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Coordinated by Community Care of West Virginia and Aetna Better Health for West Virginia, the program will provide on-demand emergency psychiatric care and care coordination for children and adolescents within 24 hours.
A new program being launched in West Virginia aims to give children access to in-person or virtual emergency psychiatric evaluations within 24 hours.
The Critical Access to Pediatric Psychiatry (CAPP) WV program is being launched by Community Care of West Virginia, a federally qualified health center serving some 50,000 patients across 17 community health centers, 51 school-based healthcare sites and seven pharmacies, along with Aetna Better Health of West Virginia, part of the CVS Health portfolio. Aetna Better Health of West Virginia is providing $1.5 million to support the new program.
The program aims to reduce the number of children and adolescents seeking emergency behavioral healthcare in ERs—a significant care gap affecting health systems not only in West Virginia but across the country—and direct children to the right resources within the state. West Virginia's health department is currently under a federal mandate to improve services for at-risk children, including those in foster care, following a Justice Department investigation that found more than 300 children in group residential care and psychiatric facilities outside the state, due in part to a shortage of in-state resources.
“We’re always working to improve access to essential pediatric psychiatric assessments for children and families in West Virginia, regardless of their location,” Kathy Szafran, executive director of Aetna Better Health of West Virginia's Mountain Health Promise program, said in a press release. “Due to limited availability of adolescent psychiatrists, children experiencing a behavioral health crisis can spend significant time in the emergency room waiting to be evaluated."
"With the coordination between Community Care and Aetna, we can now offer a virtual pediatric psychiatric evaluation anywhere in West Virginia usually within 24 hours," she added. "In conjunction with the Aetna care coordination team and Critical Access to Pediatric Psychiatry, the needed assessment and care coordination for ongoing services can be available throughout the state for under-resourced children. The goal is to get children assessed, level of care identified, and appropriate services coordinated as soon as possible. Our current outcomes are promising, keeping children with family and with the services needed.”
Along with in-person and telehealth-based care, the program will also establish a mobile mental health clinic that can be dispatched as needed to underserved communities.
CAPP WV could be a model for many states and healthcare organizations that have been dealing with a surge in ER traffic since the pandemic. Roughly half a million children are evaluated for behavioral health concerns in emergency departments each year, according to the American Academy of Pediatrics, and as little as 20% are getting the help they need, including adequate follow-up care and the right medication.
CAPP WV addresses four key pain points. As described by officials, they are:
On-demand access for Aetna members to specialized pediatric psychiatry services. The program will work with pediatricians and primary care providers to provide on-demand behavioral health services for Aetna members.
Timely psychiatric evaluations in emergencies. In situations where in-person psychiatric care is unavailable, the program will expedite psychiatric evaluations within 24 hours, including through virtual care.
Support for small rural healthcare providers. The program will offer ER consults and follow-ups for small rural healthcare providers who lack access to their behavioral health and/or pediatric specialists, giving them access to the resources they need to treat more of their patients instead of directing them elsewhere.
Ensuring connected care. For children and adolescents with medication needs who are placed on waitlists, the program will coordinate care management with established behavioral health providers to continue the care pathway.
The health system is under investigation for allegations it was canceling appointments and "cutting off" patients with medical debt. What went wrong?
Revenue cycle leaders are under pressure to collect on their patient’s bills in order to help pad an organization’s bottom line, but a new investigation is pointing out that some organizations are going too far.
Allina Health, one of the largest non-profit health systems in Minnesota, was recently called out in a New York Times report alleging that it was canceling appointments and “cutting off” patients with medical debt.
The Times’ report has now prompted a formal investigation, announced last week, by Minnesota Attorney General Keith Ellison.
According to the Times, Allina Health allegedly refused to provide certain types of care for patients with, in some instances, only $1,500 in medical debt. Although Allina would provide emergency care, it had a written policy to deny other services until that debt was paid off, the Times said.
At the time of the Times' article publication, Allina Health CEO Lisa Shannon said it “will take a thoughtful pause on any new interruptions to non-emergent, outpatient clinic scheduling while we re-examine our policy.”
“Reducing barriers to care is central to our mission as a steward of community health, and we will carefully study additional ways to educate our teams about the extensive financial services available to patients experiencing financial barriers to care,” Shannon’s statement said.
Even though Allina’s policy was paused, Attorney General Ellison is not letting the health system off the hook.
“Allina is bound under the Hospital Agreement to refrain from oppressive billing practices and provide charity care when patients need and qualify for it, as all Minnesota hospitals are. Denying patients needed care on the basis of medical debt harms every Minnesotan, whether or not they are Allina patients,” Attorney General Ellison said in a statement this week.
“My office has heard from a good number of Allina patients who have shared their own upsetting stories of being denied care for this reason,” Attorney General Ellison said.
As hospitals and health systems battle to increase margins and improve efficiency to remain financially healthy, what can revenue cycle leaders do to stay afloat? Denying care is not it.
Revenue cycle leaders have been working for years to minimize the same patient payment challenges as Allina Health, albeit with better strategies.
One strategy we see time and time again? Placing more of a focus on the front end, usually through technology, to reduce the cost to collect on the back end.
In fact, this is a strategy that Augusta University Medical Center follows. The health system realized it was missing opportunities by not prioritizing pre-service and point-of-service payments, which led to a negative patient financial experience, collecting pennies on the dollar, and writing off bad debt.
“Patients are providers’ second largest payers, so collecting payment prior to or at the time of service is critical to the overall financial health of the organization and our ability to serve the community with quality care,” Sherri Creech, AVP of patient access services at Augusta University Medical Center, told HealthLeaders.
After implementing technology and establishing new staff trainings and protocols for payment collection, the system increased its point-of-service collections by 150%--thus reducing its patients’ amount owed after care.
“The team couldn’t believe how small changes every day, like collecting a copay, can add up over time and help that bottom line,” Creech said.
Editor's note: Followingthis article's publication, Allina Health sent an email to HealthLeaders stating the following: "We have determined there are opportunities to engage our clinical teams and technology differently to provide financial assistance resources for patients who need [financial] support. We will formally transition away from our policy that interrupted the scheduling of non-emergency, outpatient clinic care." -Allina Health PR.
Mass General Brigham researchers say the large language model AI chatbot is almost as good in making clinical decisions as a med school graduate
Healthcare executives looking for support in developing a ChatGPT tool for their clinicians should take a look at the latest research coming out of Boston.
Investigators from Mass General Brigham have found that a large language model (LLM) AI chatbot is 72% accurate in making clinical decisions across all medical specialties and phases of care, and the tool is 77% effective in making a final diagnosis.
Those results make a good case for using the technology as a clinical decision support tool for clinicians—but not, as some might fear—a replacement.
“Our paper comprehensively assesses decision support via ChatGPT from the very beginning of working with a patient through the entire care scenario, from differential diagnosis all the way through testing, diagnosis, and management,” Marc Succi, MD, associate chair of innovation and commercialization and strategic innovation leader at Mass General Brigham and executive director of the MESH Incubator, said in a press release announcing the study's results.
“No real benchmarks exist, but we estimate this performance to be at the level of someone who has just graduated from medical school, such as an intern or resident," he added. "This tells us that LLMs in general have the potential to be an augmenting tool for the practice of medicine and support clinical decision making with impressive accuracy.”
The study, recently published in the Journal of Medical Internet Research, is the latest step in the whirlwind romance between healthcare and AI, and LLMs like the ChatGPT tool in particular. While some fear the technology could someday supplant clinicians, those who've been in the arena for a while say it holds value in giving clinicians the information they need at their fingertips to make decisions.
And those study results subtly point out that while LLMs are good, they aren't good enough to replace anybody.
In the study, Succi noted that ChatGPT was only 60% effective in making differential diagnoses, and it was only 68% accurate in making clinical management decisions, such as deciding what medication to prescribe after making a correct diagnosis.
“ChatGPT struggled with differential diagnosis, which is the meat and potatoes of medicine when a physician has to figure out what to do,” Succi, who co-authored the study, said in the press release. “That is important because it tells us where physicians are truly experts and adding the most value—in the early stages of patient care with little presenting information, when a list of possible diagnoses is needed.”
AI in clinical care needs "to include clinician voices at the front end, not as an afterthought," American Medical Association President Jesse Ehrenfeld, MD, MPH, said during the AIMed Global Summit this past June in San Diego.
The AIMed conference, which saw attendance skyrocket to some 1,500 people from last year to this year, served as a forum to discuss how the technology (called "augmented intelligence" rather than artificial intelligence") should be slowly and gradually adopted by healthcare. Ehrenfeld pointed out that the industry botched the roll-out of the electronic health record by rushing things and forcing clinicians to use the platform before they were comfortable with it.
"There is enthusiasm about this disruptive technology," he said, but "the existing regulatory framework is clearly not equipped to handle" AI governance.
That's why studies like that done by Mass General Brigham and pilot projects are important. Healthcare leaders need to see how the technology can and should be used before they use it.
Hospital officials say they'll be doing more research on AI tools like ChatGPT, including studying whether the technology can improve patient care and outcomes, particularly in areas where access to information and resources is strained or limited.
"Mass General Brigham sees great promise for LLMs to help improve care delivery and clinician experience,” Adam Landman, MD, MS, MIS, MHS, chief information officer and senior vice president of digital at Mass General Brigham and the study's co-author, said in the press release. “We are currently evaluating LLM solutions that assist with clinical documentation and draft responses to patient messages with focus on understanding their accuracy, reliability, safety, and equity. Rigorous studies like this one are needed before we integrate LLM tools into clinical care."
Rick Evans, senior VP and chief experience officer at NewYork-Presbyterian, says patient engagement and activation are crucial to health systems, and that executives need to focus on confidence rather than complacency.
No member of the healthcare C-suite has been affected more by the shift to consumer-directed care than the chief experience officer, sometimes called the chief patient experience officer.
This role was once defined as one of service excellence, and the executive was responsible for ensuring that the healthcare organization was delivering top-notch service, according to standards established by the health system. But with the rise of patient-centered care, that role has shifted radically around to focus on the delivery of care and services that meet the patient's expectations.
"We now ask ourselves if we're inspiring confidence," says Rick Evans, MA, senior vice president and chief experience officer at NewYork-Presbyterian. "Not happiness, but confidence. And with that, are we providing convenience?"
Rick Evans, senior vice president and chief experience officer, NewYork-Presbyterian. Photo courtesy NewYork-Presbyterian.
Evans has spent seven years as the CXO at NYP, but his 20-plus-year career has always been focused on how the patient interacts with the health system. He spent seven years earlier in his career as vice president of support services and patient-centered care with NYP, then moved up the I-95 corridor to Boston to spend four years as CXO at Massachusetts General Hospital before returning to the Big Apple.
To Evans, the CXO position is now all about technology and communication, though he's quick to add that it's not a technology position. His responsibilities focus on creating an overarching strategy to engage with the patient, and to work with other members of the C-suite to "facilitate good, consistent, clear, and compassionate communication" with patients.
Technology plays a large part in that strategy, and telehealth and digital health have helped to transform that platform into a real-time communication tool. Whereas patient interactions were once measured by phone calls and printed questionnaires, healthcare organizations now have at their disposal a wide range of tools to engage and evaluate ongoing relationships. This includes online surveys, messaging platforms, and other resources that allow the patient to interact on their own schedule.
"We also have a lot more data that can help us make [communications] more meaningful and move the needle [on quality of care]," Evans says.
Patient engagement, as well as the fast-rising concept of patient activation, are measured most often in HCAHPS scores, which come out of the federal HCAHPS Hospital Survey. But while that survey enables a health system to measure itself against other health systems, the precision of digital health tools enables health system executives to drill down and determine what that hospital or network is doing right and wrong in communicating with patients and meeting their needs.
"We want to ask those questions that our patients are uniquely qualified to answer," Evans points out. That, in turn, will go a long way toward creating programs and services that attract and keep patients.
"That messaging is important," he adds. "We're always looking to create that meaningful connection to give [patients] the services they need. You're not in a hotel or Disney World. You're in a hospital."
Patient engagement efforts require a healthcare executive to look both outside the health system and within. Workforce shortages can affect services, which in turn can affect the patient's healthcare experience. Staff stress and burnout can affect morale, which in turn affects the workplace, which in turn can affect what a patient experiences in that environment.
"You can not succeed as a chief experience officer if you do not understand the workflows," Evans says. "Without them we're just blowing into the wind."
And while the pandemic exacerbated those staffing issues, it also highlighted the opportunities of using telehealth to both address workforce gaps and improve access to care for patients. The ability to offer virtual care alongside in-person care, either as a supplement or a replacement, helps patients who face access challenges and who also want more convenience. By giving patients more ways of accessing care, they'll be more inclined to continue their healthcare journey with the health system.
"You're always thinking about sustainability in the patient experience," Evans says.
That said, there's always a chance that a health system will go too far in its attempts to connect with patients. Just because the technology is there to reach out to patients in real time doesn't mean it has to be used that way. CXOs need to map out a strategy that takes into account which communication channel a patient prefers, as well as how often a patient might wish to be contacted and when.
"How do we not get creepy?" Evans asks.
The goal, he says, is to position the health system as a trusted resource, one in which a patient has confidence. Hospitals—and their CXOs—must know when to reach out and how to connect, and offer resources that meet patient needs and expectations.
HealthLeaders Senior Editor Eric Wicklund talks with Melissa Topp, MSN-RN, executive director of care management for the Providence Health Plan, about their 'Food as Medicine' program, which tackles food insecurity and has the potential to make a significant impact on chronic care management and behavioral health outcomes.
As healthcare organizations move more services into the home, a 'living lab' smart home in Orlando's innovation community offers ideas on how to integrate healthcare with daily life.
As health systems embrace the value of the home in care coordination and management, a "living laboratory" built in the shadows of Walt Disney World is giving healthcare executives new perspective on how their healthcare programs can better integrate with home life.
The program aims to attract healthcare executives who are moving more services out of the hospital and into the home, as well as those who want to see how a smart home can collect and transmit data that could be used in clinical care management.
"This is a real home in a real neighborhood on a quiet street that is also a living lab," says Gloria Caulfield, vice president of strategic alliances at the Tavistock Group, Lake Nona's developer, and executive director of the Lake Nona Institute, which includes the WHIT House. "And we're always in the loop on what's next."
Gloria Caulfield, vice president of strategic alliances, Tavistock Group. Photo courtesy Tavistock Group.
According to Caulfield and Juan Santos, Tavistock's senior vice president of brand experience and innovation, WHIT House offers healthcare executives a different look at innovation. Each room in the house features a wide array of technological projects, from smart appliances, toilets, and beds, to 3D printers that can print pharmaceuticals or nutriceuticals to the latest in sensor-embedded windows, lighting, water purification, and gardening concepts.
The healthcare industry has taken notice. Nemours opened its children's hospital in Lake Nona in 2012, and has been among the nation's leaders in pediatric care innovation. HCA Healthcare is a partner, says Caulfield, as is the Veterans Administration and the University of Central Florida College of Medicine and the University of Florida College of Pharmacy. Those health systems and companies like Johnson & Johnson, Verizon, and KPMG are all part of the 650-acre health and life sciences park, while the nearby Lake Nona Performance Club puts innovation to the test in fitness and athletics.
Another neighbor is Fountain Life, a recently launched concierge-style healthcare provider that focuses on gathering top healthcare specialists to create centers of excellence for precision care.
According to officials, health systems are particularly interested in bedroom design, especially in pediatric care. As acute care at home programs gain traction, healthcare executives are focused on how patients can be treated in their own beds, rather than a hospital bed, and how bedroom technology can capture and transmit relevant data back to care teams. The same strategy applies to bathrooms, where technology can track medication adherence, dental care, weight and other vital signs, and urinary and bowel output.
Another area of interest is the kitchen, especially as healthcare organizations address social determinants of health in care management. Technology associated with food preparation, hydration, nutrition measurement, and meal tracking can play important roles in a variety of programs, from chronic care management to behavioral health.
Home design is also important to healthcare executives designing programs that allow seniors and those with physical and developmental disabilities to stay at home, as well as for patients needing to rehab at home after a hospital stay.
Caulfield and Santos note that while healthcare organizations across the country are launching innovation centers and labs, WHIT House looks beyond healthcare innovation in the healthcare space to study how it can be integrated into the home and daily life. The idea, says Caulfield, is to make healthcare a natural part of the home, so that it's included in design and building plans and even marketed as such by realtors.
"Health usually isn't a factor in home-buying," says Santos. "And that needs to change. [WHIT House] changes the way you interact with your home. The kitchen, for example, is absolutely full of design details that make it healthier."
Juan Santos, senior vice president of brand experience and innovation, Tavistock Group. Photo courtesy Tavistock Group.
"The whole point of this is that in designing things the way they are we can maybe change behaviors," he adds. "We strive to be a living lab."
"We're a Switzerland health and life sciences cluster," jokes Caulfield, who's also executive director of the Lake Nona Impact Forum, an invitation-only event that aims to elevate the innovation discussion. "We bring in the best people to talk about the most pressing matters in relation to healthcare and innovation. And we want everybody to be a part of that conversation."
That strategy synchs well with two trends in healthcare: The shift in care and services from the hospital to the home and the emphasis on identifying and addressing social determinants of health.
As health systems implement acute care at home and remote patient monitoring programs, they're taking a closer look at the home environment to better integrate medical technology that can gather and send data back to the care team. Smart homes would offer more of those opportunities, from WiFi platforms to sensor-embedded furniture and appliances that could facilitate data gathering and transmission.
And as healthcare providers look to understand the underlying, nonclinical factors that affect clinical outcomes, a smart home that can tell care providers what a patient is eating and how often, how much sleep and exercise a patient is getting, even when a patient uses the bathroom, will add to that wealth of information that can impact care coordination and management.
WHIT House "is continuously working" to validate those tools and technology, says Santos, noting the house schedules themes to highlight certain users or programs, such as aging in place, mental healthcare at home, the bedroom as a reference lab (there are 20 to 30 ongoing tech projects alone in that room, he says) and the importance of good sleep.
"We're actually trying to go beyond smart," he says. "We want to be responsive and be smart with a purpose."
12 healthcare organizations across the country will create a network to develop and test new programs aimed at tackling the nation's high maternal mortality rate.
Twelve healthcare organizations will be creating a network of federally funded research centers aimed at tackling the nation's high maternal mortality rate and promoting maternal health equity.
The health systems were selected by the National Institutes of Health to take part in the Maternal Health Centers of Excellence program, which includes $24 million in first-year funding and a seven-year budget of roughly $168 million. Ten will serve as research centers, while the 11th will serve as a data innovation and coordinating hub and the 12th will be an implementation science hub.
“The magnitude and persistence of maternal health disparities in the United States underscore the need for research to identify evidence-based solutions to promote health equity and improve outcomes nationwide,” Diana W. Bianchi, MD, director of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), said in a press release. “Through collaborations with community partners and others, the Maternal Health Research Centers of Excellence will generate critical scientific evidence to help guide clinical care and reduce health disparities during and after pregnancy.”
The new program crystallizes an ongoing national effort to curb health issues and deaths among expecting and new mothers and their infants, particularly in underserved populations. The nation saw more than 1,200 such deaths in 2021, or roughly 33 per 100,000 live births, a much higher number than many developed countries.
Several healthcare organizations have launched programs that use digital health and telehealth platforms to address maternal health. These platforms connect care teams to patients on demand at home, enabling those patients to connect with providers and access support and resources when and where they need the help. Some remote patient monitoring programs have also been launched to monitor at-risk mothers and their children during and after pregnancy.
The following health systems will participate as research centers:
Avera McKennan Hospital, Sioux Falls, South Dakota, Maternal American-Indian Rural Community Health (MARCH), principal investigator Amy J. Elliott, PhD.
Columbia University, New York City, NY Community-Hospital-Academic Maternal Health Equity Partnerships (NY-CHAMP), principal investigator Uma Reddy, MD.
Jackson State University, Jackson, Mississippi, Delta Mississippi Center of Excellence in Maternal Health, principal investigator Mary D. Shaw, PhD.
Medical College of Wisconsin, Milwaukee, Addressing Key Social-Structural Risk Factors for Racial Disparities in Maternal Morbidity in Southeastern Wisconsin (ASCEND WI), principal investigator Anna Palatnik, MD.
Michigan State University, East Lansing, Maternal Health Multilevel Intervention/s for Racial Equity (MIRACLE) Center, principal investigator Cristian Ioan Meghea, PhD.
Morehouse School of Medicine, Atlanta, Center to Advance Reproductive Justice and Behavioral Health among Black Pregnant/Postpartum Women and Birthing People (CORAL), principal investigator Natalie Dolores Hernandez, PhD.
Stanford University, Stanford, California, Stanford PRIHSM: Preventing Inequities in Hemorrhage-related Severe Maternal Morbidity, principal investigator Yasser Y. El-Sayed, MD.
Tulane University, New Orleans, Southern Center for Maternal Health Equity, principal investigator Emily Wheeler Harville, PhD.
University of Oklahoma Health Sciences Center, Oklahoma City, Center for American Indian/Alaska Native Resilience, Culture, and Maternal Health Equity, principal investigator Karina M. Shreffler, PhD.
University of Utah, Salt Lake City, ELEVATE Center: Reduction of Maternal Morbidity from Substance Use Disorder in Utah, principal investigator Torri D. Metz, MD.
In addition, Johns Hopkins University in Baltimore will serve as the hub for data innovation and coordination, with Andreea Creanga, MD, PhD, serving as principal investigator. And the University of Pennsylvania in Philadelphia will serve as the implementation science hub, under the direction of principal investigator Meghan Brooks Lane-Fall, MD.
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The Sentinel Event Alert, titled "Preserving Patient Safety After a Cyberattack," informs health system leadership on how to react once an attack has been detected.
With healthcare cyberattacks on the rise, the Joint Commission has issued guidance for health system executives on how to react once a data breach has been detected.
The Sentinel Event Alert, titled Preserving Patient Safety After a Cyberattack, lists a number of steps that health system leadership should take to ensure that patient care is safe. One of those most important recommendations is that leadership include all hospital staff in the process, not just IT staff.
“Cyberattacks cause a variety of care disruptions – leading to patient harm and severe financial repercussions,” David W. Baker, MD, MPH, FACP, the Joint Commission's executive vice president for healthcare quality evaluation and improvement, said in a press release. “Taking action now can help prepare healthcare organizations to deliver safe patient care in the event of future cyberattacks. The recommendations in the Sentinel Event Alert, as well as The Joint Commission’s related requirements on establishing and following a continuity of operations plan, disaster recovery plan and more, can help healthcare organizations successfully respond to a cyber emergency.”
The recommendations include:
Evaluate hazards vulnerability analysis (HVA) findings and prioritize hospital services that must be kept operational and safe during an extended downtown.
Form a downtime planning committee to develop preparedness actions and mitigations, with representation from all stakeholders.
Develop and regularly update downtime plans, procedures and resources.
Designate response teams. Create an interdisciplinary team to mobilize during unanticipated downtime events.
Train team leaders, their respective teams and all staff on how to operate during downtimes, including specific incidents that would cause downtime to go into effect.
Establish situational awareness with effective communication throughout the organization and with patients and families.
After an attack, regroup, evaluate and make necessary improvements. Take steps to recover and protect systems.
