Failure to streamline AI in the clinical setting could result in missed opportunities that healthcare leaders can't come back from.
In today's fast-paced healthcare environment, it is crucial for healthcare executives to stay ahead of the curve and embrace AI technology to ensure the highest quality of care for their patients.
AI has the potential to revolutionize healthcare by streamlining processes, improving patient outcomes, and reducing costs. From diagnosing diseases to predicting patient outcomes, AI can help clinicians make more informed decisions and provide better care to patients.
Failure to streamline AI in the clinical setting could result in missed opportunities for improving patient care, increasing efficiency, and reducing errors.
As the healthcare industry becomes increasingly more complex and data-driven, AI is no longer a luxury but a necessity for hospitals and health systems to remain competitive and provide the best possible care to their patients.
What the clinical leaders are saying
Clinical leaders must act quickly and decisively to integrate AI into their institutions, leveraging its power to enhance clinical decision-making, optimize workflows, and ultimately save lives.
In fact, healthcare is continuing to see clinicians embrace and get more comfortable with AI to ease workflows, boost the flow of patient and provider data, and improve quality of care and outcomes, Peggy Duggan, MD, executive vice president, chief physician executive, and chief medical officer of Tampa General Hospital previously told HealthLeaders.
"The important steel thread here is the 'why,' which for our physicians and team members at Tampa General Hospital is the delivery of the highest quality care possible," she says.
Clinical documentation is an example of a key area for AI adoption, Duggan says. There is a lot of work physicians do that is not value added but is required to advance care, so incorporating AI into documentation continues to offer an opportunity to free up clinicians to spend more time with patients and directly provide care, she says.
Managing data is another area where AI can boost healthcare, Duggan says. "It's critical that provider-level data flows freely, as well as patient and system-wide data, so AI will be able to help us identify more opportunities to improve patient care," she says.
AI will also continue to be used more frequently to guide clinical decision-making, Duggan says.
"At Tampa General Hospital, we are already piloting data-driven technology that supports the proper choice of antibiotics and pathways that prompt when antibiotics can be decelerated," she says. "These are great tools to support our teams while ensuring that a large volume of data—especially at a large academic health system treating some of the most complex conditions—doesn't overshadow a salient data point, which could drive not only safer care but also the delivery of the right care at the right time."
AI is likely to make major advancements in healthcare next year, says Ghazala Sharieff, MD, MBA, corporate senior vice president and chief medical and operations officer for acute care at Scripps Health.
"We recently had a retreat with a two-hour session on AI. The radiologists are asking to use AI more as they are doing their diagnostic readings. Telemedicine made a big splash during the coronavirus pandemic, and AI is the next big thing for healthcare," she says.
What are the next steps?
The time to embrace AI in healthcare is now, and the consequences of inaction could be detrimental to both patients and providers.
That is why HealthLeaders is introducing a new track of this first-of-its-kind national program HealthLeaders Mastermind: Clinical AI, to bring together leading health systems to share what they have learned about utilizing AI in the clinical space.
This event is currently underway and there are still a few spots open. E-mail exchange@healthleadersmedia.com if you would like to be considered for this one-of-a-kind program before it fills up.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Clinical AI Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program.
Nurses must figure out how to burn bright and not burn out, says this nurse leader.
Shakira Henderson, PhD, DNP, MS, MPH, EMBA, IBCLC, RNC-NIC, was born and raised on a small Caribbean Island, where she says she developed a deep appreciation of academics from an early age. Dr. Henderson holds dual doctoral degrees, PhD and DNP, and master's degrees in business, public health, anatomical sciences, and advanced nursing practice with a sub-specialization in nursing education. She also holds undergraduate degrees in biological sciences, chemistry with a minor in microbiology and nursing.
Dr. Henderson now serves as the University of Florida College of Nursing’s sixth dean and chief administrative officer. Additionally, she is the associate vice president for nursing education, practice and research, and holds the position of system chief nurse executive for UF Health. She has worked for the past two decades to promote and implement sustainable integration of clinical research and clinical operations with an equity lens within health care systems. Her research focus areas include leadership, breastfeeding and global health.
On our latest installment of The Exec, HealthLeaders sat down with Dr. Henderson to discuss her journey into nursing, and her thoughts on trends in the nursing industry. Tune in to hear her insights.
Prescription drug rebates were once a good idea. Not any more.
Editor’s Note: Sandra Clarke is the EVP and Chief Operating Officer of Blue Shield of California.
What happens when you squeeze a balloon? While the air inside shifts away from where you put pressure, the total air volume is still trapped inside. Prescription drug rebates largely work the same way: Rather than removing excess costs from the system, rebates often shift costs from one area to another.
And like an opaque balloon, it’s impossible to see what’s happening inside the drug pricing system.
Rebates exemplify drug pricing’s unfairness, lack of transparency, and limited competition, because they can enable runaway list prices and hidden fees, resulting in higher member costs and a false sense of savings.
Traditionally, pharmacy benefit managers (PBMs) negotiate drug prices with drug manufacturers without providing visibility into the process, the actual costs or hidden fees they collect. As part of this negotiation, PBMs and manufacturers agree to a rebate amount (and often fees) that the manufacturer will pay the PBM on prescriptions for the manufacturer’s drug covered by the PBM’s clients based on the drug’s list price and the volume dispensed.
Where rebates went off track
Ideally, rebates should lower costs for health plans, employers and members. Instead, they have morphed into a system that frequently does the opposite. Misaligned incentives, opaque markets, information asymmetries and barriers to competition have resulted in a dysfunctional system that does not generate fair prices or value for patients.
Rebates now often result in the use of higher-cost drugs with higher out-of-pocket costs for members instead of clinically equivalent, lower-cost medications. They are often given for expensive, branded drugs prescribed at high volumes.
Brokers, consultants, and health plans do not have visibility into how drug prices are set, only the understanding that the more a rebated drug is used, the bigger the rebate check. Health plans and employers have limited insight into whether they’re paying a fair price or getting the best value. Further, rebate offerings claimed as transparent often do not disclose hidden fees.
Are rebates worth saving?
While some in the pharmaceutical ecosystem say rebates are worth saving, I believe they are largely a trap. The data suggests that rebates are raising medication costs, not lowering them. Rebates are positively correlated with increased list prices, according to the Leonard D. Schaeffer Center for Health Policy & Economics. The Schaeffer Center found a $1.17 list price increase for every $1 rebate increase.
Sandra Clarke, EVP and Chief Operating Officer at Blue Shield of California. Photo courtesy Blue Shield of California.
With my background as a health plan CFO, a pharmaceutical company head of finance, and other executive healthcare financial roles, I know that the numbers and incentives don’t add up. It’s time to pop the balloon and do away with most rebates in their current form.
Forget rebates: Try these options instead
Manufacturers deserve to make a fair profit. They should be rewarded for contributions that help patients receive innovative and life-saving medications.
Instead of using rebates, I suggest two more equitable ways to compensate manufacturers:
Net price: The net price model delivers value by promoting direct negotiations with manufacturers and establishing a fair net price for the drug. It generates savings by lowering the list price and removing intermediaries' fees, while enabling more transparency and lowering barriers to competition. This model is better for employers, plans and members, as each stakeholder knows exactly what they are paying for. This more transparent pricing may not change the cost of every drug but would make a difference for many.
Value-based pricing: Some newer payment models focus on a value-based approach to reducing costs while increasing transparency and maintaining quality and safety for consumers. A qualified third party evaluates the drug’s efficacy compared to alternatives, and considers related costs and savings. Adding a fair margin for the manufacturer, the price then reflects the treatment’s overall value based on efficacy and relevant costs.
Another option: Adjust the price should the drug not work in a real-world setting as it performed in clinical trials. Other countries already widely use value-based pricing, and the model is increasingly popular in the United States. One study showed that in 2021, 56% of health plans had at least one outcomes-based contract in place. Value-based medication pricing is best for expensive specialty drugs and others with high price tags, when the effectiveness and health benefits are more variable.
Popping the balloon
Just moving the air inside a balloon doesn’t reduce its volume, and the same goes for drug rebates. To achieve real changes, healthcare needs to remove unnecessary costs from the system to provide savings.
Eliminating counterproductive rebates is one step, but not the only one. We need several new, innovative ways to make drug pricing more transparent and ultimately, more affordable. Making the pricing system simpler and more transparent can lead to lower costs and healthier patients, helping create a more sustainable health system overall.
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.
The latest in digital therapeutics features a new device that uses Ai to scan a patient’s sinuses and create an acoustic vibration, delivered through a headband, to reduce nasal congestion.
AI is being touted as the biggest new thing since the printing press, a technology that can clear up healthcare’s administrative headaches and improve clinical outcomes. But can it also help cure a stuffy nose?
Digital health company SoundHealth has announced De Novo authorization from the U.S. Food and Drug Administration for SONU, a digital therapeutic device that uses AI-enhanced “acoustic vibrational energy” to relieve nasal pressure. The San Francisco-based company can now market the device to consumers aged 22 and older.
“Acoustic vibration associated with humming has been shown to decrease symptoms of nasal congestion, possibly through modulation of autonomic inputs to the nasal mucosa or through nitric oxide activity, which may in turn exert a decongestant and anti-inflammatory effect on the nasal passages,” the company said in its press release.
According to a 2021 Harris On Demand survey, roughly one of every four Americans suffers from nasal congestion on a daily basis, and 85% of those with chronic nasal congestion say it impacts their daily activities. Aside from the discomfort of a stuffy nose, nasal congestion can also lead to sleep problems, headaches, coughing, and a sore throat.
The device may interest healthcare providers who, wary of the addictive nature and side-effects of nasal sprays and drugs, have been looking for alternatives to traditional medication-based treatments, including digital therapeutics.
The SONU device combines innovative new technology with an ages-old therapy.
“It's based on the really old understanding that when we hum or sing or whistle, our sinuses open, and we also feel very relaxed,” Jacob Johnson, MD, president of San Francisco Audiology, an ENT specialist with the San Francisco Otolaryngology Medical Group, and an associate clinical professor at the University of California, San Francisco, said in the SoundHealth press release.
“The vibration relaxes the sympathetic and parasympathetic parts of our autonomic nervous system,” he continued. “It opens our sinuses with resonance [and] improves the flow of mucus in the nose and promotes ciliary action. …It's a very good alternative to the other options of medications, allergy management, surgery and office procedures.”
According to the company, the SONU device includes a headband and smartphone app that scans the user’s sinuses to create a digital map, then calculates the user’s “optimal resonant frequencies.” The user then puts on the headband, which “delivers frequencies tailored to the patient based on the app’s calculations.”
But don’t feel bad for nasal sprays. If they lose their appeal for defeating stuffy noses, they may find a new use, such as in treating Alzheimer’s.
The insurer plans to open 23 new senior primary care centers in Walmart Supercenters, and is partnering with Google Cloud to boost its AI capabilities
Amid pullbacks by several large disruptors, Humana is reinforcing its presence in the primary care landscape.
The insurer announced this week that it would open 23 new senior primary care centers at Walmart Supercenter retail stores in Florida, Texas, Georgia, and Missouri. The clinics, operating under the CenterWell Senior Primary Care and Conviva Care Centers brands, join roughly 300 other Humana-branded clinics in 15 states.
“Embracing technology solutions in healthcare can help lower costs and improve consumer experiences,” Humana CEO Jim Rechtin said in a press release. “At Humana, we plan to use the capabilities offered by Google Cloud to make it easier for our members and patients to have affordable access to the right care at the right time. Google Cloud’s technology platform can make our contact centers more responsive, our provider networks easier to navigate, healthcare coverage easier to understand and primary care better tailored to individual needs.”
The two announcements come at a time when retail giants Walmart, Walgreens, CVS Health, and Amazon are either shutting down or consolidating their primary care and virtual care plans, citing challenges to creating a sustainable (or profitable) business model.
Healthcare executives aren’t exactly surprised at those decisions.
"For primary care practices, when you buy them and then you think you can run them profitably by just being behind the scenes, having a standardized billing system, it's ludicrous," former Banner Health CEO Peter Fine said in a recent HealthLeaders interview. "We're going to see a lot more crashing and burning because they think this is just an easy business to get into and they're not always totally sure of how to handle insurance and not totally sure about really understanding the behaviors of the consumer."
Humana’s expansion aims to rebut that trend by focusing on population health—in particular, the senior care market, which is expected to grow significantly over the next six years. The insurer, which acquired locations in Texas and Nevada last year from Cano Health and announced plans this year to move into North Carolina and Louisiana, aims to give its members a branded primary care option.
“These nearly two dozen primary care centers are specifically designed for seniors, and each location’s design, including dedicated entrances and easy parking, offers patients the access that they have come to expect at our clinics across the nation,” CenterWell President Sanjay Shetty, MD, said in a press release. “We are eager to expand on our mission to help patients lead happier, healthier lives.”
In collaborating with Google Cloud, Humana is jumping on the fast-moving AI bandwagon, which promises to improve care through administrative efficiency and data analysis.
"By combining Humana's deep understanding of healthcare with Google Cloud's cutting-edge AI and cloud technologies, Humana can unlock new possibilities for operational efficiency, clinical insights, and personalized care,” Google Cloud CEO Thomas Kurian said in a press release.
Yale New Haven Health launched a major initiative four years ago to reduce variation in care at the health system's four acute-care hospitals and outpatient sites.
Yale New Haven Health is seeking to reduce variation in the delivery of care with the health system's Care Signature Initiative.
Decreasing variation has been a central goal of quality improvement since W. Edwards Deming pioneered the concept in the Toyota Production System in the 1970s. In care delivery, research has shown the consequences of inappropriate variation include underusing needed services, overusing unwarranted services, higher costs, and worse clinical outcomes.
Here is how Yale New Haven Health is reducing variation in care delivery.
Click here to read the accompanying article, which features comments from Thomas Balcezak, MD, MPH, chief clinical officer for Yale New Haven Health.
The increase is attributed inflation, prescription drugs, and behavioral health utilization.
Healthcare costs are predicted to reach a 13-year high in 2025, according to a report by consulting firm PwC.
According to the report, an 8% year-over-year increase is expected for the group health insurance market, along with a 7.5% increase for the individual market. PwC attributes the increases to inflation, prescription drugs, and behavioral health utilization.
This is unwelcome news, coming so soon after the release of the Centers for Medicaid and Medicare Services’ proposed 2025 Physician Fee Schedule. If finalized as is, physician reimbursement will be lowered by 2.8%, despite earlier predictions of practice costs increasing by 3.6% in 2025.
Additionally, provider billing practices will also face increased scrutiny, as the proposed rule aims to combat suspicious billing practices within Medicare’s Shared Savings Program.
Revenue and financial leaders have been prioritizing financial stability for the last few years, seemingly to no avail. If it isn’t inflation, it’s workforce issues, uncooperative payers, low reimbursement, or a storm of all of the above fraying system’s budgets.
Providers have long been vocal about the need for reimbursement to keep pace with inflation, or at least cover the cost of care.
Revenue cycle technology has been a popular option for many systems and individual practices looking to save money. Whether the goal is to improve efficiency or automate redundant tasks, the investment enables staff to work on more complex tasks—although the return on investment may vary.
Other leaders have seen success focusing on payers with meticulous and persistent appeals efforts for denials.
Richardville was a CIO for more than 30 years at health systems including Intermountain, Atrium and ProMedica.
Craig Richardville, MBA, CHCIO, Intermountain Health’s award-winning Chief Information and Analytics Officer, has left the health system to pursure other opportunities in healthcare.
“These are exciting times for all of us in healthcare IT,” he wrote in his social media post. “I want to thank the many partners who work in this space that are so valuable to the successes we've had but mostly to the people, the caregivers who commit and contribute to the mission each and every day.”
Richardville was a familiar presence on social media and at innovation conferences and a strong supporter of digital health innovation.
Craig Richardville.
He joined Intermountain as its Chief Digital and Information Officer in 2022, after more than three years as SVP and Chief Digital and Information Officer at Denver-based SCL Health (which merged with Intermountain). Prior to that, he’d been CIO and chief analytics officer at Atrium Health in North Carolina for more than 20 years and vice president of information services at ProMedica for 11 years. His many honors include the 2015 John E. Gall Jr. National CIO of the Year Award, from HIMSS and CHIME; the 2021 National CIO of the Year Healthcare ORBIE Award, the 2020 Colorado CIO of the Year Award, and the 2017 Carolinas CIO of the Year Award.
Richardville had a busy tenure at Intermountain, and listed several accomplishments on his social media post, including consolidating nine EHR platforms across the enterprise into one Epic platform; helping the health system develop and launch several AI programs; developing digital health programs to improve patient care; transitioning the health system’s Microsoft and Google cloud environments into one Microsoft Azure platform; and transitioning multiple ETP systems into one with Workday.
"I've got 12 CIOs or CDOs in the industry that used to work for me, and I'm just privileged that those people have grown," he said. "It's really [about saying] 'I'll give you the challenge, I'll grow your résumé, I'll make you more valuable to the market, and if I'm able to keep you I'll just continue that. But if there are other opportunities somewhere else, I'm here to help you capture those as well so you can fulfill your life goals.'"
He was also a familiar presence at innovation events like ViVE. At last year’s conference in Nashville, he spoke of the collaborative nature of healthcare innovation at a time when health systems and hospitals were struggling to be competitive.
"I might see something really interesting and tell (another healthcare executive) about it, or someone will tell me, 'You should check this company out,'" he said. "It's the chance to meet up and talk with people."
He also signed on this past March to support the Match IT Act of 2024, a bill now before Congress that would create a federal definition of ‘patient match rate’ that providers would address as they would a clinical quality measurement.
“[T]his legislation will address our nation’s current inability to consistently and accurately identify patients to their health records,” he said in a press release. “Improved standardization of patient demographic data will lead to more accurate patient matching, which in turn will produce advances in patient safety, more complete information for clinical care, and cost savings from reducing the need for repeated medical care, among other benefits.”
Nurse leaders always have a lot on their plates, so since we are halfway through 2024, it's time for a mid-year check-in.
So far this year, the nursing shortage has remained top of mind for many CNOs, followed by the rise of new technologies such as virtual nursing and AI. Leaders have also been working to address nurse wellbeing and burnout, workplace violence, and innovative recruitment and retention strategies.
Here are three current top trends in nursing, according to Vicky Tilton, vice president, patient care services and chief nursing officer at Valley Children's Healthcare.
This virtual care model gives nurses time back at the bedside, according to this CNE.
On this episode of HL Shorts, we hear from Cynthia Latney, senior vice president and CNE at OhioHealth, and HealthLeaders Exchange member, about what the nurses' role is in the virtual care model at OhioHealth's new Pickerington Methodist Hospital. Tune in to hear her insights.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
