A new study finds that a third of providers surveyed are using digital health to treat OUD and substance abuse, yet the tools aren't being used to expand treatment or reach those who need help.
Digital health tools are increasingly becoming the weapon of choice for healthcare providers treating patients living with opioid use disorder (OUD), according to new research from several New England healthcare organizations.
But that weapon isn't being used as well as it could be.
More than a third of health systems with accountable care organization contracts are using at least one type of technology, including remote patient monitoring and on-demand support tools, says a study recently published in JAMA Network Open. Oftentimes those tools are used alongside the traditional treatment path of in-person care, suggesting that those using the technology are doing so because they can, rather than because they need to.
"Our results suggest that digital health technologies for OUD are more likely to be deployed by organizations with relatively robust traditional SUD treatment resources," the study, conducted by researchers from Harvard, Yale, Dartmouth, UnitedHealthcare and Beth Israel Deaconess Medical Center, concluded. "As such, the technology appears to complement existing SUD treatment resources rather than substitute for unavailable SUD treatment resources."
OUD and substance abuse combine to form one of the nation's most devastating health concerns, one that has been increasing in the wake of the pandemic. The issue is complicated by the fact that many patients conceal their problems or avoid medical treatment, as well as the fact that many are also living with behavioral health issues in need of treatment.
The study, drawn from a 2021-22 survey of 505 ACOs, of which 276 responded, finds that 33.5% of those responding are using some type of technology, such as virtual mental health therapy and tracking, virtual peer recovery support, and digital recovery support for adjuvant cognitive behavioral therapy (CBT). Just as important, that percentage increased among providers with a dedicated addiction medicine specialist or a registry to track mental health.
That's an important distinction. Digital health has long been considered an import platform to reach patients who either can't or won’t access healthcare providers for treatment. This means providers can and should be using these tools to connect with people who they might otherwise not treat or who would skip treatment. The study suggests that providers are using the technology to bolster care for patients they're already treating, and that providers who already focus on OUD and substance abuse care are using the tools.
"Organizations with substantial resources may have the ability to effectively integrate digital services," the study reported. "On one hand, organizations can extend treatment provided by their clinicians through mobile tools to track mental health symptoms remotely. On the other hand, technologies could substitute for insufficient SUD resources to meet clinical demand for patients with OUD. If technologies are primarily available in organizations with robust SUD treatment resources, then they are not yet reaching their full potential to advance access to care for patients with unmet needs in organizations without traditional treatment alternatives."
Therefore, for digital health to really have an impact on OUD and substance abuse treatment, it has to be used to reach those not receiving treatment. As well, this technology has to be made available to more healthcare providers who haven't traditionally treated patients with OUD or substance abuse issues but who can, including primary care providers and rural and community health clinics.
The study offers suggestions for expanding use of the technology to more organizations, as well as addressing health equity concerns.
"Our findings suggest a mismatch between need and deployment," researchers pointed out. "Organizations with fewer SUD treatment resources were less likely to adopt emerging technologies. To address this mismatch, policy initiatives could focus efforts on overcoming barriers to technology implementation in high-need, resource-limited healthcare settings. For example, policy makers and payers might test policies and reimbursement schemes that support health care organizations without local SUD treatment resources to integrate digital health technologies for OUD into their practices and workflow."
"Initiatives to advance the uptake of technologies may address costs, knowledge, user engagement, organizational culture, leadership, interoperability, and data security concerns," the study continued. "Training and education for patients and clinicians may be a productive avenue to increase adoption. For example, Kaiser Permanente used both clinician referrals and direct-to-patient approaches to drive service use during a large-scale integration of digital mental health technologies. Future efforts may require investing in trained staff, such as digital navigators, to support patients and clinicians to overcome technological, workflow, and digital literacy constraints. Digital navigators offer an opportunity to overcome both patient- and staff-level barriers to technology use even in low-resource settings."
The implication is that while digital health is being used to address the substance abuse crisis, it could be used much more effectively, not only as a complement to existing programs but as a platform for more providers to reach more people in need of help.
The Oakland-based payer with about 4.8 million members has announced a partnership with Microsoft to build an integrated data hub, called the Blue Shield Experience Cube, on Microsoft's Azure cloud platform. Officials say the hub will enable payers, providers, and other parties to access usable data more quickly and efficiently to streamline and improve care management for members.
“Our goal is to create high-tech, high-touch experiences for our members that are holistic and personalized by removing longstanding silos and bringing together data in the cloud,” Lisa Davis, BSC's executive vice president and chief information officer, said in a press release. “Microsoft’s cloud technology can help Blue Shield better coordinate with providers to open up greater access to care and services for our members. When data is available in near real-time, it enables shared decision-making among members and providers to improve health outcomes and reduce the cost of care.”
The news follows an announcement in May of a collaboration between BSC and Google Cloud to pilot an AI program aimed at expediting the prior authorization process.
“We want to help ease the administrative burden on our healthcare providers so they have more time to deliver the best care possible," Davis said at that time "Leveraging Google Cloud technologies and artificial intelligence, we are working to ensure our members get timely access to clinically necessary care and services."
With Microsoft, BCS is now turning its attention to improving the care journey for its members. The first project to be launched through the Blue Shield Experience Cub will be the development of an integrated digital health record, which will include a member's health information, medications, labs, ER visits, healthcare utilization, plan coverage, and other data.
"The information brought together by the Experience Cube will facilitate more data-driven care coordination to recommend actions that help members through transitions of care or prompt Blue Shield care managers to create programs that connect members to resources that address social determinants of health," officials said in the press release.
BCS has already moved some of its services into Azure, reportedly enabling the health plan to process billions of transactions in weeks instead of months. Future plans include expanding the capabilities of the Experience Cube to integrate more data, including costs of healthcare services, and incorporate AI tools.
Mainstay Life Services, which offers support for people with intellectual and/or developmental disabilities in Pennsylvania, reduced ER and urgent care clinic visits and improved clinical outcomes through virtual care.
A Pennsylvania-based support provider serving people with intellectual and/or developmental disabilities (I/DD) has reportedly saved almost $100,000 in emergency care costs over the past two years through telehealth.
Pittsburgh-based Mainstay Life Services, which currently supports roughly 400 people and their families across 42 sites, has partnered with New Jersey-based StationMD, which offers specialized telehealth services for people with I/DD in 21 states. Through that collaboration, StationMD has facilitated 245 telehealth visits over that two-year span.
According to a press release issued by StationMD, 92% of those visits were resolved without need of a medical transport, and 27% of those visits (67 visits) would have resulted in transport to an ER or urgent care clinic had telehealth not been available. This resulted in a savings of $98,758 in reduced hospital and emergency care costs.
“People with I/DD often have complex medical issues in addition to their underlying disability diagnosis," Maulik Trivedi, MD, FACEP, co-founder and chief strategy officer for StationMD, said in the press release. "Our clinicians are able to address and resolve over 90% of the medical concerns via our telehealth solution. We’re providing a backbone of care and serving as a critical medical resource 24/7 for individuals, families, and support staff.”
The savings point to the value of virtual care for a specific population that faces extra challenges in accessing healthcare. Whether living at home or in a structured setting, people with I/DD often need specialized care and aren't able to easily visit a doctor's office or clinic.
"Research shows that organizations have increased their use of telehealth technologies to better serve individuals with I/DD," the brief states. "Some reported benefits of telemedicine for people with I/DD include lower cost of care, lower transportation costs, improved medication reconciliation communication, and less exposure to communicable diseases especially during the [COVID-19 Public Health Emergency]. By assessing the impact of telehealth on individuals with I/DD, healthcare providers can continue to adapt and innovate ways to better serve people with I/DD through the use of various telehealth modalities."
According to a separate RIC brief, a 12-month pilot partnership in 2018 between StationMD and New York's Partners Health Plan resulted in 679 telehealth visits, of which 90% were resolved without need for further medical care. That, in turn, saved Partners $2.2 million in ED and hospitalization costs, $20,800 in transportation costs and $1,900 per member in medical costs.
Mainstay, which has increased its use of telehealth services by 288% since January 2022, plans on expanding its relationship with StationMD. They also plan to talk about the partnership at the 2023 Rehabilitation & Community Providers Association (RCPA) conference this October in Hershey, Pennsylvania.
“StationMD has helped the people we support to connect immediately from the comfort of home with doctors who understand them best," Kim Sonafelt, Mainstay's chief executive officer, said in the press release. "We’re seeing better health outcomes. Their team is happier, and the cost-savings allow us to offer better services.”
The hospital has created a high-tech command center to monitor patient progress through the hospital and address any pain points and potential care concerns.
As healthcare organizations across the country embrace telemedicine and digital health platforms within the hospital, they're creating high-tech command centers to manage all those new connections and capabilities.
One of the latest is Children's Mercy Kansas City, which partnered with GE HealthCare to craft a NASA-inspired Patient Progression Hub, a 6,000-foot "mission control center" that allows care providers to track a wide range of services, from patient care and supply chain to weather and traffic beyond the hospital's walls.
"It gives us a complete look at the patient as well as the surrounding community," says Stephanie Meyer, the health system's senior vice president and chief nursing officer. "We're looking at the entire patient flow instead of just a piece of it."
The hub brings together many of the new technologies that comprise healthcare innovation strategy these days, including remote monitoring, audio-visual telemedicine, predictive analytics and AI, and technologies built into the EMR platform that allow administrators to monitor a patient's progress through the hospital from admission to discharge.
The strategy is an expansion of the central nurse's station on a patient floor, where nurses could keep an eye on many patient rooms through connected devices and audio-visual telemedicine feeds. That idea gained value during the pandemic, when health systems looked to monitor contagious patients without sending nurses or other staff into each room.
Today's command centers are much larger, monitoring more than one wing, even entire hospitals. Some are located in large rooms built for that purpose, while other health systems are carving out empty space left over from previous expansions or even in nearby office buildings or warehouses. The development of wireless monitors, expanded connectivity, and more sophisticated telemedicine platforms gives health systems more opportunities to gather data and track patients and staff from a distance.
Meyer and Jennifer Watts, MD, an emergency medicine physician and Children's Mercy Kansas City's chief patient progression medical officer, says the hub took several years to design and build and involved input from many different departments and people, from IT staff to nurses.
While some parts of the hub were tested out over the past half-year, the hub officially opened in April. And it comes at a perfect time, as healthcare leaders look to virtual care technology to reduce stress and burnout among staff and create more engaging workflows.
"For a long time people were just fixated on what was right in front of their faces," Watts says of the hard times caused in no small part by the pandemic. "We wanted to get all of our [employees and staff] to look up and see things from an enterprise level. The processes we could make easier, the workflows we could affect. We wanted to make things meaningful again."
The hub features a video wall containing customized apps, or tiles, to monitor the flow of patients through the health system. Those working in the hub can drill down and follow specific patients, look at staff schedules and scheduled services like labs and tests, even manage open beds and identify bottlenecks. Data analytics and AI tools on the back end track not only current activity but plan out future tasks, identifying surges and problems before they affect staff or patient care.
"Prior to implementation, the organization relied on manual processes and often retrospective data to understand patient census and anticipate discharges," Jodi Coombs, MBA, BSN, RN, Children's Mercy's executive vice president and chief operating officer, said in an April press release announcing the hub's opening. "Now we have visibility into operations across the entire system to make faster and smarter complex decisions as soon as vital workflows change. The Patient Progression Hub journey enables endless possibilities for using real-time data to drive actions that deliver excellent patient care and supports our team members."
Watts and Meyer say the NASA-inspired command center can be intimidating at first because of the high-tech look and feel, and that caused some trepidation among nurses and staff members who would be working there. Many of those people were brought into the planning stages early on to add input on how the technology and layout could be designed to be less intimidating.
"This is a very complex, multi-faceted technology," Meyer says. "It involved a lot of buy-in and training on how to interact with everything."
The benefits, meanwhile, are numerous—and discovered on an almost daily basis. Patient care is coordinated and streamlined right up through an expedited and more efficient discharge process, which reduces stress for staff as well as patients and their families. If a patient is showing signs of distress or his or her data is trending in the wrong direction, a nurse in the hub can identify that concern and take action before it becomes an emergency. Even external issues like dangerous storms, accidents, and traffic jams are monitored so that the hospital can prepare for new patients.
"We're looking at the future of pediatric care," says Meyer. "And it gives [staff and employees] a renewed hope in the future of healthcare."
Meyer says Children's Mercy Kansas City will add new technologies and capabilities in time, including more AI and predictive analytics tools, remote patient monitoring programs that extend from the hospital to the home, and wearables and other digital health tools.
We're going to do things that we haven't even thought of yet," says Watts. "We're just starting on this journey."
HealthLeaders Innovation and Technology Editor Eric Wicklund talks with Dr. Deanna Willis, a physician and professor at the Indiana University School of Medicine, about new technologies and treatments being used in Alzheimer's care management.
The chief scientific officer at Ferring Pharmaceuticals USA, born and raised in Nigeria, has seen the dire consequences of inequalities in women's healthcare play out before her eyes. For example, 20 years ago in Nigeria her young cousin, Georgina, died from undiagnosed uterine cancer.
Growing up observing a Nigerian culture where women and men were not treated equally, Garner developed a lifetime mission to swing the pendulum to a more balanced position in women’s health--not only in Nigeria, but around the world.
"I often speak about having close relatives in Nigeria who are literally dying from conditions that women just shouldn't be dying from anymore," she says. "While there has been progress made in some areas of women's health, as long as there are women dying from conditions as common as pregnancy, I feel like we've made virtually no progress."
Elizabeth Garner, chief scientific officer at Ferring Pharmaceuticals USA. Photo courtesy Ferring Pharmaceuticals USA.
In the US, for example, the maternal mortality rate is increasing, not decreasing.
"As far as its rates of maternal mortality, the US is looking very much like a developing nation," Garner says. Worse yet, Black women are approximately three times more likely to die from a pregnancy-related cause compared to white women. There are many causes for this, including lack of access, distrust of the healthcare system, and ongoing racism.
Among the health challenges faced in maternal care is the threat of preeclampsia, which occurs when new blood vessels developing in the placenta don't work properly, leading to high or erratic blood pressure for the mother. The condition is commonly treated with magnesium.
"Preeclampsia is a major cause of death during and after pregnancy in this country," Garner says. "And we still treat that condition with intravenous magnesium. How is that possible in 2023?"
Breaking Down the Challenges in Women's Healthcare
Garner says more research is needed to identify and understand the threats to women's health, including conditions that happen only with women.
"We need desperately to just understand the science of women's health," she says. "Even as women, we don't understand most of what happens to us. Without the science, how do you develop the medicines to address these conditions?"
But more research also creates a need for more investment in developing treatments for women's health conditions.
"In women's health the industry has underinvested for so many years," says Garner. "In 2020, only 1% of the R&D spend of $200 billion went to conditions that solely affect women."
Recently, while speaking before an audience of investors, Garner asked how many had invested in women's health.
"There was nobody in that room who had invested in women's health, and incidentally there were only about four women in the audience," she says.
There is a perception in the industry that there is no profit in women's health, but Garner says that's a wrong assumption.
"There are huge opportunities to make money and we need to get the business case out there so investors will figure that out," she says.
Another factor is that women may be hesitant to talk openly about their health. Women as patients need to shoulder some of the responsibility for their healthcare, Garner says, meaning they need to speak out about uncomfortable topics and clearly outline symptoms for their physicians no matter how embarrassing it may feel.
"It's time women moved beyond the stigma of women's health conditions and speak honestly and descriptively to their practitioners," she says. "This is a global issue. The US has the same issues around stigmatization of women's conditions as in Nigeria. I firmly believe that the fact that historically women have not been comfortable talking about all their issues is a big reason why there hasn't been the attention paid to women's health needs."
Garner says she is motivated to create ways to reduce the stigma so that patients will open up more about their conditions, allowing physicians to learn how to address those issues. She says programs like Fertility Out Loud and Safe Birth are helping to increase this awareness.
Ferring partners with advocacy organizations, such as Resolve, to increase education as well as government organizations to increase access.
"For me, it's all about access and making everything available, no matter where or who you are," she says.
Another factor that will help improve women's healthcare, according to Garner, is putting more women in the top seats.
"The more women in leadership roles, the more we'll see a true investment in women's health, because women understand there is absolutely money in the space, and a need, because we are willing to spend the money to improve our health," she says.
Calculated Risks on a Career That Resonates
With 30 years of experience in reproductive medicine and maternal health, Garner is using her passion and her professional skills to move the needle on improving women's health globally. Her goals include becoming the CEO of a women’s healthcare company.
Prior to joining Ferring in 2022, she held chief medical officer roles for ObsEva and Agile Therapeutics, both women’s healthcare companies. At Agile, she led the Phase 3 clinical development of Twirla, a low-dose contraceptive patch. In 2010, at Merck Research Laboratories, she was instrumental in obtaining FDA approval for Gardasil, the human papillomavirus (HPV) vaccine.
Taking calculated risks has been her MO from the beginning of her career, when she switched to OB GYN practice during her residency. She then jumped from clinical practice to industry, which at that time was an unheard-of career move.
"I definitely got a lot of pushback," she says. "But I wanted to have more impact on patients than I could by caring for one at a time. It was certainly worth that risk."
As a leader Garner gets a boost from showing others how to take calculated risks and stretch themselves in their job.
"What I enjoy the most is working with teams, and growing people, and allowing them to shine," she says. "That aspect of drawing people out and showing them what they can do is one of the things I like best about being a leader. "
The New Jersey-based mom of three takes her downtime seriously and enjoys spending it at home with her family.
"I'm a family person. I have three children, two sons and a daughter, all born in July," she says. Her oldest recently got married, and her youngest lives with autism.
"I love the opportunity on the weekends to just literally be home, just sitting with my son," she says.
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The Virginia hospital will use an analytics platform integrated with its EHR to track patient feeding metrics, identify pain points, and offer best practices to improve staff workflows and clinical outcomes.
A children's hospital in Virginia is integrating digital health technology into its neonatal intensive care unit to improve care management for preterm babies and infants with acute medical conditions.
The partnership between Roanoke-based Carilion Children's Hospital and Astarte Medical will enable NICU staff to access the latter's NICUtrition platform, which analyzes patient feeding practices and outcomes to identify feeding protocol effectiveness, patient risk factors, and best practices that can positively impact patient outcomes.
The technology, which will be integrated with the hospital Epic electronic health record platform, is critical to a 60-bed hospital that typically operates at or close to capacity.
NICUtrition "is able to reflect both longitudinal and real-time patient feeding and growth metrics that help our care teams make evidence-based decisions," Dena Goldberg, PhD, RDN, a clinical dietitian and neonatal specialist at Carilion Children's Hospital, said in an e-mail to HealthLeaders. "Because the platform streamlines data-gathering, we no longer have to collect nutrition and growth outcome data by hand and then use statistical software to analyze it. It's not replacing any jobs but augmenting our teams and reducing the burden placed on resources."
The fast-paced, stressful environment of an NICU often puts high demands on staff who are monitoring frail babies and tracking key vital signs and metrics every hour, if not more often. Digital health tools that can accessed through the EHR can help with that data gathering and analysis, offering crucial clinical decision support when and where needed.
Goldberg said the technology will be evaluated over the next 3-6 months to see how it affects daily workflows as well as clinical outcomes. That research may be used to help expand the platform to other areas of pediatric care, including cardiac care and cerebral palsy.
A survey of more than 200 healthcare executives by IDC and Redox finds that despite the tough economy, health systems will be spending more on technology like AI and RPM to address workforce issues and improve clinical care pathways.
The push to stay on top of the digital health landscape is prompting healthcare organizations to increase their technology investment in the coming year. And they're very interested in automation and remote patient monitoring solutions.
That's the takeaway from a new survey from Redox and global tech advisory firm IDC, which analyzed the insights of some 205 IT executives at US-based health systems. Of that sampling, 88% said they plan to increase their third-party technological investments in 2023-24.
While the results of the survey might be surprising considering many health systems are struggling to stay in the black during an uncertain economy, the emphasis on technology investment isn't. Recent events like the American Telemedicine Association conference, HLTH, HIMSS, and ViVE have all been dominated by discussions on using technology to improve back-end processes and clinical care pathways and address workforce shortages, stress and burnout.
According to the survey, more than half of healthcare IT executives see digital transformation as the most important goal for their organization, with 35% citing cost reduction and 31% picking either improving quality of care or improving patient safety as critical goals. Another 30% selected using data as a strategic asset.
Those priorities are intersecting with two trends in healthcare: The development of AI and the shift of services from the hospital to the home.
According to the survey, almost 70% of healthcare executives see telemedicine and other virtual care solutions as playing a key role in addressing staff shortages, still the biggest pain point facing health systems. More than 60% say RPM programs will be critical, and just over 40% see increased value in automated appointment scheduling tools.
Additionally, 43% said they have RPM programs in place now or are making additional investments, and 55% said their using the platform to manage patients with chronic conditions or to trigger real-time clinical interventions, while 45% plan to use RPM to enable earlier discharge of high-risk or frail patients. Some 77% of those surveyed said they'll have between five and 20 RPM programs by 2024, and amny said they'll be expanding to cover behavioral health treatment as well.
Just as important, if not more so, is the use of automation to gather and analyze healthcare data coming into the enterprise. Almost 50% of those surveyed say automation will be a key benefit when deploying new technology, while 43% cite reduced costs, 40% cite data reliability, and 39% list data availability. Another 31% point to organizational agility as a top benefit, hinting at the growing issue of competition in the healthcare space.
On the flip side, integration and interoperability are still key challenges in getting all that new technology to work. Some 40% of healthcare executives surveyed cited integration and middleware as their biggest IT headaches, coming just ahead of privacy, security, and data protection.
“Delivering health data that’s complete, accurate, and standardized at the point of care makes it possible for providers to offer the personalized care that consumers want,” Redox CEO Luke Bonney said in an accompanying press release. “But before that can happen, the data must be usable; clinicians, as users, must be able to customize their data experience, accessing only the data they want, when and where they need it.”
As far as multimodal strategies go, roughly half of those surveyed see mobile applications as the most beneficial digital patient engagement platform, while a third also call it the most challenging to use and deploy.
Finally, healthcare leaders say in-person trade events, which have been on the rebound since the end of the pandemic, are their most influential source of information on new technologies. Some 30% selected events, while 27% picked peer review sites, and 26% selected either interactions with sales executives or vendor advertising.
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