Joneigh Khaldun, MD, MPH, FACEP, sees the national pharmacy chain as an integral part of a new healthcare ecosystem that uses data and technology to overcome barriers to care.
CVS Health's first-ever chief health equity officer says the national pharmacy chain is placing itself at the front of the health equity movement because it has the name-brand recognition to help underserved communities.
"People see us as a trusted brand," says Joneigh Khaldun, MD, MPH, FACEP, who also serves as vice president of the Rhode Island–based company, which includes among its many subsidiaries CVS Pharmacy, MinuteClinic, CVS Caremark, Aetna, Osco Drug, and Oak Street Health. "Nowadays people are more likely to go to their neighborhood pharmacists than a primary care provider."
Khaldun, who joined CVS Health in late 2021 and is also an Emergency Department physician for the Detroit-based Henry Ford Health System, has the background to address health equity. Prior to joining CVS Health, she was Michigan's chief medical executive and chief deputy director for health for the state's Health and Human Services Department, where she oversaw public health, Medicaid, behavioral health, and aging services. She also spearheaded Michigan Gov. Gretchen Witmer's COVID-19 response strategy and was appointed in 2021 to President Joseph Biden's COVID-19 Health Equity Task Force.
Khaldun says health equity is a long-standing issue, affecting underserved populations long before COVID-19 cast a spotlight on the topic. But with the glare of public perception came a new interest in addressing the issue with innovative technologies and strategies.
Health equity "has become a buzzword, but health disparities aren't new at all," she says. "What is exciting is the energy around addressing the root causes. The entire healthcare ecosystem has changed, and it has given us new opportunities" to level the playing field for consumers who have problems accessing the care they need.
Part of that change comes from the expansion of the healthcare marketplace, and the introduction of new and more diversified participants, such as Amazon, Microsoft, Google, Walmart, Walgreens, and CVS Health. Traditional healthcare organizations are working hard to stay competitive, often by using consumer-friendly technology and strategies to keep their patients.
Khaldun won't talk about whether CVS Health is competing with or partnering with health systems, but she does say the CVS network can address one aspect of health inequity: Lack of trust in the healthcare industry. Underserved populations often feel disenfranchised from local health systems due to barriers in accessing care. Having them access care through CVS Health helps to break down those barriers and put more faith in healthcare providers, she says.
Khaldun has a three-pronged approach to addressing health inequity: Empowering people to take charge of their own care, using data to identify each person's unique healthcare journey, and using technology to take action. Consumers often encounter care gaps, she says, when they don't have the data they need to make the right healthcare decisions.
"To understand the disparities and inequities, you have to have the right information," she says. "That’s what we can do."
Khaldun also says virtual care "is going to be an important part of our healthcare ecosystem," enabling CVS Health to link consumers to the care providers they need to see no matter where they're based. That will go a long way toward breaching the barriers to care caused by lack of access, she says, and open the door for new opportunities in care management.
Not lost in the equation is the impact that pharmacies can have on care delivery. Advocates say pharmacists can and should play a more active role in care management because they often have access to the data needed to link consumers to effective treatments and are often the best resource to address an ineffective treatment or identify new care plans.
"That's why CVS Health is certainly a healthcare innovation company," she says. "Pharmacists have an incredibly important role to play in this."
The digital health company launched by former Allscripts and Livongo executive Glenn Tullman is touting partnerships with 10 health systems across the country.
Ten major health systems are joining forces with a digital health company to create a nationwide concierge medicine platform targeted at large employers.
Transcarent, launched just two years ago with $200 million in investments by former Allscripts and Livongo executive Glenn Tullman, aims to push the value-based care model by incentivizing health and wellness and offering competitive prices for services.
“Our close collaboration with these ten leading health systems will allow us to better design care pathways, provide higher-quality care, and faster access," Tullman said in a press release issued today. "By aligning with health systems who can guarantee both quality of care and competitive pricing, we can reduce administrative burden, and just as important, demonstrate true measurable value for the people who pay for care - employers and their employees. We’ll also more closely integrate the digital experience with hands-on care."
The Transcarent National Independent Provider Ecosystem includes:
Advocate Health
Atrium Health
Baylor Scott & White Health
Corewell Health
Hackensack Meridian Health
Intermountain Healthcare
Mass General Brigham
Memorial Hermann Health
Mount Sinai Health System
Virginia Mason Franciscan Health
The model builds on the idea of a direct-to-consumer healthcare platform by linking in well-known healthcare systems to offer primary and specialty care services, including second opinions. Officials say the platform will offer in-person and virtual care, including telehealth-based physical therapy, orthopedic consultations and a pharmacy marketplace.
The attraction for businesses lies in a network of known healthcare entities offering care at scale.
"By directly contracting for rates upfront with our health systems and guaranteeing same-day payment, which no one else does, we can also guarantee our employer clients very cost-effective outcomes," Transcarent officials said in the press release.
The New Hampshire health system is using a virtual health program to train rural providers to handle difficult births, while also plugging in a robust telemedicine network to offer on-demand access to specialists.
Rural hospitals are closing their labor and delivery (L&D) units at alarming rates, forcing more expectant parents to give birth in an ill-prepared emergency room or other location, like the back of an ambulance.
At New Hampshire's Dartmouth Health, officials are combining virtual learning and a hub-and-spoke telemedicine platform to address difficult and emergency births. This includes STONE (Simulation Training for Obstetric and Neonatal Emergencies) training delivered on a virtual platform to rural healthcare providers such as emergency department personnel and paramedics, as well as an around-the-clock Tele-ED platform offering on-demand access to specialists to assist in emergency births.
"Sometimes babies come fast," Kevin Curtis, MD, MS, medical director of connected care and the Center of Telehealth at Dartmouth-Hitchcock Medical Center, said during a presentation at the Northeast Telehealth Resource Center's annual meeting this month in Nashua, New Hampshire.
In New Hampshire, 11 of 27 hospitals, or 40% of the state's hospitals, have shut down their L&D units since 2011. All but one are in areas designated by the U.S. Health Resources and Services Administration (HRSA) as rural service areas. Nationwide, 217 hospitals have closed their L&D departments, creating more maternity care deserts, where access to services is strained.
Many rural hospitals are closing L&D units because of the cost of staffing and keeping open a unit that doesn't see a lot of activity over the course of a year, but the consequences are dire, especially for expectant parents experiencing a difficult birth, requiring a C-section, or needing immediate care by neonatal intensivists. On top of that, most rural EMS units and emergency departments don't have quick access to those specialists. The result is an increase in difficult births and a resulting surge in babies and mothers experiencing health problems, including death.
That's true in New Hampshire, a decidedly rural state in northern New England with one teaching hospital (Dartmouth-Hitchcock Medical Center) and a network of smaller hospitals and clinics overseeing a population of roughly 1.4 million. Aside from lack of access, residents also must contend with rough terrain and snowy winters, making travel difficult.
The lack of resources for pregnant families "is projected to get worse, and it's happening all over the country," says Curtis. "We're seeing these [complicated births] more often, and even bedside teams are asking for our help."
Dartmouth Health's answer is two-fold. Using a one-year HRSA grant, the health system created a virtual STONE program, and has seen more than 120 rural providers and EMS personnel go through the program so far. The program gives providers the education they need to handle difficult births and uses simulation to guide those providers through various scenarios.
Beyond training rural providers to handle difficult births, Curtis and Patricia Lanter, MD, MS, associate professor of emergency medicine at Dartmouth-Hitchcock's Geisel School of Medicine and associate program director of the emergency medicine residency program, saw an opportunity to integrate the health system's robust telehealth network. Dartmouth Health Connected Care, which launched 11 years ago, now offers eight different telemedicine services across the state through its hub at Dartmouth-Hitchcock Medical Center in Lebanon, including TeleEmergency care at 13 hospital EDs and TeleICN (neonatal intensive care) services at 11 sites.
Through the Lebanon hospital, the health system's telehealth team can connect providers in distant and remote locations with ED doctors or OB-GYN or TeleICN specialists to handle difficult births and resulting in care for both the mother and baby.
Lanter says rural healthcare providers "are scared to death" of having to handle complicated births and are eager to have experts on a real-time audio-visual platform helping them. It's also important, she says, to have those specialists on hand to help providers when something goes wrong, such as the death of a baby or mother.
Curtis says the Tele-ED program has assisted in roughly five OB emergencies since the program was launched in May, while the TeleICN platform has been called in, on average, five times a month to help with infant care. And he expects those types of emergencies to become more frequent and complicated as rural healthcare sites struggle to stay open and difficult pregnancies and births increase.
But while the program is no doubt saving lives, it's also expensive. Curtis says the price tag to keep the hub manned 24 hours a day every day is prohibitive, particularly in a region where there aren't that many emergencies.
"TeleEmergency [care] still isn't pervasive at all in this country," he says.
Curtis and Lanter say they'll look for ways to make the STONE program sustainable. As for the Tele-ED platform, Curtis says that will remain open, as it's part of the health system's core mission. They charge a subscription rate to each hospital in the network, he says, but that doesn't cover the overall costs.
"It's very expensive," he says. "We couldn’t offer a break-even price because no one could afford it."
HealthLeaders Innovation and Technology Editor Eric Wicklund talks with Carter Groome, founder and CEO of First Health Advisory, on the latest cybersecurity concerns that are keeping healthcare executives up at night.
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The recent UAW strike draws on similar workforce concerns revenue cycle leaders have been facing with their staff for years: technology advancement.
While the recent United Auto Workers’ (UAW) strike is historic for many reasons, the union’s asks aren’t a far cry from the demands of the healthcare workforce.
One demand by the UAW, though, parallels an issue revenue cycle leaders have been facing with their workforce for years: wanting to know where they stand in the wake of technology advancement.
For context, the UAW is voicing its concern—along with better employment benefits and wage increases—over job security related to an increase in electric-powered vehicles that require fewer parts and fewer laborers. They want to make sure their jobs remain secure as technology advances. Who else is thinking the same? Your revenue cycle staff.
We know that healthcare organizations are embracing revenue cycle automation and AI at a fast pace, with executives seeing technology as a means of improving the quality and accuracy of tasks, reducing manual labor, and improving clinical and staff workflows.
In fact, automation in the revenue cycle isn’t an if, it’s a when, and each time you implement new technology in the department, it’s not improbable that your revenue cycle staff is questioning their viability.
While the concerns of your revenue cycle staff might differ slightly from the situation faced by the UAW, at a time when workforce retention is top of mind and nearly half of healthcare workers fear that AI could take their jobs, hospital leaders need to pay attention to these massive industry strikes.
Luckily, there are a few valuable lessons that hospital leaders can draw from in this labor dispute to protect their teams from the fears of job insecurity as automation and AI continues to take hold of the revenue cycle.
Create open and transparent communication
Leaders need to maintain open lines of communication with revenue cycle staff and address concerns about technology and AI encroaching in on their department. Be transparent about the organization's plans and reassure staff that technology is meant to complement their work, not replace it.
Invest in staff training
Demonstrate your commitment to employee growth by investing in continuous training and upskilling. Show that the organization values its employees' development and is willing to adapt to changing technology together.
In fact, advancing employees’ skills should be viewed through the lens of your business objectives. As upskilling and reskilling are increasingly part of the workplace conversation, business leaders need to approach these programs as far more than short-term soultions for staff.
Emphasize job security
Make it clear that while technology may change job roles, it doesn't necessarily mean a loss of jobs. Emphasize the importance of human judgment, empathy, and critical thinking the revenue cycle—skills that are not easily replaceable by AI.
On the front and back end, patients value the human touch in these interactions, and this will continue to be a critical aspect of the revenue cycle.
And as for critical thinking, coders or clinical documentation improvement staff often use these skills to query providers and report more accurately—something AI can’t do.
Make it known AI is a tool, not a replacement
Revenue cycle leaders implement AI and technology to enhance the efficiency and accuracy of revenue cycle processes, not to necessarily replace FTEs—so make sure your staff knows that is the intention. Showcase how these technologies can reduce administrative burdens, allowing them to focus on more strategic and patient-centered tasks.
Employ collective problem-solving
Engage staff in discussions about how technology can improve their workflow and address pain points. Encourage them to provide input and be part of the decision-making process when adopting new technologies.
Provide fair compensation and benefits
While there’s a fine line between competitive salaries and financial stability, leaders should ensure that revenue cycle staff receive competitive compensation and benefits. Address any disparities or concerns related to wages and benefits promptly.
Share the long-term vision
Share the organization's long-term vision for revenue cycle technology and how staff will be integral to achieving it. Make it clear that their roles will evolve and adapt alongside technology. Leaders also need to remember that revenue cycle technology is only as good as the human staff that runs it behind the scenes.
That all being said, incorporating these strategies can help revenue cycle leaders proactively address concerns among their staff. Leaders need to ensure a more stable and collaborative work environment, which will reduce the likelihood of future workforce issues due to automation and AI advancements.
Stuart Battersby, CFO of Firefly Health, a virtual, advanced primary care provider, chats with associate content manager Amanda Norris on the strategies it has implemented to improve financial outcomes and drive growth in a virtual environment and beyond.
OSF HealthCare is one of several health systems launching a virtual nursing program aimed at improving nurse workflows and addressing workforce shortages.
When OSF HealthCare encountered problems hiring nurses for its med-surg units, executives decided to launch a virtual nursing program to fill the gaps and improve nurse morale and efficiency.
"That's one of the hardest positions to fill," says Kelly George, the Illinois-based health system's vice president of performance improvement. "And we were seeing that a lot of our nurses [were dealing with] a heavy workload. We decided that we would try anything we could do to better support the staff that we have."
With workforce shortages across the board, from nurses to doctors to IT and support staff, health system leaders are leveraging a number of strategies to improve the workplace, reduce stress and turnover, and entice more people into the industry.
HealthLeaders is convening a select number of the industry's top decision-makers next week in Nashville to address clinical and financial approaches to workforce shortages. The two-day HealthLeaders Teams Exchange will feature panel discussions on four topics: Strategic workforce planning, recruiting and retaining clinical talent, workforce innovation and technology, and physician alignment and partnerships (including nurse staffing and scheduling).
Workforce stabilization, especially in the nursing ranks, is top-of-mind for many healthcare executives. According to a survey of about 780 healthcare professionals conducted in April by Joslin Insight on behalf of telehealth company AvaSure, the two most important metrics for chief nursing officers using virtual nursing platforms are nurse satisfaction and retention (86%) and improving the workload for current staff (82%).
OSF HealthCare is one of several health systems across the country to explore virtual nursing platforms to stabilize the workforce (among them are Jefferson Health in Philadelphia, Michigan-based Trinity Health, and Nashville's Vanderbilt Health, all of which recently announced new programs). George says OSF looked to other health systems for guidance and found that many are at the same stage of development.
"It's still very early for everyone," she says.
Indeed, inpatient telemedicine programs were popular during the pandemic, as health systems sought to separate infected patient populations from doctors and nurses to curtail the spread of the virus. Virtual platforms were also effective in monitoring multiple patients, rooms, or even departments from one location, like a nurse's station, giving hospital administrators a means of doing more with a depleted staff.
The challenge for healthcare decision-makers with these platforms is ROI. Telemedicine programs aren't exactly inexpensive, and CEOs and CFOs need to see the hard benefits to a new program before signing off.
At the Medical University of South Carolina (MUSC) in Charleston, officials tested a virtual nursing service about a year ago, says Emily Warr, MSN, RN, administrator for the health system's Center for Telehealth. That program was geared toward helping new nurses learn the ropes.
"We learned from that endeavor that it's not enough," Warr says. "It has to be much more complex and bring more value."
So MUSC pivoted, creating a platform designed not only to remotely monitor patients in their rooms but to help with administrative tasks, from charting in the EMR to onboarding and discharges. That program will debut soon in four of the health system's rural hospitals, where the nursing ranks are especially strained.
"This program can't just focus on workforce economics or quality [of care]," she says. "One is not enough. There has to be a quality component. We've got to impact patient care."
At OSF HealthCare, George says the virtual nursing program will be closely watched by executives, and that clinical outcomes have to be included in the ROI, alongside nurse retention and satisfaction.
"We recognize that we have to be able to show the value," she says.
Kelly George is a contributor to the HealthLeaders Teams Exchange Community. HealthLeaders Exchange isan executive community for sharing ideas, solutions, and insights. Please join the community at https://www.linkedin.com/company/healthleaders-exchange/. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com
A pilot program in Maine is proving the value of a telemedicine network that links remote primary care providers with specialists.
An eConsult program launched in Maine last December has improved care management and coordination for several small, rural primary care providers, while reducing expensive and time-consuming trips to a specialist.
The Maine eConsult Network, a one-year pilot program developed by the non-profit MCD Global Health, now encompasses eight primary care organizations across the predominantly rural state. More than 500 specialist consults have been conducted through the virtual network in the past six months, officials say, with 70% of those eConsults resulting in continued care by the patient's PCP, just 25% leading to an in-person visit with the specialist, and 5% needing more information.
The program addresses a care gap plaguing healthcare organizations across the country. Access to specialist consults is difficult owing to the declining numbers of specialists and high demand for their services. In rural areas those specialists are few and far between, requiring patients to travel long distances for in-person visits. Urban areas may have more specialists, but scheduling an appointment can often take months.
An eConsult platform enables a primary care provider to send patient information through a telemedicine portal to a specialist, who reviews the case and can ask for more information, request an in-person visit or determine that the PCP can handle the case, perhaps even offering clinical decision support. The platform is designed to reduce unnecessary in-person visits and the stress they put on patients, while speeding up the treatment process and improving clinical outcomes. It also helps PCPs treat more of their patients, a key business metric.
Since eConsults are relatively new, many payers don’t reimburse for the service. That includes CMS, which this year began offering Medicare and Medicaid coverage in specific circumstances and is seeking data on the overall value of the platform. MCD received funding from the state's Department of Health and Human Services to set up the program, and an evaluation will be done by the Maine Rural Health Research Center at the University of Southern Maine.
Daren Anderson, MD, was one of the first to explore the value of eConsults with the Connecticut-based Community Health Center and the Weitzman Institute, where he served as director. He's now president of ConferMED, an eConsult company serving federally qualified health centers (FQHCs) in several states and the platform for the Maine eConsult Network.
“With traditional specialty consultations, complicated logistics, and tracking combined with limited access, especially for patients in rural areas, can result in delays and worse clinical outcomes," he said in a press release issued by MCD. "As an alternative, eConsults provide advice and guidance from specialists quickly and easily and reduces the need for face-to-face visits. This results in better care for patients and a better process for everyone. For most cases, it takes far more work to coordinate and track face-to-face visits than simply getting an eConsult from a specialist, and the eConsult often provides all that is needed.”
In Maine, specialty consults can be especially challenging. At Mount Desert Island Hospital (MDI) in Bar Harbor, doctors treat patients on several nearby islands as well as small communities along the rugged coastline.
“I work on an island, but sometimes, it feels like I’m an island and I don’t have specialty resources,” Natasha Neal, DO, MPH, a family medicine provider at MDI, said in the MCD press release. “Knowing that I can place this consult and have this conversation with a specialist makes us less isolated and better equipped to serve patients, especially when they otherwise will wait months to learn more.”
“It is often possible, via eConsults, to get guidance on what tests to order, help interpret results, and recommend medication,” added Jennifer Monti, MD, a cardiologist based in southern Maine who is part of the Maine eConsult Network. “These three core functions reduce the amount of time it takes for care plans to be executed, which means more efficient, less expensive care for patients, and the face-to-face visit with the specialist, if needed, can be more nuanced and higher value because the patient will be present with relevant testing already performed.”
