center of that care platform?
“Is the home ready?” asks the president and chief impact officer of the Rosalynn Carter Institute for Caregivers. “Most of us would say, ‘Gosh no, not at all.’ They want to take care of (a patient) at home, but the home isn’t ready. And it’s hard even when you’re not [talking about] acute care.”
Fueled by the promise of remote patient monitoring and the acute care at home (or Hospital at Home) strategy, healthcare leaders see the home as a better place than the hospital room for many patients to recover from treatment. Armed with studies that show that patients heal faster and better at home than in the hospital, they’re crafting programs that include everything from digital health and telehealth technology to in-person visits from nurses, doctors, and specially trained paramedics. Some of the more advanced acute care programs include multiple daily visits and technology designed to bring the ICU experience into the home.
But Bhatt says patients—and their family members are caregivers—aren’t prepared for that type of activity in their homes.
Paurvi Bhatt, president and chief impact officer, Rosalynn Carter Institute for Caregivers. Photo courtesy Rosalynn Carter Institute for Caregivers.
“As we know, when you enter anybody's household, no matter what part of the world you're from, you're in someone else's culture,” she says. “The way we organize taking care of each other changes household by household. It's not the same as hospital room by hospital room. There's standardization that needs to happen for clinical outcomes that need to somehow meet with the reality of what might happen at home.”
For example, care teams might not be familiar with cultural, religious, even family practices or habits, not to mention a patient’s own preferences on everything from sanitation to meals to the daily routine of favorite TV shows. Any disruption in those routines can have a negative effect on patient engagement and satisfaction.
And that can affect clinical outcomes. Patients who are disturbed by the commotion around them might not be so inclined to follow doctor’s orders, or they might rush through things just to get everyone out of the house. And already-stressed family members and caregivers might be even more stressed by the intrusion.
To be sure, the home is an intriguing care location, and any health system that doesn’t have a strategy that encompasses home-based care is behind the curve. Earlier this year, a survey of 1,000 U.S. adults and sponsored by digital health company Vivalink found that more than 80% had taken part in some sort of care at home program, 84% said they’d do it again, and 77% said they’d trust their doctor’s recommendation to take part in such a program.
The challenge, Bhatt says, is getting people to think outside the hospital.
Healthcare leadership needs to stop planning these programs solely from a clinical perspective, she says, and look at how the home, its occupants and even the neighborhood are impacted. They need to include patient and caregiver advocates in planning and bring patients and their caregivers into the conversation prior to going into the home.
“Now that the clinical outcomes are starting to demonstrate some value,” Bhatt says, “[let’s bring a] different set of people to the table now and say, ‘OK, now let's look at this.’”
This strategy goes hand-in-hand with identifying and addressing social determinants of health, a popular strategy throughout healthcare these days. A hospital may send someone to the home to assess SDOH, looking at whether the home has broadband and if there’s enough food in the refrigerator, but they too often focus on barriers and pay little attention to how the home—and home life--can shape healthcare delivery.
For example, how can the care team accommodate a patient’s wishes and work with family members and care providers to coordinate activities? How can a care plan be modified to better include family members and caregivers? And what can the hospital do to make sure this program doesn’t create more stress at home?
“Half of the reason why caregivers are unseen is because they believe it's part of their duty to their family,” says Bhatt, who is advocating for a federal Office of Caregiver Health. “We've got to pay attention to them, because if they're not right there and we're not aware of what phase of caregiving are they in, we're going to lose that connectivity.”
Those questions will need to be answered as home-based care programs, such as Hospital at Home, evolve. These strategies may not get much-needed support from payers and the federal government if they end up causing more distress in the home and fall out of favor with the people they’re designed to treat.
“I'm convinced it can work,” Bhatt says, “but I I'm worried about what might happen if we don't start to plan what the [problems] might be and think creatively about how we can [address them].”
Kathy Driscoll, MSN, RN, NEA-BC, CCM, September 27, 2024
New digital tools provide efficiency and better clinical data for nurses while empowering patients with easy access to their health information and their clinicians, says this CNO.
Editor's note: Kathy Driscoll, MSN, RN, NEA-BC, CCM, is the senior vice president and chief nursing officer at Humana.
In recent years, we have witnessed significant advances in technology that have reshaped the health care industry and particularly improved the home health landscape. Innovations such as telehealth services and remote patient monitoring assist health care practitioners in their daily tasks and help extend the reach of care to underserved and hard-to-reach communities.
In a time of persistent workforce shortages, gaps in access to care and increased complexity of care, technology has proven vital to expanding care delivery methods, benefiting patients and providers alike.
Going mobile
For example, CenterWell Home Health’s PRIME wound management program began piloting a new mobile app in 2021 to help its nurses more accurately track a patient’s progress on wound recovery. The app includes software that measures a wound's length, width and depth, improving the consistency and reliability of this task.
As use of the tool became more commonplace, the clinicians began to recognize the need for certain changes and additional features, such as simplifying the user interface and adding a rear-camera “selfie” mode – in cases when photographing a patient’s wound from the front of their tablets was difficult. We shared these recommendations with the company behind the app, who is now working to implement them. This made our clinicians feel heard – and thereby empowered.
One of the significant benefits resulting from these advances is that home health nurses can now spend more time caring for patients rather than being consumed by administrative work. For instance, voice-to-text technology has revolutionized documentation by enabling health care professionals to convert speech instantly into text, speeding up record-keeping and ensuring more accurate patient records.
Clinicians are also leveraging the potential of mobile health applications and remote monitoring devices to help improve quality of care delivery and treatment management. These tools track patient health metrics in real time, enabling health care providers to monitor a patient’s condition continually and respond promptly when problematic changes are detected.
Portable noninvasive monitoring technologies help provide detailed insights into patients’ health without the need for invasive procedures. These technologies are particularly beneficial for patients in rural or underserved areas, helping ensure that geographical location does not compromise quality of care. This helps providers streamline their processes, aiming to limit any lapses in communication from the clinic to the patient’s home that could affect treatment.
Transformation through telehealth
The widespread adoption of telehealth has also dramatically transformed the health care landscape, proving its essential role in care delivery during the COVID-19 pandemic when traditional face-to-face interactions were limited. Telehealth platforms can benefit care delivery in the home, making more frequent interactions between provider and patient possible and enabling better management of chronic diseases.
Features such as virtual visits and remote diagnostics enhance care without the need for physical travel. As telehealth technology continues to evolve, its role in supporting patient engagement and optimizing health care resources can significantly improve patients’ access to care.
These digital tools provide efficiency and better clinical data for nurses while empowering patients with easy access to their health information and their clinicians. Stronger patient-provider relationships develop when patients feel in control of their health, which facilitates more personalized care tailored to the individual’s needs.
Good physician-patient communication can ultimately lead to improved patient health due to factors such as increased comprehension, stress reduction and increased compliance. With ongoing innovation and the thoughtful integration of new tools—complemented by nurses' skills and their human touch—we can improve the quality of patient care, creating a more effective, patient-centric health care system.
Editor's note: Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at payer and provider organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content.
Digital health supporters say there’s no evidence of fraud in RPM programs, refuting an OIG report that calls out the fast-growing digital health strategy for misuse.
The federal government’s call for more oversight of remote patient monitoring (RPM) programs isn’t sitting well with digital health advocates.
Following a report this week from the Office of the Inspector General (OIG) hinting at a possibility of fraud in requests for Medicare reimbursement in RPM programs, the Alliance for Connected Care has criticized the “inaccuracies and subjective nature” of that report and called on the OIG to retract it.
RPM is one of the fastest growing programs in the country, popular with health systems and hospitals looking to monitor patients outside the hospital, clinic or doctor’s office. Its growth is tied to two factors: Medicare reimbursement, which began in 2018 when the Centers for Medicare & Medicaid Services (CMS) began coverage for “remote physiological monitoring” (and later for “remote therapeutic monitoring”), and the pandemic, which gave many healthcare leaders a reason to expand telehealth and digital health efforts into the home.
In many cases the ROI for RPM programs is still murky, and Medicare reimbursement is a crucial part of the sustainability and scalability puzzle. Continued growth, especially among smaller health systems and hospitals, will most likely be tied to governmental and payer support.
According to the OIG, RPM use soared tenfold from 2019 to 2022, from 55,000 Medicare enrollees to more than 570,000. As a result, Medicare reimbursement increased from $15 million in 2019 to more than $300 million in 2022, with increases in both the number of enrollees using RPM and the average payment per enrollee.
However, the OIG says 43% of the enrollees in RPM programs aren’t meeting the three requirements for Medicare coverage: (1) enrollees must receive education and assistance setting up the device; (2) the device used must be FDA-approved and internet-enabled, with providers collecting data at least 16 of every 30 days; and (3) enrollees must be part of a treatment management program, in which the provider reviews the data and makes care management decisions.
According to the OIG report, both OIG and CMS have raised concerns that RPM programs are being conducted fraudulently, particularly by digital health and telehealth companies, and CMS doesn’t have any way of identifying how that fraud is taking place.
“In both traditional Medicare and Medicare Advantage, providers use general procedure codes to bill for remote patient monitoring that indicate only which component of remote patient monitoring was provided (e.g., the device or treatment management),” the OIG report stated. “The codes do not include more detailed information, such as the type of device.”
“This lack of transparency limits CMS’ ability to ensure that remote patient monitoring services meet requirements,” the report continued. “For example, without additional information about the types of health data being monitored, CMS cannot ensure that it is paying for remote monitoring of physiologic data (as opposed to nonphysiologic data) as required. The lack of this information also inhibits CMS's ability to assess the effectiveness of remote patient monitoring and make any necessary changes to coverage in the future.”
Those conclusions don’t sit well with the Alliance for Connected Care. In a letter sent Tuesday to Inspector General Christi Grimm, alliance founder Krista Drobac, a partner at Sirona Strategies, listed five inaccuracies with the report and another four instances where she said the report demonstrates bias.
Among the errors, according to Drobac:
The OIG says there is no order requirement for RPM, but that requirement is included in Medicare’s 2021 Physician Fee Schedule as well as in guidance from Medicare Physician Contractors.
There is no CMS requirement that an RPM device be “internet-connected.”
CMS has not officially adopted the 16-days-in-30 data collection rule as a requirement, and said in the 2024 Physician Fee Schedule that it was not a requirement to receive Medicare reimbursement under CPT codes 99457 and 99458.
In addition, Drobac said the OIG report suggests that fraud is being committed when there is no evidence of any wrongdoing. She notes that the surge in RPM use from 2019 onwards is based more on the fact that reimbursement began in 2018. And she urged the agency not to repeat the same mistake with RPM that it has done with “telehealth fraud,” which is more of a telemarketing issue than a telehealth issue.
“There is no context about fraud in the Medicare program,” she wrote. “In the same year that the entirety of RPM claims were $311 million, the false claims alone in Medicare were $31.2 billion. That tells a different story than the misleading headline and pull-out statements in the report. If we applied the fraud amount in the rest of the program of 3-10%, the fraud in RPM would have been between $9.3 million and $31 million in 2022. That’s less than .01% of the fraud in Medicare.”
“We would be happy to work with you on designing and recommending tools to address the real fraud that is happening in the Medicare program,” Drobac concluded. “Better control of inappropriate Medicare enrollment, solicitation, and prescribing while instituting stronger monitoring and audits to ensure fraudulent providers are caught sooner and weeded out of the system.”
Health systems and hospitals are taking a closer look at how they impact the environment. At Valley Children's Healthcare, that begins with a giraffe-shaped microgrid and a 'Green Team'
While innovation strategy is often focused on improving the health of patients and providers, it's ironic to think that the healthcare industry is a major contributor to the decline of the planet's well-being.
Healthcare facilities are among the largest consumers of resources—hospitals alone represent only 7% of all healthcare facilities yet are responsible for almost 70% of total healthcare electricity use. According to the National Academy of Medicine, the healthcare industry accounts for nearly 20% of the GDP, and is responsible for about 8.5% of all carbon emissions in the U.S.
With that in mind, a growing number of hospitals are taking a closer look at how they impact the environment. And they're taking steps to become more environmentally friendly, with strategies that affect everyone from the CEO and CFO down to the cafeteria worker.
Formerly called the Children's Hospital of California, the Madera, California-based health system broke ground this past weekend on a microgrid project that's designed to meet the U.S. Department of Energy's Better Climate Challenge goals of cutting greenhouse gas emissions in half by 2030 and lead to net-zero emissions by 2050.
The microgrid, which includes solar panels, fuel cells and battery storage that will allow the hospital to generate, store and distribute electricity, was financed in part from Inflation Reduction Act tax credits, with benefits over the long term in reduced energy costs. It's expected to cover 80% of Valley Children's Healthcare's energy needs when it becomes operational in 2025 and save about $15 million in energy costs over the next 25 years.
It's also in the shape of the hospital's mascot, George the Giraffe. And that nod to creativity is what's helping to generate enthusiasm for a strategy that affects everyone.
"It brings with it a lot of energy," says Barry.
Danielle Barry, SVP and chief operating officer, Valley Children's Healthcare. Photo courtesy Valley Children's Healthcare.
In more ways than one. Barry says the hospital began its environmental journey in 2022 with a focus on energy resiliency. With a coverage area of 11 counties and an increasing number of wildfires and rolling blackouts threatening operations, leadership wanted to make sure the power would always be on. At the same time, they wanted to have more of an impact on how that power was generated and how it impacted the environment for their young patients.
"This ties into our mission statement to help children live healthier lives," Barry notes. "It's more about wellness and keeping kids healthy."
That feeling isn't limited to pediatric hospitals. A recent report in Nature Climate Change, published by researchers from the Dana-Farber Cancer Institute, finds that both patients and providers are concerned about the environmental impact of healthcare, and they're interested in considering environmental factors when discussing treatment options.
"Our findings point to the need to better educate physicians and health professionals about changes they can make, as well as those they can advocate for within their institutions, which benefit patients but also are less toxic to the environment," Andrew Hantel, MD, who co-authored the study, said in a recent news report. "The goal isn't to shift the burden of climate-informed healthcare decisions onto patients, but to engage with them on these issues and make sure they're a normal part of conversations with their doctors."
And at Valley Children's Healthcare, that begins with the microgrid.
"The microgrid will offer us operational expense savings related to how we procure our power," Barry says. "And that's dollars that we can invest right back into our operations and taking care of kids."
Going Green: A Team-Based Approach
While the microgrid is integral to that strategy, it's part of a multi-phased approach. Valley Children's has also launched a 'Green Team,' comprised of employees from all corners of the organizations, including clinicians, janitors, IT and finance people and cafeteria workers.
Barry says they had no difficulties filling out the Green Team.
"We found a number of team members who really have a passion for this journey, and they have really taken off with creating the plan and the goals related to that work," she says.
Their mission is to take a look at hospital operations from the viewpoint of consuming resources, setting baselines and goals for each department. They've looked at how to reduce the use of gas in the OR, methods for reducing waste—especially plastic and paper—throughout the campus, composting food waste, even finding uses for used coffee grounds. They've even started their own garden and put the focus on using food from local farms.
Barry says she and others involved in the program have to weigh each new strategy or program against the budget. Saving the environment and providing a better future for the kids might sound terrific on paper, but those efforts do come with a price tag.
"Not every idea gets adopted," she says. "With some of them, the cost outweighs the benefits, so we prioritize."
Next Up: Tackling the Transportation Conundrum
The third phase of the program will be even more ambitious. Valley Children's Healthcare will be looking at transportation issues, including their fleet of vehicles and how staff get to and from work each day. Can transports and other delivery services be changed to reduce the number of trips taken? Should the health system switch to electric vehicles? Could shuttle services or other mass transit strategies be combined with scheduling changes to reduce the number of staff driving to work alone each day? And can people be convinced to change their driving habits?
"Some of this will be challenging, because we're talking about culture change," she says. "But that's also what makes it exciting."
That strategy also intersects with the health system's increasing use of telehealth, which studies have shown can have a positive impact on environmental goals.
"Any opportunity to keep a kid closer to their home is something that we're always seeking to be able to do," Barry says.
Barry says she had to learn "an entire new study of information" to understand the ins and outs of environmental stewardship in healthcare, including the number of federal and state agencies that figure into every new idea or program. But that type of innovative thinking, she says, is common in children's hospitals.
"I think because pediatric healthcare does not oftentimes represent a large enough slice of the pie for … government payers or private payers or others, we've had to be very creative and out-of-the-box thinkers," she says. "How do we continue to thrive and survive for the kids that are our future? How do we continue to be innovative in that space?"
There might be a surplus of registered nurses, but a shortage of others, according to this report.
Nurses in particular have felt the impact of the workforce shortage in the past few years, and CNOs have been working nonstop to recruit and retain the best talent possible to bridge the gaps.
However, the numbers seem to be shifting, depending on the profession.
Here are the predictions for the nursing workforce, according to a new report by Mercer.
Denver Health is experimenting with a hybrid work model for nurse leaders, says this CNO.
On this episode of HL Shorts, we hear from Dr. Kathy Boyle, chief nursing officer at Denver Health, about how new staffing models are impacting recruitment and retention. Tune in to hear her insights.
Disruptors are more than the market failings of retail giants. On this episode of the HealthLeaders podcast, Finance Editor Marie DeFreitas is joined by Rick Hinds, Senior Vice President and Chief Financial Officer at UC Health and a HealthLeaders Exchange member to discuss market disruptors.
Nursing and the expectations of the job have changed drastically in recent years, and CNOs need to understand why to pivot their strategies.
Many things have changed in healthcare in the past few years, since the beginning of the COVID-19 pandemic and the implementation of new technologies and workflows.
Recruitment and retention have become increasingly more difficult for CNOs and other nurse leaders, as both new graduate nurses and tenured nurses are leaving the workforce at alarming rates.
According to the American Nurses Association, almost 18% of newly licensed registered nurses (RNs) quit their jobs within the first year. A 2024 study found that new graduate RNs are leaving for a multitude of reasons, including their age, health status, supervisor and peer support, job demands, job competence, organizational commitment, job satisfaction, and work environment.
Why are nurses leaving?
Melanie Heuston, chief nurse executive at the WVU Medicine and HealthLeaders Exchange member, explained several additional reasons for this departure from the workforce, including the attitude toward nursing on social media.
"Social media has not been our friend," Heuston said, "I think it's absolutely been a place where people can talk about the negative and not necessarily the positive."
Heuston recommended that health systems focus more on social media and use strategies to improve the nurses' experiences.
"I do think that we as leaders need to own the work environment and I think that there's been some bullying in nursing, which I'm not proud to say," Heuston said, "but it's there, and we've got to get strategies to get that under control."
Heuston also cited the nursing shortage, and how more nurses are necessary to create a better work environment.
"It's a little bit of a chicken and egg problem," Heuston said, "you need more nurses to make the work environment better, as it's one of the ingredients."
According to Gloria Carter, vice president and chief nursing officer at St. Mary's Medical Center, and HealthLeaders Exchange member, another contributing factor is the prioritization of work-life balance.
"It's not just the new nurses, I think overall individuals have learned about having resiliency and focusing on work and life balance," Carter said. "I think when you look at it from that lens, there are individuals that are saying 'I need to be mindful and take that time out for me.'"
Changing expectations
Additionally, there has been a generational shift in what to expect from nursing as a profession, according to Heuston. New generations of nurses want to take advantage of new technologies to advance their nursing practice.
"They want the ease of technology," Heuston said, "and we need to be better at responding to that."
Along with many other organizations, Heuston said that WVU Medicine has piloted virtual nursing to support their nursing staff.
"I like to actually call it virtual patient care, so nurses don't believe we're replacing nursing, we're trying to support it," Heuston said. "It's warmly received by newer nurses. In fact, they're starting to expect it."
Heuston also explained that new nurses want to have a supportive environment where nurse leaders check in frequently and deliberately, and provide feedback.
"Generationally, I think that is more the expectation," Heuston said, "to get a lot of feedback, both positive, and what we need to do to improve."
Building resiliency
CNOs are in the position to bridge the gaps between new expectations and the realities of nursing, which involves building resiliency among new graduate nurses while also improving the work environment.
Now more than ever, according to Heuston, nurse managers have been acting as coaches and counselors due to more generational anxiety and depression caused by the COVID-19 pandemic.
"I think equipping [nurse managers] with better tools to be in that role, because they weren't trained to be in that role," Heuston said, "I think we could do better at getting more resources for them to be better."
For nurses, Carter said it's all about having awareness and accessing your support systems.
"It's also [about] connecting within the community and networking with your friends and family, and just bringing awareness and being open to having the dialogue about what you need individually," Carter said. "Then also being a part of that solution in terms of communicating for others that may be having similar challenges."
St. Mary's Medical Center has implemented a wellness app that nurses can use to track physical activities, such as walking, strength training, and other exercises, and obtain nutrition recommendations and other wellness practices that focus on mental and physical well being.
"Participants receive points that accumulate for submission for a reward card of their choice," Carter said.
Heuston suggested using podcasts, since many nurses engage with that medium rather than old fashioned communication methods.
"I'm very interested in doing [a podcast] with a younger generational nurse who can help to educate me on the needs of the workforce," Heuston said. "I think it's [about] being open to all the wellness support that we can offer our staff other than just a relaxation room where they don’t even have time to go, or putting structures in place where they can go there and feel like they can recharge."
This is part one of a two-part series. Part two will be published Monday, September 30, 2024.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Health systems and hospitals are facing competition from retail companies and other so-called disruptors. Executives at a recent HealthLeaders virtual summit explained how they’re addressing that challenge with new programs that meet patient needs and preferences.
How are health systems and hospitals reacting to increased competition? They’re pointing out that no one does healthcare better than your own doctor and nurse.
And while companies like Amazon, Walmart, and Walgreens are seeing mixed success in penetrating the market, they are highlighting inefficiencies in traditional care and pushing healthcare’s decision-makers to embrace concepts like on-demand virtual care and online scheduling.
“We’re competing on convenience, access, experience, cost—all the things that traditional health systems typically struggle with,” said Diedra Kramer, vice president of consumer strategy for Sutter Health. “So I think we’re going to have continue to adapt and change to keep up.”
Kramer and Haddas Lev, associate chief operating officer for ambulatory care services and COO of community health services for Denver Health, took part in the HealthLeaders Disruptors & Retail NOW online summit this past week. Both said their health systems are facing pressure to improve care delivery through patient-centered care, but that pressure is coming more from patients than disruptors.
The conversation targeted a key innovation strategy for healthcare organizations across the country. Consumers are dissatisfied with their healthcare experience to the point that they’re abandoning the traditional primary care provider and seeking on-demand care from non-traditional sources, be it a retail-based virtual care program, a telehealth vendor or a stand-alone clinic.
To keep their patients and stabilize the bottom line, healthcare leaders are embracing consumer-facing care and borrowing certain tactics from other industries, such as retail, banking and travel.
“There are many options for non-traditional healthcare,” said Lev, whose health system serves roughly one quarter of Denver’s population and handles one of every three births. “Many of them are offering really low-cost care with the added benefit of convenience.”
“Healthcare is different,” added Kramer. “But the reality is that our consumers’ expectations are being shaped outside of healthcare, and they’re bringing these expectations to us.”
“Consumers (will) consider, select and stay loyal to something that’s the easiest to navigate, interact and transact with,” she said.
Taking the Friction Out of Healthcare
Both Lev and Kramer said their health systems are embracing strategies aimed at creating frictionless care, using digital health and telehealth technologies that reduce time spent scheduling and waiting for care.
At Denver Health, Lev says the school-based telehealth program, with 19 health centers in public schools across the city offering medical, dental and behavioral health services, is meeting a critical need for healthcare services among school-aged children. And the virtual urgent care program launched a few years back is seeing 10% to 15% growth each year.
And at Sutter Health, Kramer says an online patient scheduling platform has made it easier for patients to make appointments with their care providers, reducing no-shows and cancellations.
These strategies, Kramer said, requires alignment across many departments, including marketing, call center operations, digital health, patient experience and of course clinical care delivery. Likewise, Lev said, a direct-to-consumer (DTC) telehealth strategy requires its own infrastructure, with input on marketing, education, staffing, education and ongoing maintenance.
Lev said health systems must balance the need to be forward-thinking with the concern that these new ideas and technologies cost money, might not be reimbursed and won’t really catch the attention of picky consumers.
“You want to [be] at the forefront and innovative in those spaces, but you don’t necessarily want to be the Guinea pig every time,” she said.
For example, she said, some physicians are using asynchronous (also known as store-and-forward) telemedicine tools to support virtual visits, but Colorado’s Medicaid program isn’t reimbursing for those services. That puts pressure on the health system to decide whether it’s worth the extra money.
“We have to figure out what the ROI is as a whole,” she said. “If we’re able to see that ROI regardless of the reimbursement model, that might be sufficient. But if this becomes a bigger part of our business rather than a supplemental service, … reimbursement for care may be necessary.”
Helping Patients and Providers
And while consumer-centric or patient-facing is all the rage, every health system is dealing with workforce shortages and staff stress and burnout. Few clinicians want to hear that a new tool requires “just one more click,” or that these advances will give them time to see more patients.
“If you’re bringing forward a consumer-first offering or approach, you can’t add burden to your care providers,” Kramer said.
To that end, she said, new programs have to benefit the provider as much as the patient. A virtual care program has to balance patient needs with provider workflows—a challenge that retail companies and other non-traditional entries into the healthcare space might not consider.
New programs like online patient scheduling and AI tools to clean up in-basket messaging should be designed not only to improve convenience and access to care, but take pressure off of providers to handle administrative tasks. In that way they’ll not only improve patient engagement and satisfaction, but also give clinicians more reasons to embrace them.
“That’s something that we’re challenging ourselves to continue to do, to look for those win-wins and make sure that we’re supporting both our patients as consumers and our care teams,” Kramer said.
As the healthcare industry evolves toward value-based care, both Kramer and Lev said they’ll be looking at a care platform that includes collaboration and addresses not only current care needs but health and wellness. That might include partnerships and programs that address housing, nutrition, exercise, even family services.
“Maybe [we’re} partnering with organizations that we wouldn’t necessarily have thought to partner with previously,” Lev said. “We want to address not only their healthcare but their barriers to healthcare.”
At the end of the day, both Lev and Kramer said healthcare leadership has to remember that they’re the experts in delivering care. They have a trusted relationship with patients and the knowledge of how to deliver care, rather than marketing care as a retail product, alongside dryer vents and shower curtains.
“The advantage of the incumbent or actual systems is that we are best positioned to change and transform and actually disrupt healthcare because … we’re connected to our patients,” Kramer said. “They want the connected experience that’s integrated into the system, and we can deliver on that.”
