If you remove nurses, it's "no man's land," says this nurse leader.
On this episode of HL Shorts, we hear from Katie Boston-Leary, director of nursing programs at the American Nurses Association, and HealthLeaders Exchange member, about different ways that health systems could reflect the value of nursing in their budgets. 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.
HealthLeaders Innovation Editor Eric Wicklund talks with Dane Hudelson, Senior Director of Enterprise Data & Analytics at Sanford Health and a member of the HealthLeaders Mastermind Program on AI in Revenue Cycle and Finance Operations, about how the health system has built its AI capabilities in-house and developed a strong strategy for future growth and innovation.
Repetitive needlesticks might no longer be necessary with new technology, say these nurse leaders.
Several new care delivery models are taking over the nursing industry and streamlining daily nursing practices, now including needlestick procedures.
Repetitive needlesticks can be a challenge in hospitals, from both a nurse and patient perspective. A recent survey conducted by the Harris Poll revealed that out of the participants with a recent hospital stay, 59% of patients needed multiple needlestick attempts for IV insertion, and 71% for blood draws, with 11% needing 10 or more sticks to obtain a single blood sample.
Impact on patients
These numbers are representative of a major issue. According to the survey, more than half of Americans report some fear of needles, and a top reason is fear of multiple insertions. The survey also reported that 77% of patients are not aware that they should expect no more than two needlestick attempts from one clinician, no matter what condition they have.
However, IV and blood draw procedures are a necessary part of the hospital stay, and according to Anna Kiger, system chief nurse officer at Sutter Health, they make the patient experience less positive.
"It is one of the most frequent tasks that a nurse or phlebotomist does," Kiger said, "so if you come for healthcare, it's a high probability we're going to stick you at least once, if not more."
There are several factors that can also make needlestick procedures more difficult, Kiger explained.
"Whether it's in the emergency department or later on in the acute care setting, we do need to obtain blood samples from them for a variety of reasons," Kiger said, "and unfortunately, due to the acuity of their diagnosis and their age, obtaining a clean single needlestick to get the blood can be very difficult."
According to Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, repetitive needlesticks impact patients in both the short and long term. Not only do needlesticks increase anxiety and pain among patients, but incorrect vascular access practices in general can impact health literacy and lead to potential rehospitalizations or disease progression.
"When patients are more anxious, they're less likely to understand the procedures that are being explained to them," Acito said. "Short term, they're not hearing about their care, about their needs, about their diagnosis, and long term, they're not hearing about the things they need to do upon discharge."
Needlestick alternatives
Luckily, alternatives to repetitive needlesticks are on the horizon.
According to Kiger, there is now a device that can provide needleless blood draws.
"This particular technology, which allows a nurse to obtain a direct blood draw through an IV catheter, does eliminate the need for a needlestick," Kiger said, "and that particular device can be used in the ED or in the inpatient setting."
This new technology is called the PIVO™ device, currently owned by BD, which essentially enables a small tube to enter the blood vessel through the IV to avoid an additional needlestick when blood draws are necessary.
"It's an IV with a tail essentially coming out of it," Acito said. "The patient should expect one stick when they come into the hospital and they have the IV inserted, unless they need a special test like blood cultures, then this PIVO™ device would be used."
In patients Kiger has observed, the experience with the device is painless and the blood samples taken with it are of the same quality as those obtained through a needle aspiration.
"If you can remove the needle and obtain a quality blood sample and get to the test result that is required for a physician to make a decision, then I'm all in favor of doing that," Kiger said, "because it's one less penetration of the skin, which is our protection from infections, and the patient gets an entirely different experience, a painless experience for most, obtaining blood."
Acito said they oftentimes employ licensed practical nurses (LPNs) to do the blood draws with the device, which can greatly benefit them as well as the patient.
"This allows [the LPNs] to work at the top of their license, while reinforcing education that has already been provided to the patient, interacting with the patient, providing other needs while they're in the room," Acito said.
In addition to the PIVO™ device, Acito emphasized the importance of good IV care to help decrease repetitive needlesticks.
"Once you put in the IV, if you maintain it well and you choose the site properly, you can use devices that help you find the vein so that there's a decrease in the number of sticks," Acito said. "How many blood draws you get is really determined by your diagnosis and the number of tests that need to be run to find [it] or to see if the treatment is working."
There have already been positive outcomes from using this device as well, according to Acito.
"The positive outcome is that you don't waste more resources trying to find a vein, [and] trying to stick the patient," Acito said. "When you walk in, no longer do you have to check this arm and check that arm and find that vein. You already have access."
The bottom line is that it's better for the patient, Acito explained, because it decreases exposure to excessive bleeding, bruising, or infection.
"They know when they come in and they get that PIVO™ device because of education from the nurse that this is going to be the site where [they] get [their] medications [and] IV fluids, and it's also where we're going to draw [their] blood from," Acito said.
Training and education
Both nurses and patients need to be educated about needlesticks and vascular access procedures and their alternatives.
CNOs must ensure that nurses receive the proper training on how to make patients feel more comfortable during a needlestick experience.
"I think it's really important for the nurse to always recall for themselves what it would be like or even a personal experience with having had an IV," Acito said. "Completely engage the patient, distract them, [and] make sure that the patient is fully educated on what to expect."
Kiger said the most important thing leaders can do is educate other nursing and hospital leaders about the new technology alternatives that do allow for successful needleless blood draws, like the PIVO™ device.
"First of all, basic education, getting more literature out, getting more published research out, getting the experiences of those who actually use a device like this in clinical practice, and then also getting the patient's perspective out there," Kiger said. "Then I think it becomes a matter of showing that over time, this is actually an easier way to draw blood."
Primary care providers are struggling. Can augmented intelligence tools give them the support they need to enjoy healthcare again?
Editor’s Note: Michael S. Barr, MD, MBA, MACP, is a board-certified internist and the former executive vice president for the Quality Measurement & Research Group at the National Committee for Quality Assurance (NCQA).
Primary care is in trouble
According to a report from the Milbank Memorial Fund, The Physicians Foundation, and the Robert Graham Center about the crisis facing primary care:
The number of primary care physicians per capita has declined from 68.4 primary care physicians (PCPs) per 100,000 people in 2012 to 67.2 PCPs per 100,000 in 2021.
Only 15% of all physicians who enter residency training practice primary care three to five years after residency.
Nearly half of family physicians rate the usability of electronic health records (EHRs) as poor or fair, and more than one-third are unsatisfied with their EHRs.
KFF Health News journalist Elisabeth Rosenthal put it best when she wrote:
“American physicians have been abandoning traditional primary care practice — internal and family medicine — in large numbers. Those who remain are working fewer hours. And fewer medical students are choosing a field that once attracted some of the best and brightest because of its diagnostic challenges and the emotional gratification of deep relationships with patients.”
Much of the frustration experienced by physicians relates to burnout. The American Medical Association (AMA) defines burnout as “a long-term stress reaction that can include emotional exhaustion, depersonalization (i.e., lack of empathy for or negative attitudes toward patients), [or the] feeling of decreased personal achievement.”
According to the Agency for Healthcare Research and Quality (AHRQ), “Burnout can also threaten patient safety and care quality when depersonalization leads to poor interactions with patients and when burned-out physicians suffer from impaired attention, memory, and executive function.” An AMA survey in 2022 identified that primary care physicians (Internal Medicine, Family Medicine, Pediatrics) were among the top six physician specialties with the highest burnout (52% to 58%).
What causes burnout?
EHRs, administrative burdens, and organizational factors are the leading contributors to frustration and physician burnout. This Harvard Health Blog, written to educate patients, includes the following apt description:
“The causes of physician burnout are complex, but have to do in part with increasing workload, constant time pressures, chaotic work environments, declining pay, endless and unproductive bureaucratic tasks required by health insurance companies that don’t improve patient care, and increasingly feeling like cogs in large, anonymous systems. Parasitic malpractice lawyers are always circling, which causes us to waste an enormous amount of time with defensive documentation. The transition from paper charts to electronic medical records, which seemingly were designed to maximize revenues instead of clinical care, has created a technological barrier between doctor and patient, and between doctors.”
Michael S. Barr, MD, MBA, MACP, former executive vice president of the Quality Measurement & Research Group at the National Committee for Quality Assurance (NCQA). Photo courtesy NCQA.
The American College of Physicians (ACP) and other medical professional societies are focused on addressing this issue through policy and advocacy. A 2017 position paper from ACP titled “Putting Patients First by Reducing Administrative Tasks in Healthcare” takes an analytical approach to categorizing administrative tasks to identify and mitigate their adverse effects on clinicians, patients, and the healthcare system, pointing out that:
“Tasks that become burdensome may differ from payer to payer; appear one month without notice, then reappear modified or changed the next; and often result from not using documentation that already exists in the medical record.”
Can AI help?
Given AI’s ubiquity, most people will tell you that it stands for artificial intelligence. Most of us have given a lot of thought to how AI is poised to affect our lives and livelihoods in the years to come. Many fear that AI-powered software might eventually make their jobs redundant.
The AMA takes a more optimistic approach. They’ve decided to use AI as an acronym for augmented intelligence, “as a conceptualization of artificial intelligence that focuses on AI’s assistive role, emphasizing that its design enhances human intelligence rather than replaces it.”
That framing is useful, because augmented intelligence is actually emerging as a potentially valuable “partner” for clinical teams to help address common challenges in primary care – many of which contribute to burnout and frustration in practice.
An AMA survey report (2023) found enthusiasm for AI in healthcare, with 65% of physicians surveyed seeing an advantage to AI. The report found particular enthusiasm for AI tools that can help reduce administrative burdens such as documentation and prior authorization, and to support diagnosis and workflow. At the same time, 41% of physicians reported equal excitement and concern, with their ambivalence stemming mostly from the potential impact to patient-physician relationships and patient privacy.
When appropriately trained, maintained, and implemented in the clinical workflow, proponents of AI in healthcare have hopes and expectations it will produce significant benefits by:
Reducing the documentation burden (e.g., ambient AI generating progress notes via ambient AI, drafting replies to patient messages, completing prior authorization requests, producing referral notes and discharge summaries).
Identifying at-risk/high-risk populations for early, proactive interventions and support.
Producing actionable patient summaries and reports.
Supporting improvements in risk adjustment and appropriate coding.
Providing diagnosis support to reduce missing, delayed, or incorrect diagnoses.
Suggesting treatment plans based on clinical conditions accounting for patient needs, preferences, and other factors.
Handling repetitive and predictable administrative tasks (e.g., eligibility checks, appointment reminders, standard reports).
Providing translation services.
The effectiveness and success of AI in healthcare will depend on the appropriate and ethical application of the technology. This includes transparency about its limits, biases, and potential to cause unintentional harm. Importantly, clinical recommendations and summaries should link to the source documentation to allow clinical teams the opportunity to review and confirm the accuracy and validity of the information.
Other considerations include user acceptance of the technology (i.e., the usability of the AI interfaces and reports), the cost to implement and maintain, and potential liability from inaccurate guidance that could lead to patient harm. Data privacy and security is another important concern: clinical teams and health systems must be confident that appropriate protections are in place and consistent with HIPAA and other regulations.
Future of Health: The Emerging Landscape of Augmented Intelligence in Health Care, a research paper produced by AMA in collaboration with Manatt Health, provides a good framework for understanding the issues, identifying use cases, and planning for AI implementation in practice. Many of the use cases highlighted are non-clinical – that is, they address the administrative hassles and tasks at the root of clinician burnout.
Will AI make a difference in primary care?
There are good indications that AI, appropriately designed and implemented in the workflow of busy clinicians, can reduce the stress associated with administrative tasks, documentation, and clinical care. .
However, integrating AI into healthcare must be done carefully, ethically, and with an understanding of its promise and limitations. Organizations such as the new Coalition for Health AI (CHAI) are focused on developing guidelines “to drive high-quality healthcare through the adoption of credible, fair, and transparent health AI systems.” The CHAI Blueprint for Trustworthy AI Implementation Guidance and Assurance for Healthcare provides an excellent academic approach to addressing these imperatives.
But primary care needs help now. I am optimistic that AI systems can address many tedious administrative tasks that cause significant frustration in practice. With appropriate transparency, usability testing, and sufficient clinician training, AI systems could also be used to support clinical documentation, quality gap closure, population health initiatives, and risk adjustment.
But clinicians and their team members will always need to be able to view the clinical evidence used by AI systems to generate inferences and recommendations. Those systems are there to augment physicians–not to replace them. Decision-making and clinical interventions will always remain the responsibility of clinicians.
To ensure big data is used to influence outcomes that are meaningful to the nursing profession, nurse executives need to act as data visionaries and architects. But how?
Have you ever found yourself poring over stacks of data, feeling more like a statistician than a nurse? If you have, welcome to the world of big data.
"You have all of these different data sources coming at you on a weekly, monthly, quarterly basis. The CFO has a stack of data for you, your productivity-management engineer people have a stack of data for you, HR has a stack of data for you, and then your quality director, your clinical folks, have a stack of data for you," Jane Englebright, former chief nursing executive and senior vice president at Nashville, Tennessee-based HCA, previously told HealthLeaders.
"And your job is to sort through all that data and synthesize it in some way and come up with brilliant conclusions about how to run the organization," she said.
But how can it be done efficiently and effectively?
When a CNE is analyzing and synthesizing data, it's typically done manually and is a very time- and labor- intensive process, in part, because technology systems have traditionally been built in silos. "Often they don't even call the units the same thing. They don't name them the same thing. They don't necessarily define them the same way," Englebright said.
For example, the definition of a day may vary from system to system and the way a month is calculated in the finance systems may differ from how it is calculated in the payroll system.
Trying to "figure out how to keep up with your agency hours and what the cost of your agency is in the finance system versus the scheduling system," Englebright says, is "just a nightmare, trying to make all of these different things sync."
The lack of data standardization can also make it challenging for a CNE to assess how the organization or a particular unit is performing and to make well-informed decisions about what to change. Having good data is key to making effective changes.
"For those of us who grew-up studying the biological sciences, we understand that we have taken a very linear, Newtonian-approach to data over something that's really much more like a biological system," she explains. "When you perturb one part of our system… it has ripple effects throughout the entire organization."
Failure to recognize how this data interacts throughout the system has been a limitation in the types of data analytics that have been put forth.
"The frustration that we often have as nurse leaders in looking at this data, is [that] some of the variables we care about the most, aren't even in the data," Englebright says. "We don't have something that measures nursing competence, for example. We don't have something that measures how committed the nurses are. We don't have something that measures if the patient really [is] going to do the stuff we just invested all this time in teaching them to do."
Because of this, CNEs end up having to advocate for the things they care about in a person-on-person debate, rather than being able to make a persuasive business case based on data, she says.
For all its current stumbling blocks, big data holds the potential to change healthcare delivery for the better. But for that to happen, nurse executives need to act as data visionaries and architects.
To support CNEs in doing this a workgroup that grew out of the University of Minnesota's annual Nursing Knowledge: Big Data Science Conference developed the CNE Big Data Checklist.
It outlines three main areas where nurse executives should become leaders in driving the use of big data:
To create a culture that thrives on data
To develop big data competencies for the organization
To create an operation infrastructure to support big data use
This article is part of HealthLeaders’ How Do I? series. Read the entire article here.
Organizations have a responsibility to understand how nurses contribute, says this nurse leader.
HealthLeaders spoke to Katie Boston-Leary, director of nursing programs at the American Nurses Association, and HealthLeaders Exchange member, about her thoughts on the prospect of nurse reimbursement and how organizations can demonstrate the value of nursing.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
CVS Health is identifying at-risk members of Aetna health plans of upcoming heat waves and connecting them with resources for care management.
CVS Health has launched a digital health program aimed at consumers affected by heat waves and other extreme weather events.
The company is using a data analytics platform to identify at-risk patients, such as those with chronic health conditions, when an excessive weather event is expected to occur in their area. The service is currently available to members of Aetna health plans, with plans to expand to CVS Pharmacy and Minute Clinic locations.
“Extreme heat kills more Americans each year than all other weather events combined,” Dan Knecht, vice president and chief clinical innovation officer for CVS Caremark, said in a press release. “In addition to fatalities driven by heat strokes, extreme heat can worsen chronic conditions such as cardiovascular disease, asthma and chronic obstructive pulmonary disease.”
With more health systems and hospitals using digital health tools to connect with patients outside the hospital or doctor’s office and boost engagement, strategies like this could become more popular. Healthcare organizations need these types of outreach to improve care management and coordination and address preventive health and public health issues.
Technology plays a key role in these programs. Data analytics and AI tools can help care providers quickly identify at-risk patients and even send tailored e-mail, text, or phone messages. They can also alert primary and emergency care providers, including hospital emergency departments and clinics, to prepare for increased traffic.
Looking even further, these platforms could be used to synch in police, fire, ambulance and EMS departments as well as telehealth programs.
Through the CVS Health program, Aetna care teams can identify and contact at-risk members as many as seven days ahead of an extreme weather event and connect them to the appropriate resources, such as Oak Street Health clinics and other urgent care clinics, cooling centers, and pharmacies.
The company is first focusing on heat waves, with excessive heat alerts and pargeted outreach for those affected by hot weather. It plans to expand the platform in the fall to patients susceptible to reduced lung function, asthma and cardiac problems caused by excessive exposure to air pollution.
This type of program could also be expanded to cover extreme cold weather, smog alerts (or other alerts tied to air quality), wildfires, floods, dangerous storms, even epidemics and other outbreaks.
The Bipartisan Policy Center is recommending that Congress extend the CMS model for five years and study whether the innovative program is cutting costs and improving care outcomes.
The Bipartisan Policy Center is recommending that the Centers for Medicare & Medicaid Services extend the Acute Hospital Care at Home (AHCaH) program for another five years while launching a study to determine whether the innovative program is reducing costs and improving care outcomes.
The Washington-based think tank’s report comes at a crucial time for supporters of the Hospital at Home strategy. The November 2020 waiver issued by CMS for its AHCaH model, which relaxes rules on providing home-based acute care and enables hospitals and health systems to seek Medicare reimbursement, is set to expire at the end of this year, a move that could threaten the sustainability of many programs.
Currently CMS has authorized 331 health systems and hospitals to operate an ACHaH program, though not all are doing so; others are running or developing variations of the acute care at home model.
“Research shows that hospital at home models yield positive health outcomes,” the BPC report states, citing a small study which found that the program led to shorter hospital stays, lower readmission rates, fewer diagnostic tests, and lower costs compared to patients admitted to the hospital for the same health concerns.
“Initial data show promise, including the potential for cost savings,” the report added. “But more research is needed on patient and caregiver experiences, access and patient selection, the cost impact on Medicare and Medicaid, hospital expenses, and service delivery across diverse populations. Research is also needed on whether the relatively small number of hospitals participating is nonrepresentative and unique. … Congress needs more clarity about the likely financial effects of the model if it were to move from a model with low uptake, which is the case today, to something that would be implemented on a larger scale.”
An Alternate Take on the Hospital at Home Model
While the model has drawn a lot of support, including a users group of healthcare organizations lobbying to make the model permanent, it has its detractors. Some have said the program is too complex and costly, drawing on too many resources for patients who should be hospitalized.
Jain argues that the model should be re-evaluated to filter out what he calls the “toxic positivity that has defined the hospital-at-home movement.” In certain cases the program will work, he adds, but there has to be “a definable cost advantage and sound, scalable, highly reliable underlying logistics.”
Immediate and Long-Term Recommendations
The BPC report offers several immediate policy recommendations, including:
Congress should extend the AHCaH model for five years to maintain participation, support investment from payers and providers and gather additional evidence on the program’s value. “A temporary reauthorization of five years would likely increase participation in AHCaH and incentivize state Medicaid investment, improving the diversity of participation,” the report said. “It would also allow policymakers to collect data on the model to guide future reauthorizations and make informed programmatic and financial decisions.”
Congress should provide funding for and direct CMS to provide technical support for health systems and states launching the ACHaH model, especially to improve access for Medicaid members.
Congress should also provide funding for a CMS-initiated study of the cost and quality of the ACHaH model, with a report submitted back to Congress by September 2028.
Congress should direct CMS to strengthen regulatory guidance for health systems and hospitals that include evidence-based protocols for the use of telehealth and remote patient monitoring (RPM), infectious prevention practices, fall prevention and escalation for clinical deterioration.
Congress should direct CMS to create quality measures for the ACHaH model, covering functions like tracking adverse events beyond mortality, a patient’s ability to connect with the care team after hours, and care team response times to escalations.
Congress should direct CMS to develop evidence-based, standardized language for health systems and hospitals to use when offering the program to patients.
The report also identifies key issues that federal policymakers will need to address when deciding the future of the program beyond five years. They include whether to make the program permanent, extend it further or end it; whether to modify the model to ensure sustainability; and how to ensure safety and program integrity as more health systems and hospitals adopt the model.
The Orlando-based nonprofit OneBlood says it's still operating but at "a significantly reduced capacity."
Orlando-based OneBlood is recovering from a "ransomware event" discovered on Monday and it's asking the more than 250 hospitals it supplies to "activate critical blood shortage protocols" as cybersecurity teams determine the extent of the attack.
Spokeswoman Susan Forbes says the nonprofit blood center is still operating and collecting and distributing blood but "at a significantly reduced capacity."
"We have implemented manual processes and procedures to remain operational," Forbes says, adding that these stopgap measures "take significantly longer to perform and impact inventory availability."
"In an effort to further manage the blood supply we have asked the more than 250 hospitals we serve to activate their critical blood shortage protocols and to remain in that status for the time being," Forbes says.
OneBlood did not say what the hackers were demanding or if a ransom was paid.
This week's attack on OneBlood is the latest in a string of high-profile cyberattacks targeting healthcare-related entities. The Change Healthcare hack in March paralyzed large swaths of the nation's care delivery system and cost parent UnitedHealth about $2.5 billion, including $22 million in ransom payoffs.
'A National Security Concern'
Mary Mayhew, president and CEO of the Florida Hospital Association, says OneBlood became aware of the hack on Monday, which investigators, including the Federal Bureau of Investigation, have traced back to Russia.
Mayhew says OneBlood handles about 80% of the blood supply for Florida hospitals and also supplies three other southeastern states. The blood center "was completely shut down" in the hours after the attack but has gradually brought services back on-line, Mayhew says.
"What we've heard is that they now have control over all their systems taken back from the cybercriminal," Mayhew says. "They are optimistic day-over-day, that their capacity will continue to increase as they are able to bring their systems back online.
"They are unable to give a date certain, but they believe it's a matter of days, not weeks. But we could continue to operate well below 100% of what a hospital typically receives and depends on for blood supply for at least another three to five days."
To compensate, Mayhew says the National Blood Task Force has been activated.
"They are drawing from the Red Cross and other blood centers and other national resources to try to get some blood into Florida," she says. "The biggest major concern is platelets. Platelets have a very short shelf life by days, and it's important to understand that for transplant surgeries, for open-heart surgeries, for certain cancer treatments, platelets are absolutely critical."
Mayhew says the OneBlood attack "really reinforces a focus on this as a national security concern."
"By that, I mean this is affecting our public health infrastructure when you are threatening the life-saving resource of the supply of blood," she says. "Just as we would have a national security response if there was an attack to our electrical grid or any other infrastructure that we depend on, this is obviously life and death when they jeopardize and undermine the supply of blood in our country."
Supported by a CMS alternative payment program, Illinois-based Egyptian Health is actively addressing SDOH and other barriers and helping kids get the care they need.
Rural healthcare organizations are getting serious about identifying and addressing the barriers that are keeping children and young adults from accessing the care they need—especially behavioral healthcare.
Many organizations, from health systems and hospitals to local clinics and public health groups, are screening for social determinants of health the moment someone comes through their door, if not sooner. Through surveys, interviews and digital health tools that can sift through claims and EHR data, they’re spotting barriers early on, including issues with housing, families, food, schooling and transportation.
“When kids come in and they have all of these other needs, basic needs, that if those aren’t met first, it’s really hard [for them to] to receive the more specialized services that they need,” says Angie Hampton, CEO of the Egyptian Health Department. “We were seeing that across the board.”
Founded in 1951 as a public health department, Egyptian Health serves a wide swath of rural Illinois known as Little Egypt. Based in Fairfield, the organization added behavioral health services in 1972; it’s now their fastest growing service, as more and more kids show up with behavioral healthcare needs that aren’t being addressed.
Hampton estimates some 11,000 children and their families rely on Egyptian Health for care. Any child under the age of 21 who is enrolled in Medicare or CHIP is eligible for those services.
And many are having problems accessing those services.
Egyptian Health was one of eight healthcare organizations selected in 2020 to enroll in the Centers for Medicare & Medicaid Services’ Integrated Care for Kids (InCK) Model, an alternative payment model borne out of the CMS Innovation Center that aims to reduce healthcare expenses and boost quality of care for children. The seven-year project, for which CMS has set aside almost $126 million, will reward providers who develop programs that identify and address barriers to access for at-risk children, putting them in front of the right care teams and keeping them out of the Emergency Room.
Hampton says Egyptian Health, like so many other healthcare organizations, was often reacting to SDOH and other barriers before developing a strategy to proactively identify and address them. Without that strategy, she says, kids were falling through the cracks, either ending up in the local hospital or avoiding care altogether.
Working with Solventum, a health management company spun off earlier this year from 3M, Egyptian Health began combing through claims data and other information to get a better picture of the youth population in their coverage area. They then created a strategy for surveying these youths on SDOH and other barriers and creating connections with the right resources to address those barriers.
A key element to this program, Hampton says, is primary care. Alongside the partnership with the state’s Medicaid program, Egyptian Health is coordinating care with a network of local hospitals, federally qualified health centers (FQHCs) and clinics. Under the CMS InCK model, participating providers will receive inventive payments based on the success of the program in meeting performance metrics, such as reduced ED visits and admissions and increased well child visits and follow-ups.
“Honestly it allows us … many additional opportunities,” Hampton says of the program, now in its fifth year and ready to report on outcomes and issue its first payouts this fall. She says Egyptian Health is “really focusing on what those interventions can be” and moving toward a time when they can focus more on care and less on the obstacles.
She says the program should also help the region’s schools, where teachers and other staff are spending more time addressing healthcare concerns and less time teaching.
One barrier that Hampton is seeing among providers is a lack of experience with alternative payment models. That has slowed adoption as providers learn what they should be doing to qualify for reimbursements.
She also sees a need to emphasize whole-family care and care for adults, which spurred Egyptian Health to expand the program to address those populations as well. The idea, she says, is that by resolving the barriers to care that one person or one family experiences, the door may open to affect and improve care for others.
Hampton says she’s eager to see the first results come out in August, which will provide concrete examples of how the program is working and give providers the incentive to keep addressing SDOH. And she’s working on new partnerships and grant opportunities to keep that momentum going when the InCK program ends in two years.
“We’re here now and it will only get better,” she says.
