A digital health collaboration aims to give health systems and health plans access to both virtual visits and on-demand house calls for fragile patients living with cardiovascular disease.
Healthcare organizations looking for a more proactive method of care management for patients with cardiovascular disease should take note of a new collaboration that combines 24/7 virtual access to specialists with house calls.
MedArrive, a Texas-based company active in the mobile integrated health space, is partnering with Heartbeat Health, a New York-based provider of virtual cardiology services. The partnership will give patients access not only to specialists for a telehealth visit but also on-demand EMS providers and specially-trained paramedics for house calls.
The collaboration seeks to address the more than $320 billion, or 15% of the nation's total healthcare budget, spent each year on treating or managing cardiovascular disease (CVD). And it focuses on managing care at home, rather than waiting for patients to visit their doctor or a hospital.
Mobile integrated health and community paramedicine are fast-growing strategies being used by health plans and health systems to improve care and outcomes for so-called fragile patients, or those who often access emergency care services. The concept involves sending trained personnel, such as a paramedic, to a patient's home for on-demand or routine care management, thereby reducing the chance for health concerns that result in a 911 call and transports to the ER.
The MedArrive-Heartbeat Health partnership take particular aim at the Medicaid population, many of which experience barriers to accessing on-demand care. More than 25% of that population is living with CVD, and a significant percentage of that population has a high risk of developing CVD.
"Heart disease may be the number-one killer of all people in our country, but in the intricate web of health disparities, the vulnerability of individuals on Medicaid to heart disease is an undeniable fact," MedArrive Co-founder and CEO Dan Trigub said in a press release. "They face a perfect storm of limited access to quality healthcare, socioeconomic challenges, and systemic inequalities that amplifies their risk.”
Through the partnership, now being marketed to health plans, members living with CVD can access on-demand visits by a MedArrive care team, which can connect via telemedicine to cardiologists employed by Heartbeat Health for further care management and coordination.
"The integrated approach holds significant importance for engaging underserved populations, including people in rural regions or economically disadvantaged urban areas where accessing cardiology care presents greater challenges," the two companies said in the press release.
HealthLeaders payer and finance editor Jay Asser is joined by Bill Ringwood, associate principal with Vizient and Sg2, and Tawnya Bosko, senior principal for Vizient and Sg2, to discuss how providers can prepare for increased levels of Medicare Advantage in their market. Ringwood and Bosko identify trends in the private program and share how Vizient and Sg2 are well positioned to help organizations in their approach.
In this episode, HealthLeaders speaks with Kristen Noles, performance improvement manager with the University of South Alabama Health System about University Hospital's participation in a grant funded pilot program to reduce nursing staff's stressors to avoid burnout.
The chief of pediatric hematology, oncology, and stem cell transplantation at Stanford Medicine Children's Health says new ideas in immunotherapy, stem cell transplants, gene therapy, and gene editing are helping care providers do things they've never done before.
Innovation in pediatric healthcare often focuses on the tiniest of factors affecting the tiniest of patients. And Tanja Gruber, MD, PhD, says research around the makeup and functions of the gene are enabling care providers to get a better idea of how to tackle cancer.
HealthLeaders recently sat down—virtually—with Gruber, chief of pediatric hematology, oncology, and stem cell transplantation at Stanford Medicine Children's Health to discuss innovative ideas like immunotherapy, stem cell transplants, gene therapy, and gene editing, and how they're helping to improve outcomes for millions of children.
Q: What new technologies or strategies are you now incorporating into care management?
Gruber: This is an exciting area of pediatric oncology. The community is very proactive about new science and technology within the clinical space, and that is opening doors to new care models and treatment plans for children and adolescents. Current areas of innovation specific to pediatrics are in immunotherapy, stem cell transplant, gene therapy, and gene editing.
For example, at Stanford Medicine Children’s Health, we have a large chimeric antigen receptor (CAR) T-cell therapy program, which boosts a child’s own immune system to target specific proteins on cancer cells and fight the disease. This has been used for types of leukemia and lymphoma, and there are currently clinical trials exploring this modality for other types of cancers and tumors.
Tanja Gruber, MD, PhD, chief of pediatric hematology, oncology, and stem cell transplantation, Stanford Medicine Children's Health. Photo courtesy Stanford Medicine Children's Health.
This is important because we believe in multi-modality through a combination of treatments, and multi-disciplinary via specialties across the care spectrum. In pediatrics (and pediatric cancer), it’s not enough to treat the disease itself. We must incorporate other healthcare professionals as a part of a long-term, holistic treatment plan – whether physical therapy or mental health. It’s also worth noting that artificial intelligence (AI) is an emerging topic in the pediatric community. The adult field has led the charge here; however, pediatrics is starting to get more involved.
Q: What are the challenges you deal with in using these new treatments?
Gruber: Location or proximity to specialty care facilities and children not being able to administer certain tests for themselves present a new set of challenges. Immunocompromised children also face a plethora of different challenges from their adult counterparts that require unique treatment plans. We saw this during the pandemic. The pediatric community was incredibly cautious around viruses, and relied on vaccinations to help prevent complications that can happen with infections and infectious diseases.
Another growing area of concern is that earlier detection and treating children with cancers earlier in life will likely result in more strain on the healthcare system as they venture into adolescence and adulthood. Survivors need to be monitored post-treatment, they need frequent follow ups, and they need to be watched closely as they grow. Add onto this the physical, mental, and emotional toll that cancer treatment places on the body at a time when children are growing and vulnerable, and you see the critical importance of holistic, multi-disciplinary care.
Q: Do you feel there is enough healthcare innovation directed toward pediatric care, or is it difficult to find the right technology and/or companies to address what you need?
Gruber: Our community is very proactive about pediatric healthcare innovation from a technology and strategies perspective. However, one area that we must continue to advocate for is drug development. We cannot be left out of that conversation. Currently, the industry is looking into mandates and requirements for certain portions of research and development spend to be targeted to pediatrics. This is – and will continue to be – a game changer.
We’ve also seen impressive responses from patients on clinical trials. The conversation is about education. Enrolling children in clinical trials takes on more complexity – how you communicate with families, how you coordinate with research, how you gather consent, how you administer care, and more. I’ve been really impressed with how the pediatric community has provided innovative care opportunities and world-class treatment through clinical trials.
Q: How have advances in stem cell transplants and gene therapy affected pediatric care?
Gruber: A lot of the work with gene therapy has been geared toward inherited disorders as opposed to cancer, but that is shifting. And it will be critically important in the long run to make sure pediatrics isn’t left out of this conversation.
With stem cell transplants, the positive results are clear. A lot of people might not be aware, but this care has been around for decades and is continuing to evolve. In fact, Stanford Children’s Pediatric Stem Cell Transplantation program was established in the 1980s, and we have transplanted more than 1,000 patients since that time.
Currently, we are identifying ways to evolve stem cell transplantation, including using new antibody-based methods instead of traditional chemotherapy or radiation to prepare patients’ bodies for the transplant. As a part of this, we’re working with our community via the Pediatric Transplantation & Cellular Therapy Consortium and the Blood & Marrow Transplant Clinical Trials Network to advance these innovations.
Q: What new technologies or strategies are on the horizon for pediatric healthcare? What are you looking forward to using?
Gruber: A topic that’s being discussed in the industry is early detection. Typically, pediatric and adolescent patients do not have access to earlier screenings, as childhood cancer is rare. That is changing as research shows genetic mutations that drive certain inherited disorders also increase the risk of childhood cancer.
Another example, which is still in its infancy, is identifying predisposition for pediatric patients. This opens up so much opportunity for care. This can be the result of individual testing, family testing, or other genetic warning signs. It encourages adolescents to take control of their healthcare and puts a focus on providers helping patients make a smooth transition into adult care.
We are having ongoing conversations in pediatrics about when to start screenings and how to educate patients and families. We are fortunate at Stanford Medicine Children’s Health as we have access to that transition with our colleagues from Stanford Health Care. As an industry, this isn’t common, so more work needs to be done.
Q: What has surprised you, good or bad, about how technology is incorporated into pediatric care?
Gruber: A wonderful surprise has been how well patients and families are responding to clinical trials – and how our population continues to advocate for pediatric innovation. Speaking to patients and families about how clinical trials and technology innovations can improve care and deliver better outcomes has been a positive experience.
Similarly, seeing the community rally around these initiatives to make sure all patients, regardless of location, are made aware of and have access to state-of-the-art care has been heartwarming. For me, the fact that the patient has not been lost in technology conversations shows the true desire of our pediatric provider community to do whatever it takes to improve outcomes for sick children.
Q: Has technology allowed you to collaborate more with other healthcare providers on a patient's care? If so, how has this improved care?
Gruber: Collaborate is the perfect word to describe how we’re able to improve care, together, with our network of healthcare providers. In California, pediatric patients have access to clinical trials that are funded through philanthropy. Collaboration allows us to extend the reach of our world-class care centers and provide greater access to care throughout rural areas or underrepresented communities.
The pediatric oncology community and Stanford Medicine Children’s Health are mindful about health equity, and there are efforts to leverage resource-rich hubs to help patients and families overcome travel, housing, treatment concerns, and more when it comes to getting cancer care to underrepresented minorities in outlying communities. With the help of philanthropic efforts and initiatives like the Ronald McDonald House, pediatric patients and families who otherwise would typically not be able to participate in clinical trials are supported. This would not be possible without collaboration.
Q: How do you see your role evolving?
Gruber: Patient-centered care, backed by research and innovation, remains at the heart of our roles in pediatrics. However, in recent years, shifts have taken place that put a greater emphasis on communication. Communication, both between researchers and practitioners, as well as between providers and families. With new technology comes a need for education. But technology for technology’s sake doesn’t help patients in the long run.
Encouraging communication between these groups is crucial to ensure research and innovation is targeted, providers feel technology can be applied in a way that makes sense for the patient, and patients are aware of the care options they have and feel comfortable with what lies ahead. You add in the push for multi-disciplinary treatment and the movement for health equity, and those communication lines become even more critical to advancing pediatric care.
The University of Washington School of Medicine and Scene Health are continuing a federally funded project that uses video-based remote patient monitoring to treat people dealing with substance abuse issues at home rather than in a clinic.
Editor's note: This article has been amended to add the annual cost to health systems of medication non-adherence.
A multi-state pilot program overseen by the University of Washington School of Medicine will test whether an innovative remote patient monitoring program for methadone treatment can improve outcomes for patients living with substance abuse.
UW is partnering with Baltimore-based digital health company Scene Health, formerly emocha Mobile Health, on the program, which is funded by a $1.96 million small business innovation research award from the National Institute on Drug Abuse. The pilot will use Scene Health's video directly observed therapy (video DOT) platform, which enables patients to film themselves taking their medication and send that video to their care provider.
The pilot comes at a crucial time for a healthcare industry struggling to address an epidemic in substance abuse and looking for new ways to reach patients at home who can't or won't visit a clinic or doctor's office for regular treatment. Methadone has proven effective in treating opioid use disorder (OUD), but it's commonly taken by patients in a clinic or doctor's office.
It also addresses an issue plaguing healthcare organizations across the board: Medication adherence. Studies have shown that patients need to take their medications at least 80% of the time for that treatment to take effect, yet in the US adherence rates are typically at 50% or lower. RPM and digital health platforms that can boost that adherence rate could help health systems tackle $500 billion in preventable costs each year tied to treatment and hospitalizations.
That's where Scene Health comes into play. The company, spun out of Johns Hopkins, has proven the value of video DOT in treating patients living with hepatitis C, and is partnering with providers and some Medicare and Medicaid MCOs to address remote treatment for hypertension, asthma, diabetes, organ transplants, and sickle cell disease. In addition, the Centers for Disease Control and Prevention (CDC) announced this past March that video DOT meets the standard of care for programs treating patients with tuberculosis.
Some healthcare providers offer doses of methadone that patients can take home, so that they don't have to go to a clinic or office to keep up with their treatments, but federal regulations are very strict, greatly limiting those opportunities. During the pandemic the Substance Abuse and Mental Health Services Administration (SAMHSA) relaxed those rules to allow more home-based treatment, but the old rules are scheduled to go back into effect in May 2024.
Another issue is funding. Some healthcare providers steer clear of methadone treatment because of limited opportunities for reimbursement, and payers want proof that these services, including RPM, improve adherence and outcomes. Congress is considering reauthorizing The SUPPORT for Patients and Communities Act, a set of addiction treatment and recovery services that will expire on September 30 and which include funding for programs that provide remote treatment options.
The UW partnership is the second phase of an ongoing project to prove the value of this platform for treating OUD. The first phase, a 60-day pilot launched during the pandemic, proved the feasibility of the platform and saw a boost in medication adherence, while a subsequent qualitative study proved that the technology was more convenient for both patient and providers and gave patients more opportunities for continuous treatment.
The goal now is to push the platform out on a much larger scale and prove its value as an OUD treatment not only to regulators but to payers.
"Findings from this phase will inform the evidence-based policy changes required to extend the use of video DOT technology for remote monitoring of methadone maintenance therapy, increasing access to care and advancing patient-centric outcomes for individuals with opioid use disorder," Judith Tsui, a professor of medicine at the UW School of Medicine and one of two clinical investigators for the pilot, says in a press release.
"Currently, SAMHSA’s regulations differentiate between a ‘supervised dose’ and a ‘take-home dose,'" says Scene Health CEO Sebastian Seiguer. "This project explores the possibility of creating a middle ground for patients and OTPs: a supervised take-home dose. With the recent declaration by the Centers for Disease Control that remote/video DOT sessions are equivalent to in-person DOT, the time has come to revolutionize methadone treatment."
UNC-Chapel Hill will use a five-year, $3.73 million NIH grant to establish the Center for Virtual Care Value and Equity (ViVE)
A new program in North Carolina aims to research and develop virtual care services that address health inequity.
The University of North Carolina at Chapel Hill will use a five-year, $3.73 million grant from the National Institutes of Health's National center for Advancing Translational Sciences to launch the Center for Virtual Care Value and Equity (ViVE).
“This groundbreaking initiative is pivotal for healthcare innovation and demonstrates Carolina’s leadership in virtual care research,” Saif Khairat, PhD, MPH, an associate professor and Beerstecher-Blackwell Distinguished Term Scholar in the UNC School of Nursing, associate director of the Carolina Health Informatics Program and director of the Carolina Applied Informatics Research Lab, said in a press release. “The Center for ViVE will foster expertise in virtual care data and create workforce development opportunities with its partners throughout North Carolina and the nation.”
The project is one of many across the country aiming to apply new technologies and strategies to an ongoing challenge: Breaking down the barriers to care that impact underserved populations. Those barriers are often called social determinants of health, and can include family, work and transportation issues, cultural pressures, technical literacy, and behavioral health concerns.
The pandemic brought to the forefront the value of telehealth in improving access to care, but it also highlighted those barriers.
"While telehealth services have made healthcare more convenient to some groups, certain populations remain underserved due to lack of access to technology and financial instability," UNC officials said in the press release. "The challenge of promoting health equity in virtual care is often overlooked due to the complex issues involved in implementing virtual care, such as patient privacy, reimbursement models, new workflows, and technology adoption."
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A recent survey finds that consumers aren't concerned about protecting their personal health information on digital channels, and they may not understand what HIPAA does and doesn't do. But that doesn't mean providers can take it easy on cybersecurity.
Healthcare organizations that are working to protect patient data on digital channels may be coming up against an unexpected barrier: Their patients may not care.
Some 58% of consumers surveyed earlier this year by The Harris Poll on behalf of ClearDATA said they've never considered where their health information is shared while they're using digital health apps, and only 27% of those surveyed place privacy and security among the top three factors when choosing and online care provider.
The May survey of some 2,053 consumers raises an interesting question: Are consumers not that interested in cybersecurity, or are they mistakenly assuming their sensitive health information is being protected?
“As more and more Americans flock to direct-to-consumer digital health apps and resources, most people don’t know the sensitive health data they share with these companies could be passed on to third-parties or sold to data brokers, without so much as a single consent form,” Chris Bowen, ClearDATA's founder and chief information security officer, said in a July press release on the survey's results. “No company should ever be allowed to profit off a person’s private health information. Far more needs to be done to protect PHI at a regulatory level and, in the meantime, digital healthcare companies bear a particular responsibility to better educate patients about how their data will be used, and what they can do to keep their data private.”
Ignorance may be a factor. Some 81% of consumers surveyed said that assumed their data was protected by the Health Insurance Portability and Accountability Act (HIPAA), and 68% reported they're somewhat or very familiar with HIPAA. Yet HIPAA makes no mention of protected health information (PHI) used or stored on digital health apps or by healthcare organizations that aren't "covered health entities," like health systems and providers.
That could be a problem as more and more consumers use digital health apps or seek care from non-traditional care providers, particularly through online channels. It also reinforces an effort within the healthcare industry to have the federal government update HIPAA.
Regardless of the debate around HIPAA, the survey points to a lack of interest among consumers to place a value on privacy and security. While 27% listed privacy and security as one of their top three concerns when picking a care provider, other factors getting more support were acceptance of health insurance (68%), the option for in-person care (49%), and an immediate response to booking an appointment or getting medication (41%).
That's especially true among younger generations who are more accustomed to going online for healthcare. While 69% of those over 65 surveyed regarded privacy and security as more important than convenience, only 54% of consumers between the ages of 18 and 34 agreed. And while only 17% of seniors said they'd still use a digital health app if they knew their data would be shared with third parties for marketing purposes, a staggering 60% of those 18-34 said they'd still use the app.
That said, just because consumers don’t seem to place value in health systems protecting their PHI doesn't mean those health systems can slack off. On the contrary, data breaches, hacks and ransomware attacks are happening with more frequency and complexity, and health systems need to expend more time and effort to make sure their cybersecurity defenses are effective.
In addition, these breaches may result in litigation. Several healthcare organizations, including HCA Healthcare, Johns Hopkins, Norton Healthcare, Mercy Health, Harvard Pilgrim Health Care Plan, and NextGen Healthcare, are facing class action lawsuits over recent data breaches.
The answer, then, may lie in education. Health systems should inform their patients not only what they're doing to protect PHI, but to explain the importance of securing that information from prying electronic eyes. And that education should include information on what HIPAA covers and what it doesn't.
Ellis Medicine is partnering with the city of Schenectady and AION Biosystems to monitor the temperatures of oncology patients for between 30 days and 60 months.
A Schenectady, New York health system is launching a remote patient monitoring program to track the temperatures of oncology patients at home.
Ellis Medicine is partnering with AOIN Biosystems and the city on the Stay Well program, which will equip selected patients with AION's iTempShield wearable patch to measure body temperature for 30 days to six months. Patients undergoing cancer treatment are much more susceptible to infections like sepsis, which can be deadly if not detected and treated quickly.
“In many oncology patients, infection detection is the key,” AION Biosystems CEO Samara Barend told the Daily Gazette after a Thursday press conference at Ellis Hospital announcing the program. “Being able to stay ahead of it [is crucial] because a low-grade fever, even around 100, can be dangerous for these patients. Many of them don’t even realize they have an infection or that they’re on the verge of an infection, so being able to track it early and continuously is critical.”
The RPM program is part of the Smart City project launched earlier this year by the city with $2.6 million in federal Community Development Block Grants. As part of that project, the city is expanding free Wi-Fi services to bolster connectivity in underserved parts of the community.
As healthcare organizations across the country shift services out of the hospital and into the home, RPM programs are becoming a popular method for staying in continuous or regular contact with patients at risk of health complications or hospitalization. Along with patients undergoing chemotherapy, programs have been established to monitor those with chronic conditions like COPD, diabetes, and congestive heart failure, patients recovering from surgery, and new mothers and their babies.
Ellis Medicine officials said 250 patients would be monitoring through the RPM program, with plans to expand at a later date to include other patient populations.
“We wanted to start somewhere where it made a lot of sense and when you’re a cancer patient you’re immunocompromised and if your temperature starts to go up, the technology jumps on it,” Ellis Medicine President and CEO Paul Milton told the Daily Gazette.
Patrick McGill, executive vice president and chief transformation officer at Indianapolis-based Community Health Network, talks about the health system's digital health strategy and efforts to attract consumers.
Search engine optimization (SEO) might not come up often in healthcare conversations, but to Patrick McGill it's an important strategy for a health system. Being the first brand consumers think of when they are looking for healthcare affirms that your organization has made a connection with potential and existing patients.
"We're taking friction out of the healthcare experience," he says. "I want this to be as seamless as when [consumers are] Googling care."
And that means taking control of the digital points of entry into the healthcare system, from online searches to patient portals and scheduling apps so consumers can access what they need for care.
McGill, MD, MBA, is the executive vice president and chief transformation officer for the Community Health Network (CHNw), an Indianapolis-based organization of more than 200 sites of care. The health system sits at the epicenter of a competitive healthcare market, which includes Ascension St. Vincent Health and Indiana University Health as well as a growing number of telehealth companies, health plans, and retail firms with their own providers.
Amid that competition, McGill says CHNw understands the imperative of making the healthcare journey as intuitive and smooth as possible. He's at the helm of that effort, which has been underway for several years.
"We used to have a hodgepodge of web pages," he says. "Some of them would lead to dead ends. We saw lots of drop-offs [as] people didn't continue their journey. Our goal was to create one digital front door that [would offer] a consistent online experience for consumers. We have to be the connector that brings them to the care they want."
According to a 2021 study posted in the National Library of Medicine, roughly three-quarters of consumers search for online healthcare services before making an appointment, and just as many (if not more) go online first to ask healthcare questions. That inclination to search online for a care provider is even more prominent among younger generations who aren't interested in having a primary care provider and who are used to the convenience of shopping online for banking, travel, hospitality, and retail services.
McGill says CHNw needs to have an online presence just like Amazon, Walmart, and other healthcare providers, because that's where the healthcare journey starts for many people.
After chatting with executives at Providence, CHNw partnered with DexCare, a digital health company launched out of the Pacific Northwest—based health system to develop a unified online platform. McGill says the health system didn't have the infrastructure in place or the expertise in-house to create the consumer experience that the market now demands.
"How do we understand that journey?" he asked. "We were trying to think about it in terms of the customer experience."
To do that, McGill says, the health system had to understand "stickiness," or strategies to attract and keep a consumer's attention during online visits and transactions. That includes coupling the initial reason for the consumer's visit with relevant information and resources, and then integrating data from with the medical record so that providers can add appointment reminders, wellness check-ups and other services. That might include pharmacy services, labs and tests, even virtual care options.
"This allows us or even forces us to have a strategic conversation" about how to integrate in-person and virtual care, he says. And it allows the health system to create "warm hand-offs" for consumers who are looking for on-demand care via telehealth.
"The more self-service tools that we can put onto this platform, that's one more phone call (from a confused patient) that doesn't have to be made," McGill says. Or one more patient who will continue a relationship with CHNw instead of looking elsewhere.
As the health system moves forward with its digital health blueprint, McGill says the health system must become more attuned to a patient's healthcare journey, not just the episodes of care. That's part of the plan for evolving from episodic care to value-based care. And it means combining information with channels to interact more frequently with patients, giving them options that affect both immediate care and overall health and wellness.
"It's smart navigation," he says. "At the same time, we're looking at new ways to learn the behavior of a patient, [so as to] understand the journey better than we've been able to do before."
